Abstract
Sexual healthcare aims to reduce HIV and sexually transmitted infections (STIs) by promoting testing and prevention. To better reach men who have sex with men (MSM), additional strategies are needed. Here, we describe development of an intervention, which is part of a broader HIV/STI home-care program, targeted to reach MSM and motivate them to use self-sampling tests. Self-sampling includes blood sampling (finger prick) for HIV, hepatitis B, and syphilis, and a urine sample and oral and anorectal swab samples for chlamydia and gonorrhea. Intervention mapping, a systematic six-step approach, was used to guide the development process: (1) needs assessment including interviews with MSM, (2) create a matrix of change, (3) selection of theory-based methods and practical strategies, (4) intervention development, (5) implementation plan, and (6) evaluation (not included in this paper). Stakeholders were involved to increase program support and feasibility. The needs assessment revealed that testing barriers among MSM related to stigma, time, and privacy concerns. Barriers among healthcare providers related to time, competing priorities, lack of expertise, and guideline restrictions. Included intervention components are designed to overcome these barriers, e.g., engaging role models, with a website with a role model story, and providing tailored information. Methods to reach MSM were a variety of information channels (posters, flyers, and audio-visual displays) and delivery modes, such as advertisements on websites and invitational cards (online and paper) distributed by healthcare providers and MSM themselves (social network testing/peer testing). Our intervention aims to encourage MSM to engage in testing, re-testing, and providing a test to peer MSM. Evidence-based methods to overcome barriers were included to reach and motivate an increased number of MSM. Using intervention mapping stimulated systematic evidence-based decision making and adapting the intervention to the target audience and setting. The next step (step 6) is to implement and evaluate the intervention.
Highlights
Men who have sex with men (MSM) are at increased risk of acquiring human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) [1]
We used Intervention mapping (IM) to develop an intervention to promote HIV/STI self-sampling in MSM
The intervention is systematically based on theory and evidence and designed for practical application by healthcare providers in STI clinics, HIV treatment centers, and general practitioner (GP)’ offices, to reach MSM and promote uptake of HIV/STI testing
Summary
Men who have sex with men (MSM) are at increased risk of acquiring human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) [1]. HIV/STI testing and early linkage to care are critical for improving long-term individual health outcomes [4, 5]. Lack of (timely) HIV/STI testing introduces concerns for individual health, as well as public health concerns, in terms of ongoing transmission and adverse health outcomes. International guidelines for HIV/STI management recommend that all sexually active MSM are tested at least annually for HIV and all other relevant STIs: syphilis, hepatitis B (HBV), and anorectal, genital, and oropharyngeal infections of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) [1, 6]. In the Netherlands, MSM can get tested at sexual healthcare centers (STI clinics), which deliver comprehensive sexual healthcare including free-of-charge testing for HIV, HBV, syphilis, and (extra) genital bacterial STI, STI treatment, HIV care referral to the hospital HIV treatment center, partner notification, and sexual health counseling. MSM can get tested at the general practitioner (GP) for HIV and STIs
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