Pilot implementation of a home-care programme with chlamydia, gonorrhoea, hepatitis B, and syphilis self-sampling in HIV-positive men who have sex with men

Abstract

Background Not all men who have sex with men (MSM) at risk for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) infection currently receive sexual healthcare. To increase the coverage of high-quality HIV/STI care for MSM, we developed a home-care programme, as extended STI clinic care. This programme included home sampling for testing, combined with treatment and sexual health counselling. Here, we pilot implemented the programme in a hospital setting (HIV-positive MSM) to determine the factors for the successful implementation of STI home sampling strategies. Methods Healthcare providers from the HIV hospital treatment centre (Maastricht) were invited to offer free STI sampling kits (syphilis, hepatitis B, [extra]genital chlamydia and gonorrhoea laboratory testing) to their HIV-positive MSM patients (March to May 2018). To evaluate implementation of the program, quantitative and qualitative data were collected to assess adoption (HIV care providers offered sampling kits to MSM), participation (MSM accepted the sampling kits) and sampling-kit return, STI diagnoses, and implementation experiences. Results Adoption was 85.3% (110/129), participation was 58.2% (64/110), and sampling-kit return was 43.8% (28/64). Of the tested MSM, 64.3% (18/28) did not recently (< 3 months) undergo a STI test; during the programme, 17.9% (5/28) were diagnosed with an STI. Of tested MSM, 64.3% (18/28) was vaccinated against hepatitis B. MSM reported that the sampling kits were easily and conveniently used. Care providers (hospital and STI clinic) considered the programme acceptable and feasible, with some logistical challenges. All (100%) self-taken chlamydia and gonorrhoea samples were adequate for testing, and 82.1% (23/28) of MSM provided sufficient self-taken blood samples for syphilis screening. However, full syphilis diagnostic work-up required for MSM with a history of syphilis (18/28) was not possible in 44.4% (8/18) of MSM because of insufficient blood sampled. Conclusion The home sampling programme increased STI test uptake and was acceptable and feasible for MSM and their care providers. Return of sampling kits should be further improved. The home-care programme is a promising extension of regular STI care to deliver comprehensive STI care to the home setting for MSM. Yet, in an HIV-positive population, syphilis diagnosis may be challenging when using self-taken blood samples.

HIV and STI Testing Preferences for Men Who Have Sex with Men in High-Income Countries: A Scoping Review

“…Thirty-three studies identified home-based self-testing or self-sampling as the preferred method of testing [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 22 , 23 , 24 , 26 , 29 , 31 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ] ( Table 2 ). Three randomised controlled trials (RCT) found that HIVST increased testing frequency, and therefore was preferred by MSM compared to usual testing [ 17 , 21 , 54 ].…”

“…Confidentiality or privacy was identified to be a common reason for preferring self-testing amongst MSM [ 14 , 25 , 27 , 34 , 49 , 51 , 52 , 60 ]. One study, conducted in the Netherlands, used semi-structured interviews to explore key factors which allowed for the successful implementation of social network testing with HIV self-tests [ 48 ].…”

“…A cross-sectional survey that recruited 15,704 MSM in England found that although genitourinary medicine (GUM) clinics were most popular amongst MSM, self-testing was preferred amongst first-time testers [ 52 ]. It also identified that this population valued the availability of a variety of testing methods and settings [ 52 ].…”

Optimizing sexually transmitted infection care in men who have sex with men

“…Frequent HIV/STI testing plays an important role in the control of HIV/STI transmission, because it enables timely diagnoses and treatment and shortens the duration of infection [44]. Besides optimizing outcomes after diagnosis for individuals benefit, early treatment shortens the duration of an infected individual to spread the infection, benefitting the public health by using treatment as a prevention for HIV spread [45][46][47]. Studies have proposed that MSM who receive antiretroviral therapy (ART) and have achieved and maintained an undetectable viral load cannot sexually transmit the virus to others, controlling transmission [45,46,48].…”

“…The STI clinic will send tailored SMS reminders. Reminders (text messages) will be used to promote testing behavior, as reminders have proven to increase participation [45,46]. The text messages will also…”