Syphilis self-testing to expand test uptake among men who have sex with men: a theoretically informed mixed methods study in Zimbabwe

Sri-Pathmanathan, Clarisse; Nhamo, Definate; Mamvuto, Takudzwa; Chapwanya, Gwendoline; Terris‐Prestholt, Fern; Mahaka, Imelda; Marks, Michael; Tucker, Joseph D.

doi:10.1136/sextrans-2020-054911

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…However, the scoping review by Ong et al notes syphilis self-testing as a potential strategy to expand screening in key populations [ 117 ]. Since the initial search, studies in China and Zimbabwe have explored the role of syphilis self-testing in MSM [ 118 , 119 ], both of which noted the potential of self-testing to complement facility-based testing and facilitate testing of key populations.…”

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review

et al. 2022

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Background Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so. Methods A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing. Results The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing. Conclusion Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing.

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Section: Discussionmentioning

confidence: 99%

Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review

et al. 2022

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“…We assessed context-specific facilitators and barriers, and evaluated the usability of syphilis self-testing in MSM. 13 In our formative research, we found that MSM were willing to use self-test kits, and that this method provided privacy, convenience, autonomy, and reduced the potential for social and health care provider stigma. 13 There is extensive evidence on the effectiveness and acceptability of HIV self-testing in low-and middle-income countries, but data on syphilis selftesting are limited.…”

mentioning

confidence: 85%

“…13 In our formative research, we found that MSM were willing to use self-test kits, and that this method provided privacy, convenience, autonomy, and reduced the potential for social and health care provider stigma. 13 There is extensive evidence on the effectiveness and acceptability of HIV self-testing in low-and middle-income countries, but data on syphilis selftesting are limited. 14 As a result of this research gap, the World Health Organization has only given a conditional recommendation for the use of self-testing for syphilis diagnosis, even though it could potentially help to curb the syphilis epidemic in low-resource settings.…”

mentioning

confidence: 85%

Feasibility and economic costs of syphilis self-testing to expand test uptake among gay, bisexual and transgender men: results from a randomised controlled trial in Zimbabwe

Nhamo,

Mangenah,

Chapwanya

et al. 2023

Sex. Health

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Background Access to syphilis testing and treatment is frequently limited for men who have sex with men (MSM). A two-armed randomised controlled trial compared feasibility and costs of facility-based syphilis testing with self-testing among MSM in Zimbabwe. Methods This randomised controlled trial was conducted in Harare, with participants randomised 1:1. Syphilis self-testing was offered in community-based settings. The primary outcome was the relative proportion of individuals taking up testing. Total incremental economic provider and user costs, and cost per client tested, diagnosed and treated were assessed using ingredients-based costing in 2020 US$. Results A total of 100 men were enrolled. The two groups were similar in demographics. The mean age was 26 years. Overall, 58% (29/50) and 74% (37/50) of facility- and self-testing arm participants, respectively, completed syphilis testing. A total of 28% of facility arm participants had a reactive test, with 50% of them returning for confirmatory testing yielding 28% reactivity. In the self-testing arm, 67% returned for confirmatory testing, with a reactivity of 16%. Total provider costs were US$859 and US$736, and cost per test US$30 and US$15 for respective arms. Cost per reactive test was US$107 and US$123, and per client treated US$215 and US$184, respectively. The syphilis test kit was the largest cost component. Total user cost per client per visit was US$9. Conclusion Syphilis self-testing may increase test uptake among MSM in Zimbabwe. However, some barriers limit uptake including lack of self-testing and poor service access. Bringing syphilis testing services to communities, simplifying service delivery and increasing self-testing access through community-based organisations are useful strategies to promote health-seeking behaviours among MSM.

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“…How can digital STI services be used to enhance access to STI/HIV testing and what is their effectiveness? Digital technologies have been used to expand access to STI testing through self-sampling (e.g., HIV, syphilis, gonorrhea, chlamydia, human papillomavirus), (27)(28)(29) and self-testing (e.g., HIV,(30-32) syphilis, (33)(34)(35) and hepatitis C virus(36)). Digital tools cover a range of functions of varying degrees of complexity and sophistication, including booking appointments at STI clinics, ordering test kits , identifying people who would most benefit from testing (triaging), conducting online sexual health consultations, verifying completion of self-testing kits, referring people to access facility-based services, and provision of STI test results.…”

Section: Digital Sti Testingmentioning

confidence: 99%

Digital sexually transmitted infection and HIV services across prevention and care continuums: evidence and practical resources

Tucker¹,

Hocking²,

Oladele³

et al. 2022

Sex. Health

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Increased demand for sexual health services (including prevention and treatment) have spurred the development of digital STI/HIV services. Earlier advances in testing technologies opened the door for self-testing and self-sampling approaches, in line with broader self-care strategies. Advances in HIV management mean that many people are living well with HIV and no longer need intensive in person monitoring, while those at-risk of HIV are recommended to have regular asymptomatic STI screening and pre-exposure prophylaxis.This narrative review examines the evidence and implications of digital STI/HIV services, focused on promoting testing, facilitating testing, clinical management and referrals, partner services, and prevention. We have used a prevention and care continuum to structure the review to increase utility to policy as well as practice. Digital STI/HIV services can be interwoven into existing clinical pathways to enhance face-to-face services or standalone digital STI/HIV services. A growing evidence base, including randomized controlled trials and observational studies, should help inform strategies for designing effective digital STI/HIV services. However, most studies to date have focused on high-income countries and people with smartphones, despite a substantial burden of STI/HIV in low and middle-income countries. There are also important differences between digital STI and HIV services that require careful consideration. We discuss digital STI/HIV service evidence and implications to inform research and programs in this exciting field.

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Syphilis self-testing to expand test uptake among men who have sex with men: a theoretically informed mixed methods study in Zimbabwe

Cited by 9 publications

References 21 publications

Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review

Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review

Feasibility and economic costs of syphilis self-testing to expand test uptake among gay, bisexual and transgender men: results from a randomised controlled trial in Zimbabwe

Digital sexually transmitted infection and HIV services across prevention and care continuums: evidence and practical resources

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