Kinnon R MacKinnon1, Ramandip Grewal2, Darrell Hs Tan2,3,4,5, Rodney Rousseau6, John Maxwell7, Sharon Walmsley3,8, Paul A MacPherson9,10,11, Anita Rachlis3,12, Nisha Andany3,12, Sharmistha Mishra2,13,14,15, Vanessa G Allen16, Ann N Burchell17,18. 1. School of Social Work, York University, 4700 Keele Street, M3J 1P3, Toronto, Ontario, Canada. 2. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada. 3. Department of Medicine, University of Toronto, Toronto, Canada. 4. Toronto General Research Institute, University Health Network, Toronto, Canada. 5. Division of Infectious Diseases, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada. 6. Department of Immunology, University of Toronto, 1 King's College Cir, M5S 1A8, Toronto, Ontario, Canada. 7. AIDS Committee of Toronto, 543 Yonge Street, 4th floor, M4Y 1Y5, Toronto, Ontario, Canada. 8. Toronto General Hospital, University Health Network, 200 Elizabeth Street, M5G 2C4, Toronto, Ontario, Canada. 9. Division of Infectious Diseases, The Ottawa Hospital, 501 Smyth Road, L1H 8L6, Ottawa, Ontario, Canada. 10. Ottawa Hospital Research Institute, Ottawa, Canada. 11. Department of Medicine, University of Ottawa, Ottawa, Canada. 12. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Ontario, Canada. 13. Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada. 14. Institute of Medical Science, University of Toronto, Toronto, Canada. 15. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. 16. Public Health Ontario Laboratories, Public Health Ontario, 661 University Avenue, M5G 1M1, Toronto, Ontario, Canada. 17. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada. ann.burchell@unityhealth.to. 18. Department of Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada. ann.burchell@unityhealth.to.
Abstract
BACKGROUND: Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. METHODS: Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. RESULTS: A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. CONCLUSIONS: Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. TRIAL REGISTRATION: ClinicalTrials.gov NCT02019043; registered December 23, 2013.
BACKGROUND:Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. METHODS: Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. RESULTS: A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. CONCLUSIONS: Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. TRIAL REGISTRATION: ClinicalTrials.gov NCT02019043; registered December 23, 2013.
Entities:
Keywords:
Grounded theory; HIV care; Men’s sexual health; Patient process evaluation; Qualitative interviews; Sexually transmitted infections; Syphilis
Authors: Ann N Burchell; Darrell H S Tan; Ramandip Grewal; Paul A MacPherson; Sharon Walmsley; Anita Rachlis; Nisha Andany; Sharmistha Mishra; Sandra L Gardner; Janet Raboud; David Fisman; Curtis Cooper; Kevin Gough; John Maxwell; Sean B Rourke; Rodney Rousseau; Tony Mazzulli; Irving E Salit; Vanessa G Allen Journal: Clin Infect Dis Date: 2022-03-09 Impact factor: 20.999