Intervention Development Protocol for a novel, co-produced, sexually transmitted infection partner notification intervention for men who have sex with men

McQueen, Jean; Owusu, Melvina Woode; Mapp, Fiona; Estcourt, Claudia; Symonds, Merle; Comer, Alex; Nandwani, Rak; Brice, S; Howarth, Alison; Flowers, Paul

doi:10.1101/2020.10.21.20209049

Cited by 4 publications

(7 citation statements)

References 23 publications

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Section: Discussionmentioning

confidence: 99%

“…In particular, the possibility of eliciting utility values (for QALYs) from the MSM population. One-off partners, who may contribute disproportionately to onward transmission might benefit from digital PN options 5 which appear particularly under-studied. While we understand the need to resort to data from other population in the absence of evidence, this suggests there is currently no robust evidence to support any particular approach.…”

Section: Discussionmentioning

confidence: 99%

“…As part of work to develop novel PN interventions for MSM. 5 we conducted a systematic review of economic studies of PN interventions for STIs in MSM to ground future intervention development in economic reality. PN involves testing and often treatment of sex partners.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of Economic studies of Partner Notification and management interventions for sexually transmitted infections including HIV in men who have sex with men

Ogwulu

Abdali

Williams

et al. 2021

Preprint

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Objectives: Men who have sex with men (MSM) are disproportionately affected by sexually transmitted infections (STIs). Partner notification (PN) to identify, test and treat sex partners of MSM with bacterial STIs is challenging because MSM often report larger numbers of sex partners and a higher proportion of one-off partners who may be difficult to engage. However, one-off partners contribute disproportionately to onward transmission. Economic research on PN has typically focused on heterosexual people and evidence of effectiveness of PN in MSM is scant. We conducted a systematic review of economic studies of PN interventions in MSM to inform the development of a novel PN intervention for MSM with one-off partners. Method: Six electronic databases were searched up to June 2020. Cost studies and full economic evaluations, which focused on PN and/or testing and treatment (in the context of PN) of sex partners of MSM with STIs, and/or HIV, were included. A two-stage categorisation process was used for study selection and a narrative synthesis was reported. Results: Twenty-six studies of a possible 1909 met the selection criteria. Sixteen focused on MSM but only three of these were on PN. Few studies reported on patients characteristics and settings. Most studies were cost-utility analyses with outcomes reported as quality-adjusted life years (QALYs) which were derived from studies on heterosexual people. Conclusions: None of the identified studies specifically addressed cost-effectiveness of PN in MSM. The few studies identified as potentially relevant relied on costs and QALYs data from studies in heterosexual people, which may be inappropriate given the different patterns of sexual partnerships reported by these two groups. The lack of evidence on efficient PN approaches for MSM, a group with a high burden of infection, supports the need for new interventions tailored to the needs and preferences of MSM with parallel economic evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review of Economic studies of Partner Notification and management interventions for sexually transmitted infections including HIV in men who have sex with men

Ogwulu

Abdali

Williams

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Here we report on one key element of a larger, multi-stage, multi-stakeholder intervention development process which addresses the whole of the PN process from notifying partners to accessing testing and wider care (see McQueen et al, 2020 for the larger protocol; or Flowers et al, 2021). We present our analyses of data collected, after an initial stakeholder engagement event, from heterogeneous samples of GBMSM through focus groups, followed by further stakeholder input.…”

Section: The Current Studymentioning

confidence: 99%

How can we increase notification of exposure to STIs between gay and bisexual men?: intervention development using stakeholder engagement, qualitative methods and behavioural science

Flowers

Gerressu

McLeod

et al. 2021

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Rationale: The first key step in contact tracing for sexually transmitted infections (STIs) is to notify recent exposed sex partners. Gay and bisexual men and other men who have sex with men (GBMSM) bear a high burden of STIs and one-off partners contribute disproportionately to community transmission, posing a particular challenge to contact tracing. Here we explore and theorise the barriers and facilitators of GBMSM telling their one-off sexual partners about their exposure to STIs. Design: Using focus groups with diverse GBMSM from Leeds, Glasgow, London and on-line (n=28) we used a multi-level approach to intervention development to enhance contact tracing. This framework included initial stakeholder engagement; deductive thematic analysis to identify key barriers and facilitators to contact tracing with one-off partners; the use of the theoretical domains framework (TDF) to theorise these barriers and facilitators and subsequently the use of the behaviour change wheel (BCW), incorporating the behaviour change technique taxonomy (BCTT), to suggest intervention content to enhance the key step of notifying partners; and final stakeholder input to ensure this content was fit for purpose and satisfied the APEASE criteria. Results: In relation to the TDF, the barriers and facilitators primarily related to beliefs about consequences. Having used the BCW and further stakeholder engagement, our final intervention recommendations related to focussed efforts to change the culture and corresponding norms and social practice of notifying sex partners about the risk of infection in GBMSM communities. This could usefully be achieved through dedicated community engagement and partnership work, through focussed mass and social media interventions twinned with focussed peer-led work to normalise and destigmatise contact tracing. Conclusion: Through systematically working with key stakeholders, GBMSM communities and using a range of tools from the behavioural sciences, we have developed a suite of evidence-based and theoretically informed intervention content which, if developed further, could enhance GBMSMs willingness to notify sex partners about their risk of infection.

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“…Therefore, we also drew upon a range of theories and approaches from implementation science that assist with the clear specification and operationalisation of intervention ideas. (for more details see the intervention development protocol (McQueen et al ., 2020). In this way we drew upon a range of other theoretical frameworks that focus on implementation per se and ways of changing implementation behaviour.…”

Section: Introductionmentioning

confidence: 99%

Developing a co-produced, systems-informed, sexually transmitted infection contact tracing intervention for gay and bisexual men who have sex with men and their ‘one-off’ sexual partners

Flowers

Lasoye

McQueen

et al. 2021

Preprint

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ObjectiveGay and bisexual men who have sex with men (GBMSM) bear a disproportionate burden of sexually transmitted infections (STIs). Most STIS are asymptomatic and people infected won’t know to seek care unless they are told about their exposure. Contact tracing, is the process of identifying and contacting sex partners of people with STIs for testing and treatment. Contact tracing is sometimes particularly challenging amongst GBMSM because of the kinds of sexual relationships which GBMSM enjoy. These include one-off partners who are particularly important for transmission dynamics as they contribute disproportionately to onwards transmission. The effectiveness of contact tracing interventions within sexual health are patterned by sexual-partner type. Contact tracing and management for ‘one-off’ partners is an on-going public health challenge. Low motivation amongst index patients, high resource burden on health care professionals and problems with contactability are key barriers to contact tracing. Using insights from complex adaptive systems thinking and behavioural science, we sought to develop an intervention which addressed both the upstream and down-stream determinants of contact tracing and change the system in which many inter-dependent contact tracing behaviours are embedded.SettingUK community-recruited GBMSM, stakeholders, sexual hcp, dating app providersMethodUsing the MRC complex intervention framework and insights from the INDEX study, a three-phase intervention development process was adopted to specify intervention content. Phase one consisted of an inter-professional and community-member stakeholder event (n=45) where small mixed groups engaged in exploratory systems-mapping and the identification of ‘hot spots’ for future intervention. Phase two used a series of focus groups with GBMSM (n=28) and interviews with representatives from key dating app providers (DAPs) (n=3) to further develop intervention ideas using the theoretical domains framework, the behaviour change wheel and the behaviour change technique taxonomy. In Phase 3 we again worked with key stakeholders expert health care professionals (HCPs) (n=5) and key workers from community-based organisations (CBOs) (n=6) to hone the intervention ideas and develop programme theory using the APEASE criteria.ResultsThe co-produced intervention levers change simultaneously across the system within which contact tracing is embedded. Multiple change-agents (i.e., GBMSM, CBOs, HCPs) work together, sharing an overall vision to improve sexual health through contact tracing. Each make relatively modest changes that over time, synergistically combine to produce a range of multiple positively-reinforcing feedback loops to engender sustainable change around contact tracing. Agreed intervention elements included: a co-ordinated, co-produced mass and social media intervention to tip cultural norms and beliefs of GBMSM towards enabling more contact tracing and to challenge enduring STI- and sex-related stigmas; complementary CBO-co-ordinated, peer-led work to also focus on reducing STI stigma and enabling more contact tracing between one-off partners; priming GBMSM at the point of STI diagnosis to prepare for contact tracing interactions and reduce HCP and sexual health-service burden; changes to SHS environments and HCP-led interactions to systematically endorse contact tracing; changing national audits and monitoring systems to directly address one-off partner targets; delivering bespoke training to HCPs and CBO staff on one-off partners and the social and cultural context of GBMSM; DAPs active involvement in mass and social media promoting appropriate contact tracing messaging.ConclusionOur combination of multiple data sources, theoretical perspectives and diverse stakeholders have enabled us to develop an expansive, complex intervention that is firmly based in the priorities of those it will affect, and which has a solid theoretical foundation. Future work will assess if and how it will be possible to evaluate it. The resulting intervention is profoundly different than other ways of enhancing contact tracing, as it simultaneously addresses multiple, multi-levelled, upstream and social determinants of contact tracing.

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Intervention Development Protocol for a novel, co-produced, sexually transmitted infection partner notification intervention for men who have sex with men

Cited by 4 publications

References 23 publications

Systematic review of Economic studies of Partner Notification and management interventions for sexually transmitted infections including HIV in men who have sex with men

Systematic review of Economic studies of Partner Notification and management interventions for sexually transmitted infections including HIV in men who have sex with men

How can we increase notification of exposure to STIs between gay and bisexual men?: intervention development using stakeholder engagement, qualitative methods and behavioural science

Developing a co-produced, systems-informed, sexually transmitted infection contact tracing intervention for gay and bisexual men who have sex with men and their ‘one-off’ sexual partners

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