Date Published: April 16, 2019
Publisher: Public Library of Science
Author(s): Sebastian S. Fuller, Agata Pacho, Claire E. Broad, Achyuta V. Nori, Emma M. Harding-Esch, Syed Tariq Sadiq, Jerome T Galea.
Sexually transmitted infections (STIs) continue to be a major public health concern in the United Kingdom (UK). Epidemiological models have shown that narrowing the time between STI diagnosis and treatment may reduce the population burden of infection, and rapid, accurate point-of-care tests (POCTs) have potential for increasing correct treatment and mitigating the spread of antimicrobial resistance (AMR). We developed the Precise social science programme to incorporate clinician and patient opinions on potential designs and implementation of new POCTs for multiple STIs and AMR detection. We conducted qualitative research, consisting of informal interviews with clinicians and semi-structured in-depth interviews with patients, in six sexual health clinics in the UK. Interviews with clinicians focused on how the new POCTs would likely be implemented into clinical care; these new clinical pathways were then posed to patients in in-depth interviews. Patient interviews showed acceptability of POCTs, however, willingness to wait in clinic for test results depended on the context of patients’ sexual healthcare seeking. Patients reporting frequent healthcare visits often based their expectations and opinions of services and POCTs on previous visits. Patients’ suggestions for implementation of POCTs included provision of information on service changes and targeting tests to patients concerned they are infected. Our data suggests that patients may accept new POCT pathways if they are given information on these changes prior to attending services and to consider implementing POCTs among patients who are anxious about their infection status and/or who are experiencing symptoms.
Sexually transmitted infections (STIs) continue to be a major public health concern in the UK, with approximately 420,000 diagnoses made in England alone in 2017 . Young people continue to bear the burden of STIs in the UK; diagnoses among 15–24 year-olds are twice as high in men and seven times as high in women compared to other age groups . Diagnoses of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections continue to be the most common STI diagnoses among men-who-have-sex-with-men (MSM) . Other curable STIs, such as Mycoplasma genitalium (MG), have not traditionally been routinely tested for in National Health Service (NHS) sexual health clinics (SHCs) as there is limited provision of accurate, molecular based testing for MG, despite evidence of this infection causing onward health consequences such as endometritis, cervicitis, pre-term birth and pelvic inflammatory disease in women [2,3].
We planned qualitative research consisting of informal interviews with clinicians and semi-structured in-depth interviews with patients in six SHCs in the UK. Two data collection stages were planned with a year of analysis between them; we hypothesised that this would allow for iterative adaption of our topic guides to include new areas of enquiry following our mid-term analysis.
Six clinics across UK participated: London (n = 3), Devon, Yorkshire, and Eastern Scotland. London SHCs included two central London locations, including one associated with implementation of novel testing pathways and modern designs to encourage patient attendance. A total of 148 patients agreed to be contacted by the research team for an interview, of which 63 patients (42.6%) completed an interview. Identification of potentially eligible patients was conducted in different ways by members of the healthcare team in each of the six clinics (e.g., some patients were invited before eligibility screening and then asked eligibility questions, whereas others did the opposite), and so we cannot provide meaningful data on patients who declined to provide contact information to the study team.
Our study shows patients’ willingness to wait in clinic was often dependent on their self-assessed risk for infection. Insight into patients’ priorities for care, and their suggestions that specific, directed messaging may allow acceptability of various changes related to adoption of NAAT-based POCTs in SHCs gives concrete guidance for implementation of these tests. In particular, patients recommended targeting tests to those that are concerned they are infected and giving patients a choice to either wait for the results in the clinic, or return later that day for their results. Adhering to these suggestions for NAAT-based POCT implementation may lead to good acceptability of new clinical pathways for these diagnostics. We recommend further research when these tests are made available, to test these theories in practice.