Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 30;21(1):625.
doi: 10.1186/s12913-021-06602-1.

Patient perspectives on the implementation of routinised syphilis screening with HIV viral load testing: Qualitative process evaluation of the Enhanced Syphilis Screening Among HIV-positive Men trial

Kinnon R MacKinnon  1 , Ramandip Grewal  2 , Darrell Hs Tan  2   3   4   5 , Rodney Rousseau  6 , John Maxwell  7 , Sharon Walmsley  3   8 , Paul A MacPherson  9   10   11 , Anita Rachlis  3   12 , Nisha Andany  3   12 , Sharmistha Mishra  2   13   14   15 , Vanessa G Allen  16 , Ann N Burchell  17   18
Affiliations

Patient perspectives on the implementation of routinised syphilis screening with HIV viral load testing: Qualitative process evaluation of the Enhanced Syphilis Screening Among HIV-positive Men trial

Kinnon R MacKinnon et al. BMC Health Serv Res. .

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.

Keywords: Grounded theory; HIV care; Men’s sexual health; Patient process evaluation; Qualitative interviews; Sexually transmitted infections; Syphilis.

PubMed Disclaimer

Conflict of interest statement

DHST has received investigator-initiated research grants from Gilead Sciences and Viiv Healthcare, and is a site principal investigator for clinical trials sponsored by Glaxo Smith Kline. SW has spoken at continuing medical education events, served on advisory boards and participated in clinical trials with Gilead, Viiv, Jannsen, and Merck. All other authors declare that they have no competing interests.

References

    1. Drummond F, Guy R, Kaldor JM, Donovan B. The intersection between HIV and syphilis in men who have sex with men: some fresh perspectives. HIV Ther. 2010;4(6):661–73. doi: 10.2217/hiv.10.55. - DOI
    1. Refugio ON, Klausner JD. Syphilis incidence in men who have sex with men with human immunodeficiency virus comorbidity and the importance of integrating sexually transmitted infection prevention into HIV care. Expert Rev Anti Infect Ther. 2018;16(4):321–31. doi: 10.1080/14787210.2018.1446828. - DOI - PMC - PubMed
    1. Public Health Agency of Canada. Canadian Guidelines on Sexually Transmitted Infections [Internet]. Ottawa, ON: Public Health Agency of Canada; 2010. Available from: http://www.phac-aspc.gc.ca/std-mts/sti-its/guide-lignesdir-eng.php.
    1. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2010 Dec. Available from: http://www.cdc.gov/std/treatment/2010/.
    1. Fakova A, Lamba H, Mackie N. 2007 UK guidelines for the management of sexual and reproductive health (SRH) of people living with HIV infection [Internet]. UK: BHIVA, BASHH, FFPRHC; 2007. Available from: http://www.bashh.org/documents/91/91.pdf. - PubMed

Associated data