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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.
Sri-Pathmanathan, Clarisse; Nhamo, Definate; Mamvuto, Takudzwa; Chapwanya, Gwendoline; Terris-Prestholt, Fern; Mahaka, Imelda; Marks, Michael; Tucker, Joseph D.
  • Sri-Pathmanathan C; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK clarisse.sri-pathmanathan@kcl.ac.uk.
  • Nhamo D; Pangaea Zimbabwe AIDS Trust, Harare, Zimbabwe.
  • Mamvuto T; Pangaea Zimbabwe AIDS Trust, Harare, Zimbabwe.
  • Chapwanya G; Pangaea Zimbabwe AIDS Trust, Harare, Zimbabwe.
  • Terris-Prestholt F; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
  • Mahaka I; Pangaea Zimbabwe AIDS Trust, Harare, Zimbabwe.
  • Marks M; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
  • Tucker JD; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
Sex Transm Infect ; 98(3): 197-202, 2022 05.
Article in English | MEDLINE | ID: covidwho-1788980
ABSTRACT

OBJECTIVES:

Self-testing for STIs such as HIV and syphilis may empower sexual minorities and expand uptake of STI testing. While much is known about HIV self-testing (HIVST), less is known about syphilis self-testing, particularly in low-income settings. The objective of this study is to determine context-specific facilitators and barriers for self-testing and to assess the usability of syphilis self-testing in Zimbabwe among men who have sex with men (MSM).

METHODS:

This mixed methods study was conducted in Harare as part of a larger syphilis self-testing trial. The study included in-depth interviews (phase I) followed by usability testing and a second interview (phase II). In-depth interviews were conducted with MSM and key informants prior to syphilis self-testing. The same MSM then used the syphilis self-test, quantitatively assessed its usability and participated in a second in-depth interview. Phase I data were analysed using a thematic approach, guided by an adapted social ecological model conceptual framework. Phase II interviews were analysed using rapid assessment procedure methodology, and usability was assessed using a pre-established index, adapted from existing HIVST scales.

RESULTS:

Twenty MSM and 10 key informants were recruited for phase I in-depth interviews, and 16 of these MSM participated in phase II by completing a syphilis self-test kit. Facilitating factors for self-testing included the potential for increased privacy, convenience, autonomy, and avoidance of social and healthcare provider stigma. Barriers included the fear to test and uncertainty about linkage to care and treatment. Data from the Usability Index suggested high usability (89.6% on a 0-100 scale) among the men who received the self-test.

CONCLUSIONS:

MSM in Zimbabwe were willing to use syphilis self-test kits and many of the barriers and facilitators were similar to those observed for HIVST. Syphilis self-testing may increase syphilis test uptake among sexual minorities in Zimbabwe and other low-income and middle-income countries.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Syphilis / HIV Infections / Sexual and Gender Minorities Type of study: Diagnostic study / Qualitative research / Randomized controlled trials Limits: Humans / Male Country/Region as subject: Africa Language: English Journal: Sex Transm Infect Journal subject: Sexually Transmitted Diseases Year: 2022 Document Type: Article Affiliation country: Sextrans-2020-054911

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Syphilis / HIV Infections / Sexual and Gender Minorities Type of study: Diagnostic study / Qualitative research / Randomized controlled trials Limits: Humans / Male Country/Region as subject: Africa Language: English Journal: Sex Transm Infect Journal subject: Sexually Transmitted Diseases Year: 2022 Document Type: Article Affiliation country: Sextrans-2020-054911