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Background: The ability to access and navigate online sexual health information and support is increasingly needed in order to engage with wider sexual healthcare. However, people from underserved populations may struggle to pass though this "digital doorway". Therefore, using a behavioural science approach, we first aimed to identify barriers and facilitators to i) seeking online sexual health information and ii) seeking online sexual health support. Subsequently, we aimed to generate theory-informed recommendations to improve these access points. Methods: The PROGRESSPlus framework guided purposive recruitment (15.10.21–18.03.22) of 35 UK participants from diverse backgrounds, including 51% from the most deprived areas and 26% from minoritised ethnic groups. Using semi-structured interviews and thematic analysis, we identified barriers and facilitators to seeking online sexual health information and support. A Behaviour Change Wheel (BCW) analysis then identified recommendations to better meet the needs of underserved populations. Results: We found diverse barriers and facilitators. Barriers included low awareness of and familiarity with online information and support; perceptions that online information and support were unlikely to meet the needs of underserved populations; overwhelming volume of information sources; lack of personal relevancy; chatbots/automated responses; and response wait times. Facilitators included clarity about credibility and quality; inclusive content; and in-person assistance. Recommendations included: Education and Persuasion e.g., online and offline promotion and endorsement by healthcare professionals and peers; Training and Modelling e.g., accessible training to enhance searching skills and credibility appraisal; and Environmental Restructuring and Enablement e.g., modifications to ensure online information and support are simple and easy to use, including video/audio options for content. Conclusions: Given that access to many sexual health services is now digital, our analyses produced recommendations pivotal to increasing access to wider sexual healthcare among underserved populations. Implementing these recommendations could reduce inequalities associated with accessing and using online sexual health service. [ABSTRACT FROM AUTHOR]

Background: HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2 years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation. Methods: Stage 1 involved semi-structured telephone interviews and focus groups (September 2018–July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n = 39), sexual healthcare professionals (n = 54), community-based organisation service users (n = 9) and staff (n = 15) across Scotland. We used deductive thematic analysis, to derive and then map key barriers and facilitators to priority areas that experts agreed would enhance uptake and initiation. In Stage 2, we used analytic tools from implementation science to systematically generate evidence-based, theoretically-informed recommendations to enhance uptake and initiation of PrEP. Results: Barriers and facilitators were multi-levelled and interdependent. Barriers included the rapid pace of implementation without additional resource, and a lack of familiarity with PrEP prescribing. Facilitators included opportunities for acquisition of practice-based knowledge and normalisation of initiation activities. We refined our 68 'long-list' recommendations to 41 using expert input and the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria. Examples include: provision of PrEP in diverse settings to reach all in need; co-produced, culturally sensitive training resources for healthcare professionals, with focused content on non-daily dosing; meaningful collaborative working across all stakeholders. Conclusions: These evidence-based, theory informed recommendations provide a robust framework for optimising PrEP uptake and initiation in diverse settings to ensure PrEP reaches all who may benefit. Zero new HIV infections could become a reality if HIV pre-exposure prophylaxis (PrEP) programs are successfully implemented but the World Health Organization recognises that large-scale roll out is challenging. We used implementation science research tools in novel ways to evaluate one of the world's first national PrEP programs, to develop evidence-based recommendations for use across a range of settings to improve PrEP uptake and initiation. Adopting these recommendations could enable governments and societies to better address HIV prevention goals. [ABSTRACT FROM AUTHOR]

Background: HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2 years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation. Methods: Stage 1 involved semi-structured telephone interviews and focus groups (September 2018–July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n = 39), sexual healthcare professionals (n = 54), community-based organisation service users (n = 9) and staff (n = 15) across Scotland. We used deductive thematic analysis, to derive and then map key barriers and facilitators to priority areas that experts agreed would enhance uptake and initiation. In Stage 2, we used analytic tools from implementation science to systematically generate evidence-based, theoretically-informed recommendations to enhance uptake and initiation of PrEP. Results: Barriers and facilitators were multi-levelled and interdependent. Barriers included the rapid pace of implementation without additional resource, and a lack of familiarity with PrEP prescribing. Facilitators included opportunities for acquisition of practice-based knowledge and normalisation of initiation activities. We refined our 68 'long-list' recommendations to 41 using expert input and the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) criteria. Examples include: provision of PrEP in diverse settings to reach all in need; co-produced, culturally sensitive training resources for healthcare professionals, with focused content on non-daily dosing; meaningful collaborative working across all stakeholders. Conclusions: These evidence-based, theory informed recommendations provide a robust framework for optimising PrEP uptake and initiation in diverse settings to ensure PrEP reaches all who may benefit. Zero new HIV infections could become a reality if HIV pre-exposure prophylaxis (PrEP) programs are successfully implemented but the World Health Organization recognises that large-scale roll out is challenging. We used implementation science research tools in novel ways to evaluate one of the world's first national PrEP programs, to develop evidence-based recommendations for use across a range of settings to improve PrEP uptake and initiation. Adopting these recommendations could enable governments and societies to better address HIV prevention goals. [ABSTRACT FROM AUTHOR]

Introduction: Despite government support of culturally appropriate sex and relationships education (SRE), young people's access to information is limited and sexual health needs are not being met, particularly among youth from black and minority ethnic groups. Joint-working between health, education, voluntary sectors and parents has been heralded as key in redressing inequalities in sexual health outcomes and access to information. Our study focuses on SRE provision for young Muslim Bangladeshis, highlighting the complexities involved in streamlining SRE messages. Objective: To explore stakeholder views about SRE and ways to improve SRE delivery. Design: Sixteen semi-structured interviews were conducted in 2005 with stakeholders from schools, National Health Service, and parent and voluntary sector bodies in a London borough. Results: Two key factors enhancing Bangladeshi youth's risk of infection and unwanted pregnancy were identified: inadequate parental understanding about sexual health and limited parent-delivered SRE; and patchy provision of culturally appropriate, school-based SRE. Factors affecting SRE provision included culturally rooted perceptions of sex/sexuality and limited participation of stakeholders, (religious leaders, parents), in developing and delivering SRE. Conclusions: This study highlights the importance of widespread community engagement, underlining that joint-working, and the development and delivery of culturally appropriate and consistent SRE, necessitates communication and collaboration among stakeholders in young people's health and well-being. (Contains 1 table.)

BackgroundThose who go online regarding their sexual health are potential users of new Internet-based sexual health interventions. Understanding the size and characteristics of this population is important in informing intervention design and delivery. ObjectiveWe aimed to estimate the prevalence in Britain of recent use of the Internet for key sexual health reasons (for chlamydia testing, human immunodeficiency virus [HIV] testing, sexually transmitted infection [STI] treatment, condoms/contraceptives, and help/advice with one’s sex life) and to identify associated sociodemographic and behavioral factors. MethodsComplex survey analysis of data from 8926 sexually experienced persons aged 16-44 years in a 2010-2012 probability survey of Britain’s resident population. Prevalence of recent (past year) use of Internet sources for key sexual health reasons was estimated. Factors associated with use of information/support websites were identified using logistic regression to calculate age-adjusted odds ratios (AORs). ResultsRecent Internet use for chlamydia/HIV testing or STI treatment (combined) was very low (men: 0.31%; women: 0.16%), whereas 2.35% of men and 0.51% of women reported obtaining condoms/contraceptives online. Additionally, 4.49% of men and 4.57% of women reported recent use of information/support websites for advice/help with their sex lives. Prevalence declined with age (men 16-24 years: 7.7%; 35-44 years: 1.84%, P

Objectives: Patient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT. Health authority guidance for PDPT has since been provided in some areas. We investigated recent use and perceptions of PDPT for chlamydia among GPs in Australia.Methods: In 2019, we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs' chlamydia management practices, including PDPT. Logistic regression identified factors associated with ever offering PDPT. A directed content analysis of free-text data explored GPs' perceptions towards PDPT.Results: The survey received responses from 323 GPs; 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT, while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted OR (AOR) 2.9, 95% CI 1.4 to 5.8), worked in non-metropolitan areas (AOR 2.5, 95% CI 1.5 to 4.4) and jurisdictions with health authority PDPT guidance (AOR 2.3, 95% CI 1.4 to 3.9). Qualitative data demonstrated that many GPs recognised PDPT's potential to treat harder to engage partners but expressed hesitancy to offer PDPT because they considered partners attending for care as best practice. GPs emphasised a case-by-case approach that considered patient and partner circumstances to determine PDPT suitability. To alleviate medicolegal concerns, many GPs indicated a need for professional and health authority guidance that PDPT is permissible. They also desired practical resources to support its use.Conclusion: GPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment. Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice. [ABSTRACT FROM AUTHOR]

Objectives: To review characteristics of individuals newly diagnosed with HIV following implementation of a national pre-exposure prophylaxis (PrEP) programme (comprehensive PrEP services, delivered in sexual health clinics) to inform future delivery and broader HIV prevention strategies.Methods: We extracted data from national HIV databases (July 2015-June 2018). We compared sociodemographic characteristics of individuals diagnosed in the period before and after PrEP implementation, and determined the proportion of 'potentially preventable' infections with the sexual health clinic-based PrEP delivery model used.Results: Those diagnosed with HIV before PrEP implementation were more likely to be male (342/418, 81.8% vs 142/197, 72.1%, p=0.005), be white indigenous (327/418, 78.2% vs 126/197, 64.0%, p<0.001), report transmission route as sex between men (219/418, 52.4% vs 81/197, 41.1%, p=0.014), and have acquired HIV in the country of the programme (302/418, 72.2% vs 114/197, 57.9% p<0.001) and less likely to report transmission through heterosexual sex (114/418, 27.3% vs 77/197, 39.1%, p=0.002) than after implementation.Pre-implementation, 8.6% (36/418) diagnoses were 'potentially preventable' with the PrEP model used. Post-implementation, this was 6.6% (13/197), but higher among those with recently acquired HIV (49/170, 28.8%). Overall, individuals with 'potentially preventable' infections were more likely to be male (49/49, 100% vs 435/566, 76.9%, p<0.001), aged <40 years (37/49, 75.5% vs 307/566, 54.2%, p=0.004), report transmission route as sex between men (49/49, 100% vs 251/566, 44.3%, p<0.001), have previously received post-exposure prophylaxis (12/49, 24.5% vs 7/566, 1.2%, p<0.001) and less likely to be black African (0/49, 0% vs 67/566, 11.8%, p=0.010) than those not meeting this definition.Conclusions: The sexual health clinic-based national PrEP delivery model appeared to best suit men who have sex with men and white indigenous individuals but had limited reach into other key vulnerable groups. Enhanced models of delivery and HIV combination prevention are required to widen access to individuals not benefiting from PrEP at present. [ABSTRACT FROM AUTHOR]

Abstract Background National health strategies have called for an expansion of the role of primary care in England to increase access to sexual health services. However, there is little guidance for service planners and commissioners as to the public health impact of different combinations of specialist genitourinary medicine (GUM) clinics and primary care based services for local populations. Service planning for infectious diseases like sexually transmitted infections (STI) is further complicated because the goal of early detection and treatment is not only to improve the health of the individual, but to benefit the wider population and reduce future treatment costs by preventing onward transmission. Therefore, we are developing a survey tool that will enable service planners to better understand the needs of their local STI care-seeking population and which will help inform evidence-based decision-making about current and future service configurations. Here we describe the rationale and development of this survey tool. Methods/Design A pen-and-paper questionnaire asking about sociodemographics, reasons for attendance, care pathways, and recent sexual risk behaviours, is being developed for patients to complete in waiting rooms of diverse clinical services, including GUM clinics and primary-care based services in sociodemographically- and geographically-contrasting populations in England. The questionnaire was cognitively tested before being piloted. In the pilot, 67% of patients participated, of whom 84% consented to our linking their questionnaire to data on STI testing and diagnosis and partner notification outcomes from their clinical records. Discussion The pilot study suggests that both the questionnaire and its linkage to routinely-collected clinical data are likely to be acceptable to patients. By supplementing existing surveillance, data gathered by the survey tool will inform service planners' and providers' understanding of the needs and care-pathways of their patients, facilitating improved services and greater public health benefit.

Background: Digital interventions for sexually transmitted and blood-borne infections (STBBIs) testing have gained popularity as a potentially cheaper, farther reaching, and convenient STBBI testing modality especially for populations experiencing barriers to clinic-based testing. However, evidence of their health equity effects remains sparse. We reviewed the health equity effects of these interventions on uptake of STBBI testing and explored design and implementation factors contributing to reported effects. Methods: We followed Arksey and O'Malley's framework for scoping reviews (2005) integrating adaptations by Levac et al. (2010). We searched OVID Medline, Embase, CINAHL, Scopus, Web of Science, Google Scholar and health agency websites for peer-reviewed articles and gray literature comparing uptake (i.e., completion and return of test samples, repeat testing rates and frequency of testing) through digital STBBI testing with in-person models and/or comparing uptake of digital STBBI testing among sociodemographic strata, published in English between January 1st, 2010, and March 15th, 2022. We extracted data using the Place of residence, Race, Occupation, Gender/Sex, Religion, Education, Socio-economic status (SES), Social capital, and other disadvantaged characteristics (PROGRESS-Plus) framework, reporting differences in uptake of digital STBBI testing by these characteristics. Results: We included 27 articles from 7914 titles and abstracts retrieved from our search (Figure 1). Among these, 20/27 (74.1%) were observational studies, 23/27 (85.2%) described web-based interventions, and 18/27 (66.7%) involved postalbased self-sample collection. Only three articles compared uptake of digital STBBI testing with inperson models stratified by any of the PROGRESSPlus factors. Most studies demonstrated increased uptake of digital STBBI testing across sociodemographic strata. However, uptake was higher among women, white people with higher SES, urban residents, and heterosexual people. Co-design, representative user recruitment, and emphasis on privacy and security were highlighted as factors potentially contributing to health equity in these interventions. Conclusion: Evidence of health equity effects of digital STBBI testing remains limited. While digital STBBI testing interventions increase testing across sociodemographic strata, increases are lower among historically disadvantaged populations with higher prevalence of STBBIs. Findings challenge assumptions about the inherent equity of digital STBBI testing interventions, emphasizing the need to prioritize health equity in their design and evaluation. [ABSTRACT FROM AUTHOR]

Background: In the UK, sexual health services are shifting online. Uptake of online partner notification and management (OPNM) is low and there is a lack of evidence to guide its development and deployment. This study explored the acceptability of, and barriers and facilitators to, OPNM to inform the optimisation of an eSexual Health Clinic (eSHC). Methods: We conducted semi-structured qualitative interviews (n=25) with sexual health service users recruited from clinics and the community in the UK (10/2021-01/2023). Participants were >/=16 years and a recent contact of/diagnosed with a bacterial STI. Interviews explored experiences of PN, barriers to and facilitators of OPNM, and involved a walkthrough of an OPNM prototype pathway (Figure 1) using a range of fictional personas/scenarios. We analysed transcripts using thematic analysis. Results: Participants were diverse, particularly in terms of gender, sexuality, and disability status. Most found OPNM acceptable and described using some online PN methods themselves (e.g., texting). Participants wanted an online system to be tailored to the nature of their relationships, their communication/language use preferences, and degree to which they wanted to be identifiable/anonymous. An integrated pathway (e.g., an eSHC) for receiving results, accessing treatment, and linking partners to appropriate online management was important to many participants, who expressed strong personal responsibility for providing something 'actionable' (e.g., clickable link for partners to access testing/treatment) when doing PN. Some were reluctant to share personal data with an OPNM system or to click on a link shared with them. Where participants preferred to talk to partners offline, they wanted to access PN support resources within the online pathway. Conclusion: In this study, OPNM, integrated into an eSHC, was highly acceptable. Important elements to address in design and implementation are personalisation according to user preferences and needs, online support for offline PN where preferable, and consideration of trust, privacy and security issues from index patient and partner perspectives. Online systems which enable partner management as well as simply notifying partners could increase the appeal of online PN, generating buy-in from users and facilitating increased testing/treatment of contacts and improved surveillance. [ABSTRACT FROM AUTHOR]