JMIR Publications

ABSTRACT

Background:

HIV-positive and –negative (gay, bisexual and other) men who have sex with men (MSM) have experienced dramatic rises in bacterial sexually transmitted infections (STIs)—syphilis, gonorrhea, and chlamydia. STI testing and treatment mitigate adverse health outcomes and substantially reduce transmission, yet testing rates remain below recommended levels. Innovation is needed to produce the required increases in test coverage, frequency, and use of appropriate testing technologies in ways that are engaging, non-stigmatizing, and acceptable to men.

Objective:

Our objective is to build consensus regarding intervention(s) with the greatest potential for improving local STI testing services for MSM communities in Toronto, Canada.

Methods:

Following a literature review of evidence regarding effectiveness of novel testing interventions, and focus groups and surveys to describe local barriers and facilitators of testing among MSM, we will conduct a modified, e-Delphi study. We will form expert panels of community members and STI test providers. Panelists will rate potential interventions in terms of their priority, using a 7-point Likert scale from “definitely not a priority” to “definitely a priority”. They will also rank their preferences by selecting their top three preferred interventions. Surveys will be distributed in three rounds, with feedback on the distribution of responses from preceding rounds provided in rounds two and three. We will define consensus as having ≥60% members indicate a preference within 2 adjacent response points. Qualitative data on disagreements will be obtained using open-ended text responses to explain for ratings and rankings different from the majority.

Results:

Based on literature review and identification of barriers and facilitators to STI testing among community members and test providers in Toronto, we have selected eight potential interventions for inclusion in the e-Delphi Panel surveys. These include four interventions that streamline STI testing for asymptomatic individuals; two interventions that are targeted to clients; and two interventions that are targeted to providers.

Conclusions:

Findings will provide community direction for informed decision making regarding the implementation of STI testing interventions in this setting. They will will characterize the intervention climate for innovation to STI testing services, including perceived needs for changes to test delivery, relative priorities for change, and readiness for implementation. These methods may be transferable to other urban jurisdictions experiencing similar epidemics, and for other contexts where stakeholder input is needed to manage sensitive areas of concern.