JMIR Publications

ABSTRACT

Background:

Canadian clinical guidelines recommend at least annual and up to quarterly sexually transmitted infection (STI) testing among sexually active gay, bisexual and other men who have sex with men (GBM). However, testing rates are suboptimal and innovative solutions are needed to close the gap as how best to do this is not known.

Objective:

Our aim was to build consensus with regard to interventions with the greatest potential for improving local STI testing services for MSM communities in Toronto, Canada, using a web-based “e-Delphi” process.

Methods:

The e-Delphi uses successive rounds of prioritization, with feedback in between rounds, to determine priorities among groups using a panel format. We recruited experts separately from community (GBM who sought/underwent STI testing in the preceding 18 months; conducted 09/2019-11/2019) and healthcare providers (offered STI testing to GBM in the past 12 months; conducted 02/2020-05/2020). Experts prioritized 6-8 potential interventions, which were generated from a literature review, on a 7-point Likert scale of ‘Definitely not a priority’ to ‘Definitely a priority’ over three survey rounds, and ranked their top three interventions. Consensus was defined as ≥60% within a ±1 response point. Summaries of responses were given in successive rounds. We report the percentage of ‘a priority’ (encompassing ‘somewhat a priority/a priority/definitely a priority’ responses) at the final round of survey.

Results:

For the Community Experts, 43/51 (84%) participants completed all rounds; 19% were living with HIV, 37% HIV-negative on Pre-Exposure Prophylaxis (PrEP), 42% HIV-negative not on PrEP. We reached consensus on six interventions – Client reminders (95%), Express testing (88%), Routine testing (83%), Online booking app (83%), Online testing (77%) and Nurse-led testing (72%). Community Experts favoured interventions that were convenient, while also maintaining a relationship with their provider. For the Provider Experts, 37/48 (77%) participants completed all rounds; 59% were physicians. Consensus was reached on the same six interventions (range 68%-100%), but not for Provider Alerts (19%) and Provider Audit and Feedback (16%). Express, Online and Nurse-led testing were prioritized by >95% of Provider Experts because of streamlined processes and decreased need to see a provider.

Conclusions:

Both panels were enthusiastic about innovations that make STI testing more efficient with Express Testing rating highly in both the prioritization and top three ranking. However, Community Experts preferred convenient interventions that involved their provider, while Provider Experts favoured interventions that prioritized patient independence and reduced patient-provider time.