JMIR Publications

ABSTRACT

Background:

In the last two decades there has been an increasing number of sexually transmissible enteric infection (STEI) outbreaks among gay, bisexual, or other men who have sex with men (GBMSM), with circulating strains often associated with antimicrobial resistance (AMR). There remain important gaps in our understanding about how STEI transmission is sustained, and how AMR develops, that could help to inform the delivery of interventions. Repeated collection of samples with linked behavioural and clinical data over several months could help to address these knowledge gaps.

Objective:

We aimed to assess the feasibility and acceptability of longitudinal sample and epidemiological data collection among GBMSM accessing sexual health services (SHS).

Methods:

GBMSM (≥ 16 years) accessing two SHS in Brighton and Sussex were recruited between May and October 2022. Participants provided an initial rectal swab, and optional faecal sample, and completed a baseline questionnaire. Weekly follow-up questionnaires and rectal swabs were collected for a further 11 weeks. STI surveillance data was pseudonymously linked to provide additional clinical and demographic information. Selected participants were invited to take part in an optional one-to-one interview. A mixed-methods approach incorporating the qualitative insights from participant interviews was utilised.

Results:

Overall, 193 participants were recruited. Half (n=100/193; 51.8%) provided a baseline rectal swab, with a third (n=34/100; 34.0%) of them continuing to provide all 12 swabs. Alongside the rectal swab at baseline, 76.0% (n=76/100) also provided the optional faecal sample. Just over a third (n=71/193; 36.8%) of participants completed a baseline questionnaire, with a fifth (n=15/71; 21.1%) continuing to provide all follow-up questionnaires. Interviews (n=21) found that the feeling of giving something back for services received and perceived indirect benefit to self through collective benefit for peers motivated participation. The study was generally accepted with over half reflecting on the perceived ease of participation and relatively simple tasks, that could be easily integrated into normal routine with an element of flexibility. Most participants were satisfied with the 12-week study length and having a definitive end point aided the ability to assess if they would be able to participate. Barriers for completing the study procedures included not being aware of what was required, particularly for the follow-up questionnaires. Suggested improvements included more concise and easier to read instructions, with a section at the beginning to clearly list out the key procedures of the study. Text message reminders were sent but these were seen with variable utility and interpreted in different ways (e.g. personal or generic reminders or thank you messages).

Conclusions:

This study has provided evidence that longitudinal rectal swab sampling and data collection for research purposes is feasible and acceptable among GBMSM attending SHS, and has provided tangible insights to inform the design of future similar studies.