Feasibility and Acceptability of an MI-based Telehealth Intervention for Bacterial STI Screening

点击翻译按钮获取中文摘要

PROJECT SUMMARY/ABSTRACT Gay, bisexual and other men who have sex with men living with HIV (GBMSM-LWH) bear a heavy burden of bacterial sexually transmitted infections (STIs) such as gonorrhea (GC), chlamydia (CT) and syphilis. Left untreated, bacterial STIs may lead to serious health complications. Inflammatory and ulcerative STIs can also facilitate the onward sexual transmission of HIV in the presence of inadequate viral suppression. Timely diagnosis and treatment are key to prevention. Sexually active GBMSM-LWH engaged in HIV medical care are not being screened for GC, CT and syphilis at least annually, as recommended. Home specimen self-collection has increasingly been used to screen for bacterial STIs in studies conducted with diverse populations. Telehealth has also demonstrated promise in managing mental health and increasing antiretroviral therapy adherence in people living with HIV. Only few studies have combined home specimen self-collection with live audio/video (AV) conferencing, all of which have been restricted to people without HIV. None have focused on GBMSM-LWH or incorporated motivational interviewing (MI), a client-centered, strengths-based counseling approach that seeks to support individuals towards positive behavioral change. Integrating home specimen self-collection from different anatomical sites of possible exposure with MI delivered via live AV conferencing might offer a unique solution to engage GBMSM-LWH in bacterial STI screening. MI-guided discussions have the potential to increase participants’ knowledge of bacterial STIs, enhance their intrinsic motivation to protect themselves and their sex partners, improve their self-efficacy for specimen self-collection, and problem-solve barriers to seeking treatment (if warranted) and repeat testing. Our sequential explanatory mixed-methods study seeks to explore the feasibility and acceptability of a novel MI-based telehealth intervention for sexually active GBMSM-LWH. In Phase 1, we will recruit 75 participants via mobile dating apps and social networking websites, and deliver a 3- component intervention: (i) a pre-test live AV conferencing session involving an MI-guided discussion to elicit awareness of bacterial STIs and fill any knowledge gaps, bolster the perceived importance of regularly screening for GC, CT and syphilis, and improve self-efficacy for specimen self-collection, (ii) self-collecting at home and returning by mail a finger-stick blood sample (for syphilis testing), a urine sample (for GC and CT testing), a pharyngeal swab (for GC and CT testing) and a rectal swab (for GC and CT testing), and (iii) a post-test live AV conferencing session involving an MI-guided discussion to prepare participants for receiving test results and formulate personalized action plans for seeking treatment (if warranted) and repeat testing. In Phase 2, we will conduct in-depth interviews with a purposively selected subsample of 20 participants who complete progressively smaller subsets of the pre-test session, specimen return for bacterial STI testing, and the post-test session to elucidate attitudes, facilitators and barriers related to engaging in each component of our intervention.