Understanding the acceptability, barriers and facilitators for chlamydia and gonorrhoea screening in technical colleges: Qualitative process evaluation of the "test n Treat" trial

Charlotte Fleming, Vari M. Drennan*, Sarah Kerry-Barnard, Fiona Reid, Elisabeth J. Adams, S. Tariq Sadiq, Rachel Phillips, Wendy Majewska, Emma Harding-Esch, Emma C. Cousins, Freya Yoward, Pippa Oakeshott

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Low uptake of sexually transmitted infection testing by sexually active young people is a worldwide public health problem. Screening in non-medical settings has been suggested as a method to improve uptake. The "Test n Treat"feasibility trial offered free, on-site rapid chlamydia/gonorrhoea tests with same day treatment for chlamydia (and gonorrhoea treatment at a local clinic,) to sexually active students (median age 17 years) at six technical colleges in London. Despite high rates of chlamydia (6% prevalence), uptake of testing was low (< 15%). In a qualitative study we explored the acceptability, including barriers and facilitators to uptake, of on-site chlamydia screening. Methods: In 2016-17 we conducted a qualitative study in the interpretative tradition using face to face or telephone semi-structured interviews with students (n = 26), teaching staff (n = 3) and field researchers (n = 4). Interviews were digitally recorded, transcribed and thematically analysed. Results: From the student perspective, feelings of embarrassment and the potential for stigma were deterrents to sexually transmitted infection testing. While the non-medical setting was viewed as mitigating against stigma, for some students volunteering to be screened exposed them to detrimental judgements by their peers. A small financial incentive to be screened was regarded as legitimising volunteering in a non-discrediting way. Staff and researchers confirmed these views. The very low level of knowledge about sexually transmitted infections influenced students to not view themselves as candidates for testing. There were also suggestions that some teenagers considered themselves invulnerable to sexually transmitted infections despite engaging in risky sexual behaviours. Students and researchers reported the strong influence peers had on uptake, or not, of sexually transmitted infection testing. Conclusions: This study offers new insights into the acceptability of college-based sexually transmitted infection screening to young, multi-ethnic students. Future studies in similar high risk, hard to reach groups should consider linking testing with education about sexually transmitted infections, offering non stigmatising incentives and engaging peer influencers.

Original languageEnglish
Article number1212
JournalBMC Public Health
Volume20
Issue number1
DOIs
Publication statusPublished - 8 Aug 2020

Bibliographical note

Funding Information:
This independent research is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1014-35007). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Neither the funding body nor Cepheid (who provided the testing equipment) had any role in the design of the study, the collection, analysis or interpretation of the data, or the write-up of the manuscript.

Funding Information:
Pippa Oakeshott is a member of the NIHR South London Collaboration for Leadership in Applied Health Research and Care, and of the eSTI [2] consortium funded under the UKCRC Translational Infection Research Initiative which is led by Prof Sadiq. Fiona Reid is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. EA directs Aquarius Population Health that receives grants and other funding to work on projects relating to STIs from Cepheid, Binx Health, and St George’s, University of London. STS directs and EHE, EC are members of The Applied Diagnostic Research and Evaluation Unit, which has conducted diagnostic evaluations for rapid STI tests for a number of companies including: Cepheid, Binx Health, Alere, TwistDx and SpeedDx.

Publisher Copyright:
© 2020 The Author(s).

Keywords

  • Adolescent
  • Chlamydia
  • Qualitative
  • Screening
  • Sexual behaviour
  • Sexually transmitted diseases
  • Students
  • Technical colleges

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