Desai, M;
(2015)
Facilitators and barriers to active recall for HIV and STI testing of MSM at high risk of HIV infection in genito-urinary medicine clinics.
Doctoral thesis , UCL (University College London).
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Desai, Monica_Monica Desai MDRes FINAL December 2015.pdf.redacted.pdf Download (5MB) | Preview |
Abstract
Reminders have been successfully used in healthcare to improve reattendance rates but evidence for their effectiveness in sexual health remains unknown. A programme of studies explored the effectiveness of, and drivers and barriers to active recall reminders in increasing reattendance/re-testing rates for HIV/STIs among men who have sex with men (MSM), underpinned by the Theory of Planned Behaviour. The systematic literature review suggested efficacy of reminders in increasing reattendance/re-testing rates for HIV/STIs, but was unable to determine which modality of reminder was most effective. In a service evaluation, text SMS reminders were offered to MSM who reported unprotected anal sex in the past three months. The evaluation was unable to demonstrate an increase in reattendance rates; however concurrent health promotion may have counfounded the results. To explore preferred type and frequency of reminder, and attitudes to HIV/STI testing and reminders, 406 MSM attending a sexual health clinic were surveyed. Preferring SMS reminders, liking being reminded to check health status, not being concerned about the confidentiality of reminders and preferring to have a reminder to test were associated with intention to reattend in multivariable analysis, but not with documented reattendance. Concern about potential stigma of being sent a reminder was associated with reduced intention to reattend. Contextual factors influencing these attitudes to testing and reminders were explored in 16 interviews. Drivers for testing included easy access to testing facilities and the influence of peers or a regular male partner. Conversely, barriers included conflict with being in a trusting relationship, difficulty of accessing tests, fear/embarrassment and concerns about wasting resources. Key themes in responding to reminders included convenience and confidentiality of the reminder, control over receipt and response to the reminder, and reminder persistence. These findings will inform HIV testing recall policies and provides further support for preference for SMS reminders.
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