Background Not all men who have sex with men (MSM) are reached with current STI-care. We developed a home-care program to increase coverage of high-quality HIV/STI-care for MSM. The program combines home-based self-sampling testing for HIV, syphilis, chlamydia and gonorrhoea (anorectal, genital and oropharyngeal) with counselling, treatment and sexual health care after positive diagnosis. The aim of this pilot was to implement this program in the hospital setting to reveal barriers and facilitators for successful implementation.
Methods Healthcare providers from HIV hospital clinic Maastricht offered free test-kits (including STI self-sampling tests and online questionnaire) to their HIV+ MSM patients. Logistics and patient care were managed by the public health service South Limburg. Quantitative (process, questionnaire, diagnostic-tests) and qualitative (evaluation meetings, care-provider-interviews) data were collected. Primary outcomes were adoption (distribution of test-kits), reach (percentage participation), process barriers and facilitators.
Results Of 129 MSM patients, 110(85.3%-adoption) were offered a test-kit; 64(58.2%-participation) accepted; 28(43.8%) returned the samples for testing. 23(82.1%) were not recently <3 months tested. Five MSM (17.9%) were diagnosed with one or more STI. MSM reported easy and convenient test-kit usage; 67% would use it again. Hospital and public health providers found the program acceptable but identified logistical challenges. Initial missing questionnaires (29.6%) led to logistical difficulties(time-consuming). Because a large proportion of MSM had previous syphilis (18/28), sufficient serum was not always(8/18) available for full syphilis diagnostics. In case we only did syphilis screening test, 82.1% (23/28) had sufficient serum for syphilis screening test (and HIV testing).
Conclusion The home-care program with self-sampling test was acceptable for hospital, public health-care providers and MSM. MSM participation could be improved as return rate of test-kits was low. Tested MSM did have STI and were not recently tested. Although in this HIV+ population syphilis diagnoses was often hampered, we expect screening in a lower prevalent syphilis MSM group to be more successful.
Disclosure No significant relationships.
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