Tags

Type your tag names separated by a space and hit enter

Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study.
Health Technol Assess. 2019 03; 23(12):1-122.HT

Abstract

BACKGROUND

Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England.

OBJECTIVES

The study (Santé) had two main objectives - (1) to develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services and (2) to assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care.

DESIGN

The project was a multistage, mixed-methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review, an analysis of national surveillance data, the development of a triage algorithm, and interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics; the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls; in all clinics, participants would be consented to a 6-week follow-up STI screen.

SETTING

SH clinics in England.

PARTICIPANTS

Young people (aged 16-25 years), and men who have sex with men.

INTERVENTION

A three-part intervention package - (1) a triage tool to score patients as being at high or low risk of STI using routine data, (2) a study-designed web page with tailored SH information for all patients, regardless of risk and (3) a brief one-to-one session based on motivational interviewing for high-risk patients.

MAIN OUTCOME MEASURES

The three outcomes were (1) the acceptability of the intervention to patients and SH providers, (2) the feasibility of delivering the interventions within existing resources and (3) the feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial).

RESULTS

We identified 33 relevant trials from the systematic review, including videos, peer support, digital and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated that these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot; therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% vs. 46%).

LIMITATIONS

Fewer clinics were included in the pilot than planned, limiting the ability to make strong conclusions on the feasibility of the RCT.

CONCLUSION

We were unable to conclude whether or not a definitive RCT would be feasible because of challenges in implementation of a pilot, but have laid the groundwork for future research in the area.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN16738765.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 12. See the NIHR Journals Library website for further project information.

Authors+Show Affiliations

Institute for Global Health, University College London, London, UK.Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.Institute for Global Health, University College London, London, UK.Medical School, University of Exeter, Exeter, UK.Research Department of Primary Care and Population Health, University College London, London, UK.Institute for Global Health, University College London, London, UK.Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.Institute for Global Health, University College London, London, UK. London Hub for Trials Methodology Research, Medical Research Council Clinical Trials Unit, London, UK.Institute for Global Health, University College London, London, UK.Sexually Transmitted Infection Surveillance, Public Health England, London, UK.Institute for Global Health, University College London, London, UK.Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.Institute for Global Health, University College London, London, UK.Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.Institute for Global Health, University College London, London, UK.

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30916641

Citation

King, Carina, et al. "Sexual Risk Reduction Interventions for Patients Attending Sexual Health Clinics: a Mixed-methods Feasibility Study." Health Technology Assessment (Winchester, England), vol. 23, no. 12, 2019, pp. 1-122.
King C, Llewellyn C, Shahmanesh M, et al. Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study. Health Technol Assess. 2019;23(12):1-122.
King, C., Llewellyn, C., Shahmanesh, M., Abraham, C., Bailey, J., Burns, F., Clark, L., Copas, A., Howarth, A., Hughes, G., Mercer, C., Miners, A., Pollard, A., Richardson, D., Rodger, A., Roy, A., & Gilson, R. (2019). Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study. Health Technology Assessment (Winchester, England), 23(12), 1-122. https://doi.org/10.3310/hta23120
King C, et al. Sexual Risk Reduction Interventions for Patients Attending Sexual Health Clinics: a Mixed-methods Feasibility Study. Health Technol Assess. 2019;23(12):1-122. PubMed PMID: 30916641.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study. AU - King,Carina, AU - Llewellyn,Carrie, AU - Shahmanesh,Maryam, AU - Abraham,Charles, AU - Bailey,Julia, AU - Burns,Fiona, AU - Clark,Laura, AU - Copas,Andrew, AU - Howarth,Alison, AU - Hughes,Gwenda, AU - Mercer,Cath, AU - Miners,Alec, AU - Pollard,Alex, AU - Richardson,Daniel, AU - Rodger,Alison, AU - Roy,Anupama, AU - Gilson,Richard, PY - 2019/3/28/entrez PY - 2019/3/28/pubmed PY - 2020/9/15/medline KW - BEHAVIOURAL INTERVENTIONS KW - FEASIBILITY KW - PILOT KW - RISK REDUCTION KW - SEXUAL HEALTH KW - TRIAGE SP - 1 EP - 122 JF - Health technology assessment (Winchester, England) JO - Health Technol Assess VL - 23 IS - 12 N2 - BACKGROUND: Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England. OBJECTIVES: The study (Santé) had two main objectives - (1) to develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services and (2) to assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care. DESIGN: The project was a multistage, mixed-methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review, an analysis of national surveillance data, the development of a triage algorithm, and interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics; the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls; in all clinics, participants would be consented to a 6-week follow-up STI screen. SETTING: SH clinics in England. PARTICIPANTS: Young people (aged 16-25 years), and men who have sex with men. INTERVENTION: A three-part intervention package - (1) a triage tool to score patients as being at high or low risk of STI using routine data, (2) a study-designed web page with tailored SH information for all patients, regardless of risk and (3) a brief one-to-one session based on motivational interviewing for high-risk patients. MAIN OUTCOME MEASURES: The three outcomes were (1) the acceptability of the intervention to patients and SH providers, (2) the feasibility of delivering the interventions within existing resources and (3) the feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial). RESULTS: We identified 33 relevant trials from the systematic review, including videos, peer support, digital and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated that these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot; therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% vs. 46%). LIMITATIONS: Fewer clinics were included in the pilot than planned, limiting the ability to make strong conclusions on the feasibility of the RCT. CONCLUSION: We were unable to conclude whether or not a definitive RCT would be feasible because of challenges in implementation of a pilot, but have laid the groundwork for future research in the area. TRIAL REGISTRATION: Current Controlled Trials ISRCTN16738765. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 12. See the NIHR Journals Library website for further project information. SN - 2046-4924 UR - https://www.unboundmedicine.com/medline/citation/30916641/Sexual_risk_reduction_interventions_for_patients_attending_sexual_health_clinics:_a_mixed_methods_feasibility_study_ L2 - https://doi.org/10.3310/hta23120 DB - PRIME DP - Unbound Medicine ER -