Using social science methods to understand pathways to impact: a national HIV self-testing intervention targeting men who have sex with men and trans people in England and Wales.
22nd International AIDS Conference (AIDS 2018), Amsterdam, Netherlands, July 23-27, 2018
Speakers: T. Charles Witzel, Fiona Burns, Alison J. Rodger, Chris Bonnel ... Peter Weatherburn
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Background: Increasing HIV testing among at-risk populations is a global HIV prevention goal. HIV self-testing (HIVST) could expand testing to new populations. SELPHI is an online randomised controlled trial evaluating whether HIVST increases rates and timeliness of HIV diagnoses among MSM and trans people. SELPHI target sample is 10,000, and initial randomisation is to HIVST or standard care.
SELPHI has used the COM-B behaviour change model in intervention development. COM-B theorises alterations in capability, opportunity and motivation as key to successful behavioural interventions. The aim of this study is to articulate potential pathways to impact in a national HIVST intervention using COM-B.
Methods: Three formative studies investigating attitudes towards HIVST contributed to the logic model: a systematic literature map, six focus groups discussions (FGDs) (July to Nov 2015) with 47 MSM in three cities and 17 key informant interviews (IDIs) (May to Dec 2016) across England. FGDs and IDIs were transcribed and analysed thematically. Themes were extracted from qualitative data and relevant literature, then mapped onto a thematic framework informed by COM-B. The logic model was developed by transposing framework components to contextual factors, intervention processes, intermediate and trial outcomes.
Results: As shown in figure 1, contextual factors included a strong norm for regular testing supporting implementation. Perceived capability concerns (low self-efficacy and lack of support) were barriers. The logic model suggests intervention processes facilitate behaviour change by increasing motivation and opportunity. Three intervention processes enhance motivation: i) collection of behavioural information at registration increases risk perception; ii) a free kit offer enhances the desire to establish HIV status; and iii) follow-up contact increases engagement with testing. One process increases opportunity by providing an additional, convenient modality, reducing the burden of time associated with testing while increasing privacy. In order to address capability issues, advertising should enhance motivation by highlighting facilitators while addressing and minimising capability concerns.
Conclusions: The logic model describes the potential of SELPHI to affect behaviour change. By heightening risk perception and providing HIVSTs and follow-up support, SELPHI increases opportunity and motivation to test. Using COM-B allows us to better understand intervention processes and likely outcomes.