Background: Sexually transmitted infection (STI) surveillance is vital for tracking the scale and pattern of epidemics; however, it often lacks data on the underlying drivers of STIs. Objective: This study aimed to assess the acceptability and feasibility of implementing a bio-behavioral enhanced surveillance tool, comprising a self-administered Web-based survey among sexual health clinic attendees, as well as linking this to their electronic health records (EHR) held in England's national STI surveillance system. Methods: Staff from 19 purposively selected sexual health clinics across England and men who have sex with men and black Caribbeans, because of high STI burden among these groups, were interviewed to assess the acceptability of the proposed bio-behavioral enhanced surveillance tool. Subsequently, sexual health clinic staff invited all attendees to complete a Web-based survey on drivers of STI risk using a study tablet or participants' own digital device. They recorded the number of attendees invited and participants' clinic numbers, which were used to link survey data to the EHR. Participants' online consent was obtained, separately for survey participation and linkage. In postimplementation phase, sexual health clinic staff were reinterviewed to assess the feasibility of implementing the bio-behavioral enhanced surveillance tool. Acceptability and feasibility of implementing the bio-behavioral enhanced surveillance tool were assessed by analyzing these qualitative and quantitative data. Results: Prior to implementation of the bio-behavioral enhanced surveillance tool, sexual health clinic staff and attendees emphasized the importance of free internet/Wi-Fi access, confidentiality, and anonymity for increasing the acceptability of the bio-behavioral enhanced surveillance tool among attendees. Implementation of the bio-behavioral enhanced surveillance tool across sexual health clinics varied considerably and was influenced by sexual health clinics' culture of prioritization of research and innovation and availability of resources for implementing the surveys. Of the 7367 attendees invited, 85.28% (6283) agreed to participate. Of these, 72.97% (4585/6283) consented to participate in the survey, and 70.62% (4437/6283) were eligible and completed it. Of these, 91.19% (4046/4437) consented to EHR linkage, which did not differ by age or gender but was higher among gay/bisexual men than heterosexual men (95.50%, 722/756 vs 88.31%, 1073/1215; P<.003) and lower among black Caribbeans than white participants (87.25%, 568/651 vs 93.89%, 2181/2323; P<.002). Linkage was achieved for 88.88% (3596/4046) of consenting participants. Conclusions: Implementing a bio-behavioral enhanced surveillance tool in sexual health clinics was feasible and acceptable to staff and groups at STI risk; however, ensuring participants' confidentiality and anonymity and availability of resources is vital. Bio-behavioral enhanced surveillance tools could enable timely collection of detailed behavioral data for effective commissioning of sexual health services.
Bibliographical noteFunding Information:
The authors thank all the study participants and staff of SHCs involved in this study. The authors also thank all the community-based organizations who helped them to recruit participants for the qualitative study. The authors acknowledge the members of the National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections Steering Committee: Caroline Sabin, Anthony Nardone, Catherine Mercer, Gwenda Hughes, Greta Rait, Jackie Cassell, William Rosenberg, Tim Rhodes, Kholoud Porter, and Samreen Ijaz and the members of Theme A of the NIHR HPRU in Blood Borne and Sexually Transmitted Infections Steering Committee: Catherine Mercer, Gwenda Hughes, Hamish Mohammed, Jackie Cassell, Fiona Burns, Makeda Gerressu, Jonathan Elford, David Phillips, Gary Brook, Nicola Low, Anthony Nardone, Sarika Desai, Adamma Aghaizu, Alison Rodgers, and Paul Crook. The authors would like to thank Catherine Griffiths and Catherine Aicken for their help with the systematic review; Victoria Gilbart, Jessica Datta, and Emma Garnett for their help with qualitative data collection; and Lorna Sutcliffe and Jessica Datta for their help with coding qualitative data. The research was funded by the NIHR HPRU in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene and Tropical Medicine. SW and DR are funded by the NIHR HPRU in Blood Borne and Sexually Transmitted Infections at UCL in partnership with PHE and in collaboration with the London School of Hygiene and Tropical Medicine.
SW, DR, and PB set up the study, managed by PW, GH, and CM. SW and DR secured ethics and R&D permissions, and SW coordinated and managed the implementation of the study in all study sites, with support from PW, GH, and CM. SW undertook the systematic review; SW and DR undertook qualitative data collection and data analyses; SW, DR, and PB oversaw the delivery of the patient survey in GUM clinics; PB undertook the linkage of the patient survey data to GUMCAD. SW and PB analyzed the quantitative data. CM and GW secured funding from the National Institute for Health Research for the Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine. All authors contributed to the drafting of the paper and approved the final version. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health, or Public Health England.
© Sonali Wayal, David Reid, Paula B Blomquist, Peter Weatherburn, Catherine H Mercer, Gwenda Hughes.
Copyright 2020 Elsevier B.V., All rights reserved.
- Electronic health records
- Feasibility studies
- Public health surveillance
- Sexually transmitted diseases
- Web-based survey