Understanding the acceptability, barriers and facilitators for chlamydia and gonorrhoea screening in technical colleges: qualitative process evaluation of the “Test n Treat” trial

摘要

Background: Low uptake of sexually transmitted infection testing by sexually active young people is a worldwidepublic health problem. Screening in non-medical settings has been suggested as a method to improve uptake. The“Test n Treat” feasibility trial offered free, on-site rapid chlamydia/gonorrhoea tests with same day treatment forchlamydia (and gonorrhoea treatment at a local clinic,) to sexually active students (median age 17 years) at six technicalcolleges in London. Despite high rates of chlamydia (6% prevalence), uptake of testing was low ( 15%). In a qualitativestudy we explored the acceptability, including barriers and facilitators to uptake, of on-site chlamydia screening.Methods: In 2016–17 we conducted a qualitative study in the interpretative tradition using face to face or telephonesemi-structured interviews with students (n = 26), teaching staff (n = 3) and field researchers (n = 4). Interviews weredigitally recorded, transcribed and thematically analysed.Results: From the student perspective, feelings of embarrassment and the potential for stigma were deterrents tosexually transmitted infection testing. While the non-medical setting was viewed as mitigating against stigma, for somestudents volunteering to be screened exposed them to detrimental judgements by their peers. A small financialincentive to be screened was regarded as legitimising volunteering in a non-discrediting way. Staff and researchersconfirmed these views. The very low level of knowledge about sexually transmitted infections influenced students tonot view themselves as candidates for testing. There were also suggestions that some teenagers consideredthemselves invulnerable to sexually transmitted infections despite engaging in risky sexual behaviours. Students andresearchers reported the strong influence peers had on uptake, or not, of sexually transmitted infection testing.Conclusions: This study offers new insights into the acceptability of college-based sexually transmitted infectionscreening to young, multi-ethnic students. Future studies in similar high risk, hard to reach groups should considerlinking testing with education about sexually transmitted infections, offering non stigmatising incentives and engagingpeer influencers.