Syphilis self-testing to expand test uptake among men who have sex with men: a theoretically informed mixed methods study in Zimbabwe
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Abstract
Objectives: Self-testing for STIs such as HIV and syphilis may empower sexual minorities and expand uptake of STI testing. While much is known about HIV self-testing (HIVST), less is known about syphilis self-testing, particularly in low-income settings. The objective of this study is to determine context-specific facilitators and barriers for self-testing and to assess the usability of syphilis self-testing in Zimbabwe among men who have sex with men (MSM). Methods: This mixed methods study was conducted in Harare as part of a larger syphilis self-testing trial. The study included in-depth interviews (phase I) followed by usability testing and a second interview (phase II). In-depth interviews were conducted with MSM and key informants prior to syphilis self-testing. The same MSM then used the syphilis self-test, quantitatively assessed its usability and participated in a second in-depth interview. Phase I data were analysed using a thematic approach, guided by an adapted social ecological model conceptual framework. Phase II interviews were analysed using rapid assessment procedure methodology, and usability was assessed using a pre-established index, adapted from existing HIVST scales. Results: Twenty MSM and 10 key informants were recruited for phase I in-depth interviews, and 16 of these MSM participated in phase II by completing a syphilis self-test kit. Facilitating factors for self-testing included the potential for increased privacy, convenience, autonomy, and avoidance of social and healthcare provider stigma. Barriers included the fear to test and uncertainty about linkage to care and treatment. Data from the Usability Index suggested high usability (89.6% on a 0–100 scale) among the men who received the self-test. Conclusions: MSM in Zimbabwe were willing to use syphilis self-test kits and many of the barriers and facilitators were similar to those observed for HIVST. Syphilis self-testing may increase syphilis test uptake among sexual minorities in Zimbabwe and other low-income and middle-income countries.
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Syphilis self-testing, including dual HIV/syphilis self-testing, was well accepted and desirable overall.
“Syphilis self-testing, including dual HIV/syphilis self-testing, was well accepted and desirable overall (62, 63, 67-69).”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [67]
The Discussion reports that syphilis self-testing was highly acceptable among the MSM studied in Zimbabwe, and the Results describe participants’ preference for testing at home. The Methods specify a syphilis-only self-test, while the Results compare it with separate HIV self-tests; this paper does not establish the acceptability or desirability of a dual HIV/syphilis self-test. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe systematic review included 12 publications of about seven different studies, of which two were RCTs.
“Overall, the review included 12 publications of about seven different studies (61-72), of which two were RCTs (64, 66).”
Several studies showed that most participants were able to correctly self-test.
“Several studies showed that most participants were able to correctly self-test (62, 64, 66-69).”
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Nhamo, D., Mangenah, C., Chapwanya, G., Mamvuto, T., Mahaka, I., Sri-Pathmanathan, C., Ferrand, R. A., Kranzer, K., Terris-Prestholt, F., Marks, M., et al. (2023) · Sexual Health · doi:10.1071/sh23038 · Cited by 5 · see citing works
Self-citation
- Authors
- Sri-Pathmanathan, C., Nhamo, D., Mamvuto, T., Chapwanya, G., Terris-Prestholt, F., Mahaka, I., Marks, M., & Tucker, J. D.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Sri-Pathmanathan, Clarisse
- Venue
- Sexually Transmitted Infections
- Publisher
- BMJ
- Published
- 2021-04-29
- Volume
- 98
- Issue
- 3
- Pages
- 197-202
- ISSN
- 0007-134X (ISSN-L)
- 1368-4973
- 1472-3263
- PMC
- PMC7612625
- OpenAlex
- W3158494859
- Cited by
- 17
- References
- 2
- Citations by year
- 2026: 3 · 2025: 3 · 2023: 3 · 2022: 8
- FWCI
- 1.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Sexually Transmitted Infections (publishedVersion, cc-by)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Greater South Information System
- Funders
- National Institute for Health and Care Research (CL-2016-20-001)
- Medical Research Council (MR/T003995/1)
- Topics
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- men who have sex with men, HIV self-testing, socio-ecological model, barriers and facilitators, usability, linkage to care, stigma, sexual minorities, Zimbabwe
- MeSH terms
- Sexual and Gender Minorities, Self-Testing, Humans, Male, Syphilis, Zimbabwe, HIV Infections, Homosexuality, Male
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