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Open AccessArticle

Exploring Mechanisms of Action: Using a Testing Typology to Understand Intervention Performance in an HIV Self-Testing RCT in England and Wales

1
Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
2
Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne 3086, Australia
3
Institute for Global Health, University College London, London NW3 2PF, UK
4
Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1h 9SH, UK
5
HIV i-Base, London SE1 3LJ, UK
6
Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
7
SH:24, London SE1 7JB, UK
8
Centre for Behaviour Change, University College London, London WC1N 3AZ, UK
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(2), 466; https://doi.org/10.3390/ijerph17020466
Received: 7 October 2019 / Revised: 12 December 2019 / Accepted: 17 December 2019 / Published: 10 January 2020
(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)
SELPHI involves two interventions: A provides one HIV self-testing (HIVST) kit; B offers 3-monthly repeat HIVST kits if participants report ongoing risk. A logic model underpinned by the Behaviour Change Wheel informed the design of the intervention. SELPHI recruited 10,135 cis-men and trans people in England and Wales, all reporting anal sex with a man. This paper explores how the interventions were experienced and the mechanisms of action leading to impact for different groups of trial participants. In-depth interviews with 37 cis-men who have sex with men (MSM) were used to inductively categorise participants based on sexual and HIV testing histories. Themes relating to intervention experiences and impacts were mapped onto SELPHI-hypothesised intermediate outcomes to consider intervention impacts. Three groups were identified: ‘inexperienced testers’ engaged with SELPHI to overcome motivational and social and physical opportunity testing barriers. For ‘pro self-testers’, testing frequency was constrained by psychological and social barriers and lack of opportunity. ‘Opportunistic adopters’ engaged in HIVST for novelty and convenience. Perceived impacts for inexperienced testers were most closely aligned with the logic model, but for opportunistic adopters there was little evidence of impact. Distinctive groups were discernible with divergent intervention experiences. Using COM-B as a model for understanding behaviour change in relation to HIVST, our results indicate how HIVST interventions could be adapted to respond to different needs based on the target population’s demographic and behavioural features. View Full-Text
Keywords: HIV testing; self-testing; men who have sex with men; COM-B; evaluation HIV testing; self-testing; men who have sex with men; COM-B; evaluation
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Witzel, T.C.; Weatherburn, P.; Bourne, A.; Rodger, A.J.; Bonell, C.; Gafos, M.; Trevelion, R.; Speakman, A.; Lampe, F.; Ward, D.; Dunn, D.T.; Gabriel, M.M.; McCabe, L.; Harbottle, J.; Collaco Moraes, Y.; Michie, S.; Phillips, A.N.; McCormack, S.; Burns, F.M. Exploring Mechanisms of Action: Using a Testing Typology to Understand Intervention Performance in an HIV Self-Testing RCT in England and Wales. Int. J. Environ. Res. Public Health 2020, 17, 466.

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