Community-Directed Bacterial Sexually Transmitted Infection Testing Interventions Among Men Who Have Sex With Men: Protocol for an E-Delphi Study in Toronto, Canada

Background HIV-positive and HIV-negative (gay, bisexual, and other) men who have sex with men (MSM) have experienced a dramatic increase in bacterial sexually transmitted infections (STIs)—syphilis, gonorrhea, and chlamydia. STI testing and treatment mitigate adverse health outcomes and substantially reduce transmission; yet, testing rates remain below recommended levels. Innovation is needed to produce the required increases in testing levels, frequency, and the use of appropriate testing technologies in ways that are engaging, nonstigmatizing, and acceptable to men. Objective The aim of this study is to build consensus with regard to interventions with the greatest potential for improving local STI testing services for MSM communities in Toronto, Canada. Methods Following a literature review of evidence regarding the effectiveness of novel testing interventions, and focus groups, and surveys to describe local barriers and facilitators of testing among MSM, we will conduct a Web-based, modified Delphi study (e-Delphi). We will form expert panels of community members and STI test providers. Panelists will rate potential interventions in terms of their priority, using a 7-point Likert scale from definitely not a priority to definitely a priority. They will also rank their preferences by selecting their top 3 preferred interventions. Surveys will be distributed in 3 rounds, with feedback on the distribution of responses from preceding rounds provided in rounds 2 and 3. We will define consensus as having ≥60% (18/30) members indicate a preference within 2 adjacent response points. Qualitative data on disagreements will be obtained using open-ended text responses to explain for ratings and rankings that are different from the majority. Results On the basis of a literature review and identification of barriers and facilitators to STI testing among community members and test providers in Toronto, we have selected 8 potential interventions for inclusion in the e-Delphi panel surveys. These include 4 interventions that streamline STI testing for asymptomatic individuals, 2 interventions that are targeted at clients and 2 interventions that are targeted at providers. Conclusions Findings will provide community direction for informed decision making regarding the implementation of STI testing interventions in this setting. They will characterize the intervention climate for innovation to STI testing services, including perceived needs for changes to test delivery, relative priorities for change, and readiness for implementation. These methods may be transferable to other urban jurisdictions experiencing similar epidemics and for other contexts where stakeholder input is needed to manage sensitive areas of concern. International Registered Report Identifier (IRRID) PRR1-10.2196/13801

You will find the review documents related to your proposal in your ResearchNet account. If you cannot access the review documents related to your proposal through ResearchNet, please contact CIHR. The Authorization for Funding will be mailed to you shortly. The Scientific Officer Notes and reviewers' reports are provided in the language in which they were written. If you would like them to be translated, please contact us and we will be pleased to do so.
As CIHR does not notify co-applicants by mail of the decision taken, we ask that you inform the other individuals involved in this project along with their research institutions (if different from your own) of the outcome of this application.
Should you have any questions about the review process, please address them directly to support@cihr-irsc.gc.ca. Please do not contact the officers or members of the merit review committee.
Congratulations on your success in this competition! Canadian health researchers are recognized worldwide for their inspiration, curiosity, and drive. As a CIHRfunded researcher, you are helping to build this reputation and carry on Canada's tradition of scientific excellence. As you pursue your research project, it is our hope that your efforts will help create new knowledge that will improve health and strengthen the health care system for the benefit of Canadians.
As you know, peer review is the cornerstone of our research funding system. This process is made possible because of the kind volunteerism of individuals who generously gave their time to review your application. As a CIHR-funded researcher, you may be invited to serve in the peer review process as we are continuously recruiting and retaining the most accomplished, innovative and creative scientists to review health research proposals.
To meet CIHR goals, we must also continue to communicate the value of health research to Canadians. That is why we encourage you to work with CIHR to promote your research. We have developed guidelines on public communication, available at: www.cihr-irsc.gc.ca/e/30789.html, to support you in this activity.
Once again, I offer you my congratulations and best wishes for success in your research. The goal and objectives of this proposed project are clear and simple, with a manageable scope for a catalyst grant.
The proposal is very well written and clearly situates the problem and research question.
The methods are also clear and well described and appropriate for what they want to achieve. However, the applicants describe that they will be conducting an online modified Delphi study. The project could probably benefit from a face-to-face discussion of the Expert Panel for the Third Delphi round to achieve consensus on the interventions. The CBR Principles Summary only describes that the team will share the project findings with the Expert Panel members and other community stakeholders.
I wonder about the diversity of the MSM population in Toronto and whether this diversity has been documented. The application could benefit from describing how this diversity will be represented on the expert panel. Various needs in the community might affect key characteristics of potential interventions.
A bit more information on this would be useful.
The team has a good KT plan.

Potential Impact
Comments:

Summary
In Canada, HIV-positive and -negative men who have sex with men (MSM) have experienced dramatic rises in bacterial sexually transmitted infections (STIs)-syphilis, gonorrhea, and chlamydia. STI testing and treatment mitigate adverse health outcomes and substantially reduce transmission, yet testing rates remain below recommended levels. One-off "testing blitzes" have not led to frequent testing, resulting in rebounds and rising infection rates. Few undergo recommended extragenital testing for gonorrhea and chlamydia. Without comprehensive sexual health promotion, advances in HIV medicine may unintentionally fuel STI transmission. Innovation is needed to produce the required increases in test coverage, frequency, and use of appropriate testing technologies in ways that are engaging, nonstigmatizing, and acceptable.

Objectives and Approach
To answer our question, "Which bacterial STI testing interventions should be implemented and evaluated among MSM communities in Toronto?" we will: 1-Synthesize knowledge regarding current test programs and practice; barriers and facilitators of testing among MSM; and evidence regarding effectiveness for novel test interventions; and 2-Form an Expert Panel of community members, knowledge users, and researchers for a modified Delphi study to build consensus regarding intervention(s) with the greatest potential for our setting.

Outcomes
We will identify STI testing interventions most adaptable to our setting according to MSM community members, healthcare providers, and health systems experts, laying the groundwork for rigorous evaluation via a future grant proposal. Our project will lead to community-directed, informed decision making regarding STI test delivery in urban settings that may guide other jurisdictions experiencing similar epidemics.

Comments
Potential Impact #1: The application responds to the objectives and relevant research areas of the funding opportunity. Potential Impact #2: The research team has already developed strong collaborations through previous projects. Potential Impact #3: The activities of iKTE are very structured and, if their analysis is adequate (see Scientific Merit), they will have a major impact on the communities concerned by STI and HIV.
The proposal specifically addresses the objectives of this funding opportunity because it is catalytic in nature, bringing together community members, front-line providers, clinicians and researchers to generate and synthesize evidence for STI testing interventions for MSM within a CBR framework. The work will lead directly to the choice of STI testing interventions for implementation, thereby addressing the HIV care continuum in line with the CIHR HIV/AIDS Research Initiative's Strategic Plan.