Introduction People from underserved groups experience disproportionately poor sexual health and challenges accessing care. Asynchronous online consultations (a user completes a health questionnaire online, which is reviewed by a clinician) are being used within sexual healthcare to prescribe chlamydia treatment. Users require sufficient health and digital literacy to access online services and use them safely.Methods We used the PROGRESS-Plus (PROGRESS: Place of Residence, Race/Ethnicity, Occupation, Gender/Sex, Religion, Education, Socio-economic Status, Social Network; Plus: e.g., Age, Sexual Orientation, Disability) framework to guide purposive recruitment of 35 participants from diverse underserved groups, from community settings and sexual health services in contrasting areas of the UK (15 October 2021-18 March 2022). We conducted qualitative semistructured interviews and thematic analyses to derive key barriers and facilitators to using asynchronous online consultations. We applied the Behaviour Change Wheel to specify recommendations to address them.Results Over half of participants were from the most deprived areas and 40% were from minoritised ethnic groups. Key barriers included: lack of familiarity with online healthcare; perceived need to see a healthcare professional in person; privacy concerns; concerns about difficulty interpreting the questions; discomfort answering personal questions online. Key facilitators included: familiarity with online consultations; perceived low sexually transmitted infection risk; perceived increase in convenience, control and privacy; simple wording and design; and support while completing them. Recommendations included: increasing awareness and familiarity by promoting them offline and online and providing demonstrations and instructions on how to use them; encouraging people to choose them by highlighting available support, equivalence to in-person consultations and privacy and convenience; and reducing attrition by using simple wording and design, providing additional explanations and offering audio and visual alternatives to text.Conclusions Incorporating these evidence-based, theoretically informed recommendations could widen access to underserved groups and increase the usability and safety of asynchronous online consultations for chlamydia treatment. Recommendations are likely to benefit all users and could be of use across health more broadly.

BackgroundThe ability to access and navigate online sexual health information and support is increasingly needed in order to engage with wider sexual healthcare. However, people from underserved populations may struggle to pass though this "digital doorway". Therefore, using a behavioural science approach, we first aimed to identify barriers and facilitators to i) seeking online sexual health information and ii) seeking online sexual health support. Subsequently, we aimed to generate theory-informed recommendations to improve these access points.MethodsThe PROGRESSPlus framework guided purposive recruitment (15.10.21-18.03.22) of 35 UK participants from diverse backgrounds, including 51% from the most deprived areas and 26% from minoritised ethnic groups. Using semi-structured interviews and thematic analysis, we identified barriers and facilitators to seeking online sexual health information and support. A Behaviour Change Wheel (BCW) analysis then identified recommendations to better meet the needs of underserved populations.ResultsWe found diverse barriers and facilitators. Barriers included low awareness of and familiarity with online information and support; perceptions that online information and support were unlikely to meet the needs of underserved populations; overwhelming volume of information sources; lack of personal relevancy; chatbots/automated responses; and response wait times. Facilitators included clarity about credibility and quality; inclusive content; and in-person assistance. Recommendations included: Education and Persuasion e.g., online and offline promotion and endorsement by healthcare professionals and peers; Training and Modelling e.g., accessible training to enhance searching skills and credibility appraisal; and Environmental Restructuring and Enablement e.g., modifications to ensure online information and support are simple and easy to use, including video/audio options for content.ConclusionsGiven that access to many sexual health services is now digital, our analyses produced recommendations pivotal to increasing access to wider sexual healthcare among underserved populations. Implementing these recommendations could reduce inequalities associated with accessing and using online sexual health service.

BACKGROUND:Here we report on a process evaluation conducted as part of a large multisite non-randomised trial of the effectiveness of a novel whole genome sequence report form (SRF) to reduce nosocomial SARS-CoV-2 through changing infection prevention and control (IPC) behaviours during the COVID -19 pandemic. We detail how the SRF was implemented across a heterogeneous purposive sub-sample of hospital trial sites (n=5/14). METHODS:We conducted in-depth interviews from diverse professional staff (N=39). Deductive and inductive thematic analysis initially explored participants' accounts of implementing the SRF. The resulting themes, concerning the way the SRF was used within sites, were then coded in relation to the key tenets of normalisation process theory (NPT). RESULTS:Factors that enabled the implementation of the SRF included: elements of the context such as health care professional passion; the existence of whole genome sequencing (WGS) infrastructure; effective communication channels, the creation of new connections across professionals and teams; the integration of SRF-led discussions within pre-existing meetings and the ability of a site to achieve a rapid turnaround time. In contrast, we found factors that constrained the use of the SRF included elements of the context such as the impact of the Alpha-variant overwhelming hospitals. In turn, dealing with COVID-19 breached the limited capacity of infection prevention and control (IPC) to respond to the SRF and ensure its routinisation. CONCLUSION:We show preliminary support for this SRF being an acceptable, useable and potentially scalable way of enhancing existing IPC activities for viral respiratory infections. However, the context of both the trial and the alpha wave of COVID-19 limit confidence in these insights. CLINICAL TRIAL NUMBER:https://www.isrctn.com/ISRCTN50212645, Registration date 20/05/2020.

Introduction UK sexual health services are shifting online. Uptake of online partner notification and management (OPNM) for sexually transmitted infections (STIs) is low. There is a lack of evidence to guide its development and deployment. This study explored the acceptability of, and barriers and facilitators to, OPNM to inform the optimisation of an eSexual Health Clinic (eSHC). Methods We conducted semi-structured qualitative interviews (n=25) with UK sexual health service users recruited from clinics and the community (10/2021–01/2023). Interviews explored experiences of partner notification (PN), barriers to and facilitators of OPNM, and involved a walk-through of an OPNM prototype pathway (Figure 1) using fictional personas/scenarios. We analysed transcripts using thematic analysis. Results Participants were diverse in terms of gender, sexual identity, and disability. Most found OPNM acceptable and described using some online PN methods themselves (e.g., texting). Facilitators included: perception of OPNM as more convenient and less embarrassing than face-to-face/telephone PN; perception of its suitability for use with casual partners; provision of multiple tools for both identifiable and anonymous PN; and facilitation of online partner testing/treatment. Barriers included: perception of OPNM as impersonal and preferences for telling/being told in a more personal way, especially in ongoing relationships; security and privacy concerns; and distrust of online notifications. Discussion OPNM appears acceptable, but acceptability varied depending on relationship type and communication preferences. In developing an eSHC, consideration should be given to incorporating multiple options for communicating with partners that allow users to identify themselves or remain anonymous, and providing messaging that is personalisable to the relationship and context. Pairing PN with accessible online STI testing/information and treatment, where appropriate, may motivate index patients to engage in PN and efficiently link partners into online management. Building trust with users is key and may be facilitated through NHS branding and security/privacy assurances.

Background Sexually transmitted infections disproportionately affect young people and men who have sex with men. Chlamydia is Britain’s most common sexually transmitted infection. Partner notification is a key intervention to reduce transmission of sexually transmitted infections and human immunodeficiency virus but is hard to implement. Accelerated partner therapy is a promising new approach. Objectives determine the effectiveness, costs and acceptability of accelerated partner therapy for chlamydia in heterosexual people model the cost effectiveness of accelerated partner therapy and impact on chlamydia transmission develop and cost partner notification interventions for men who have sex with men. Design Mixed-methods study to develop a new sex partner classification and optimise accelerated partner therapy; cluster crossover randomised controlled trial of accelerated partner therapy, with process and cost-consequence evaluation; dynamic modelling and health economic evaluation; systematic review of economic studies of partner notification for sexually transmitted infections in men who have sex with men; qualitative research to co-design a novel partner notification intervention for men who have sex with men with bacterial sexually transmitted infections. Settings Sexual health clinics and community services in England and Scotland. Participants Women and men, including men who have sex with men and people with mild learning disabilities. Interventions Accelerated partner therapy offered as an additional partner notification method. Main outcome measures Proportion of index patients with positive repeat chlamydia test (primary outcome); proportion of sex partners treated; costs per major outcome averted and quality-adjusted life-year; predicted chlamydia prevalence; experiences of accelerated partner therapy. Data sources Randomised controlled trial: partnership type, resource use, outcomes, qualitative data: economic analysis, modelling and systematic review: resource use and unit costs from the randomised controlled trial, secondary sources. Results The sex partner classification defined five types. Accelerated partner therapy modifications included simplified self-sampling packs and creation of training films. We created a clinical management and partner notification data collection system. In the randomised controlled trial, all 17 enrolled clinics completed both periods; 1536 patients were enrolled in the intervention phase and 1724 were enrolled in the control phase. Six hundred and sixty-six (43%) of 1536 index patients in the intervention phase and 800 (46%) of 1724 in the control phase were tested for Chlamydia trachomatis at 12–24 weeks after contact tracing consultation; 31 (4.7%) in the intervention phase and 53 (6.6%) in the control phase had a positive Chlamydia trachomatis test result [adjusted odds ratio 0.66 (95% confidence interval 0.41 to 1.04); p = 0.071]. The proportion of index patients with ≥ 1 sex partner treated was 88.0% (775/881) in intervention and 84.6% (760/898) in control phase, adjusted odds ratio 1.27 (95% confidence interval 0.96 to 1.68; p = 0.10). Overall, 293/1536 (19.1%) index patients chose accelerated partner therapy for 305 partners, of which partner types were: committed/established, 166/305 (54.4%); new, 85/305 (27.9%); occasional, 45/305 (14.8%); and one-off, 9/305 (3.0%). Two hundred and forty-eight accepted accelerated partner therapy and 241 partners were sent accelerated partner therapy packs, 120/241 (49.8%) returned chlamydia/gonorrhoea samples (78/119, 65.5%, positive for chlamydia, no result in one), but only 60/241 (24.9%) human immunodeficiency virus and syphilis samples (all negative). The primary outcomes of the randomised trial were not statistically significantly different at the 5% level. However, the economic evaluation found that accelerated partner therapy could be less costly compared with routine care, and mathematical modelling of effects and costs extrapolated beyond the trial end points suggested that accelerated partner therapy could be more effective and less costly than routine care in terms of major outcome averted and quality-adjusted life-years’. Healthcare professionals did not always offer accelerated partner therapy but felt that a clinical management and partner notification data collection system enhanced data recording. Key elements of a multilevel intervention supporting men who have sex with men in partner notification included: modifying the cultural and social context of men who have sex with men communities; improving skills and changing services to facilitate partner notification for one-off partners; and working with dating app providers to explore digital partner notification options. The systematic review found no evaluations of partner notification for men who have sex with men. Modelling of gonorrhoea and human immunodeficiency virus co-infection in men who have sex with men was technically challenging. Limitations In the randomised controlled trial, enrolment, follow-up and repeat infections were lower than expected, so statistical power was lower than anticipated. We were unable to determine whether accelerated partner therapy sped up partner treatment. Mathematical modelling of gonorrhoea/human immunodeficiency virus co-infection in men who have sex with men remained at an experimental stage. It was not feasible to include healthcare professionals in the men who have sex with men intervention development due to the COVID-19 pandemic. Conclusions Although the evidence that the intervention reduces repeat infection was not conclusive, the trial results suggest that accelerated partner therapy can be safely offered as a contact tracing option and is also likely to be cost saving, but is best suited to sex partners with emotional connection to the index patient. The Programme’s findings about classification of sexual partner types can be implemented in sexual health care with auditable outcomes. Future work Further research is needed on how to increase uptake of accelerated partner therapy and increase sexually transmitted infections self-sampling by partners; understand how services can use partnership-type information to improve partner notification, especially for those currently underserved; overcome challenges in modelling sexually transmitted infections and human immunodeficiency virus co-infection in men who have sex with men; develop and evaluate an intervention to optimise partner notification among men who have sex with men, focusing on one-off partnerships. Trial registration This trial is registered as ISRCTN15996256. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research Programme (NIHR award ref: RP-PG-0614-20009) and is published in full in Programme Grants for Applied Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.

PurposeTo conduct a process evaluation of a whole genome sequence report form (SRF) used to reduce nosocomial SARS-CoV-2 through changing infection prevention and control (IPC) behaviours. Here using qualitative behavioural analyses we report how the SRF worked.MethodsPrior to a multisite non-randomised trial of its effectiveness, the SRF was coded in relation to its putative behaviour change content (using the theoretical domains framework (TDF), the behaviour change wheel (BCW) and the behaviour change technique taxonomy (BCTTv1)). After the SRF had been used, through the peak of the Alpha variant, we conducted in-depth interviews from diverse professional staff (N=39) from a heterogeneous purposive sub-sample of hospital trial sites (n=5/14). Deductive thematic analysis explored participants’ accounts of using the SRF according to its putative content in addition to inductive exploration of their experiences.ResultsWe found empirical support for the putative theoretical mechanisms of ‘Knowledge’ and ‘Behavioural regulation’, as well as for intervention functions of ‘Education’ and ‘Persuasion’ and ‘Enablement’, and for particular BCTs ‘1.2 Problem solving’, ‘2.6 Biofeedback’, ‘2.7 Feedback on outcomes of behaviour’, and ‘7.1 Prompts and cues’. Most participants found the SRF useful and believed it could shape IPC behaviour.ConclusionsOur process evaluation of the SRF provided granular and general support for the SRF working to change IPC behaviours. Our analysis highlighted useful SRF content. However, we also note that, without complementary work on systematically embedding the SRF within routine practice and wider hospital systems, it may not reach its full potential to reduce nosocomial infection.What is already known on this subject?Health psychology remains under-exploited within infection prevention and control (IPC) interventionsFor genomic insights to be understood by a range of health care professionals and elicit changes in IPC behaviour, ways of translating complex genomic insights into a simple format are needed. These simple translation tools can be described as whole genome sequence report forms (SRFs)Nothing is currently known about the use of SRFs, for SARS-CoV-2 or other infections, to change hospital-based IPC behaviour.Health psychological tools such as the behaviour change wheel (BCW), the theoretical domains framework (TDF), and the behaviour change technique taxonomy (BCTTv1) are widely used to develop behaviour change interventions but are rarely used to evaluate themContemporary guidance on conducting process evaluations highlights the value of explicitly theorising how an intervention is intended to work before systematically examining how it actually worked in practiceWhat does this study add?The paper presents a novel worked example of using tools from health psychology within a qualitative process evaluation of using an SRF during the COVID-19 pandemic in UK hospitalsThis paper is the first to report how people experienced using whole genome sequence report forms (SRFs) in order to change hospital-based IPC behaviourWe provide qualitative evidence detailing empirical support for much of the SRF’s putative content, including casual mechanisms ‘Knowledge’ and ‘Behavioural regulation’, intervention functions such as ‘Education’ and ‘Enablement’, and for particular BCTs: ‘1.2 Problem solving’, ‘2.6 Biofeedback’, ‘2.7 Feedback on outcomes of behaviour’, and ‘7.1 Prompts and cues’

Background: Barriers to rapid return of sequencing results can affect the utility of sequence data for infection prevention and control decisions.Aim: To undertake a mixed-methods analysis to identify challenges that sites faced in achieving a rapid turnaround time (TAT) in the COVID-19 Genomics UK Hospital-Onset COVID-19 Infection (COG-UK HOCI) study.Methods: For the quantitative analysis, timepoints relating to different stages of the sequencing process were extracted from both the COG-UK HOCI study dataset and surveys of study sites. Qualitative data relating to the barriers and facilitators to achieving rapid TATs were included from thematic analysis.Findings: The overall TAT, from sample collection to receipt of sequence report by infection control teams, varied between sites (median 5.1 days, range 3.0-29.0 days). Most variation was seen between reporting of a positive COVID-19 polymerase chain reaction (PCR) result to sequence report generation (median 4.0 days, range 2.3-27.0 days). On deeper analysis, most of this variability was accounted for by differences in the delay between the COVID-19 PCR result and arrival of the sample at the sequencing lab-oratory (median 20.8 h, range 16.0-88.7 h). Qualitative analyses suggest that closer proximity of sequencing laboratories to diagnostic laboratories, increased staff flexibility and regular transport times facilitated a shorter TAT.Conclusion: Integration of pathogen sequencing into diagnostic laboratories may help to improve sequencing TAT to allow sequence data to be of tangible value to infection control practice. Adding a quality control step upstream to increase capacity further down the workflow may also optimize TAT if lower quality samples are removed at an earlier stage. 2022 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

AbstractPurposeSelf‐sampling packs for sexually transmitted infections (STIs) and blood‐borne viruses (BBVs) are widely offered. There are ongoing problems with reach and sample return rates. The packs have arisen without formal intervention development. This paper illustrates initial steps of an intervention optimization process to improve the packs.MethodsEleven focus groups and seven interviews were conducted with convenience samples of patients recruited from sexual health clinics and members of the public (n = 56). To enable intervention optimization, firstly, we conducted an inductive appraisal of the behavioural system of using the pack to understand meaningful constituent behavioural domains. Subsequently, we conducted a thematic analysis of barriers and facilitators to enacting each sequential behavioural domain in preparation for future behaviour change wheel analysis.ResultsOverall, we found that self‐sampling packs were acceptable. Participants understood their overall logic and value as a pragmatic intervention that simultaneously facilitated and reduced barriers to individuals being tested for STIs and BBVs. However, at the level of each behavioural domain (e.g., reading leaflets, returning samples) problems with the pack were identified, as well as a series of potential optimizations, which might widen the reach of self‐sampling and increase the return of viable samples.ConclusionsThis paper provides an example of a pragmatic approach to optimizing an intervention already widely offered globally. The paper demonstrates the added value health psychological approaches offer; conceptualizing interventions in behavioural terms, pinpointing granular behavioural problems amenable for systematic further improvement.

Background: Whole genome sequencing (WGS) for managing healthcare associated infections (HCAIs) has developed considerably through experiences with SARS-CoV-2. We interviewed various healthcare professionals (HCPs) with direct experience of using WGS in hospitals (within the COG-UK Hospital Onset COVID-19 Infection (HOCI) study) to explore its acceptability and future use. Method: An exploratory, cross-sectional, qualitative design employed semi-structured interviews with 39 diverse HCPs between December 2020 and June 2021. Participants were recruited from five sites within the larger clinical study of a novel genome sequencing reporting tool for SARS-CoV-2 (the HOCI study). All had experience, in their diverse roles, of using sequencing data to manage nosocomial SARS-CoV-2 infection. Deductive and inductive thematic analysis identified themes exploring aspects of the acceptability of sequencing. Findings: The analysis highlighted the overall acceptability of rapid WGS for infectious disease using SARS-CoV-2 as a case study. Diverse professionals were largely very positive about its future use and believed that it could become a valuable and routine tool for managing HCAIs. We identified three key themes 1) Proof of concept achieved; 2) Novel insights and implications; and 3)Challenges and demands. Conclusion: Our qualitative analysis, drawn from five diverse hospitals, shows the broad acceptability of rapid sequencing and its potential. Participants believed it could and should become an everyday technology capable of being embedded within typical hospital processes and systems. However, its future integration into existing healthcare systems will not be without challenges (e.g., resource, multi-level change) warranting further mixed methods research.

OBJECTIVES:To develop a classification of sexual partner types for use in partner notification (PN) for STIs. METHODS:A four-step process: (1) an iterative synthesis of five sources of evidence: scoping review of social and health sciences literature on partner types; analysis of relationship types in dating apps; systematic review of PN intervention content; and review of PN guidelines; qualitative interviews with public, patients and health professionals to generate an initial comprehensive classification; (2) multidisciplinary clinical expert consultation to revise the classification; (3) piloting of the revised classification in sexual health clinics during a randomised controlled trial of PN; (4) application of the Theoretical Domains Framework (TDF) to identify index patients' willingness to engage in PN for each partner type. RESULTS:Five main partner types emerged from the evidence synthesis and consultation: 'established partner', 'new partner', 'occasional partner', 'one-off partner' and 'sex worker'. The types differed across several dimensions, including likely perceptions of sexual exclusivity, likelihood of sex reoccurring between index patient and sex partner. Sexual health professionals found the classification easy to operationalise. During the trial, they assigned all 3288 partners described by 2223 index patients to a category. The TDF analysis suggested that the partner types might be associated with different risks of STI reinfection, onward transmission and index patients' engagement with PN. CONCLUSIONS:We developed an evidence-informed, useable classification of five sexual partner types to underpin PN practice and other STI prevention interventions. Analysis of biomedical, psychological and social factors that distinguish different partner types shows how each could warrant a tailored PN approach. This classification could facilitate the use of partner-centred outcomes. Additional studies are needed to determine the utility of the classification to improve measurement of the impact of PN strategies and help focus resources.

qualitative behavioural analyses we

Introduction Online sexual health services could widen access to sexual healthcare. However, some may struggle to use online services for various reasons, such as low socio-economic status and learning difficulties1. To inform development of an inclusive and accessible eSexual Health Clinic (eSHC2), this study aims to detail barriers and facilitators (B&Fs) to using online sexual health services among populations who may struggle. Methods Using the PROGRESS+ framework3 to inform purposive sampling, we recruited diverse participants (N=35) who had struggled to/never used online sexual health services, across NHS Trusts/Health boards and UK community-based organisations. Interviews investigated B&Fs to accessing sexual health information and advice online, ordering and returning STI self-sampling kits, getting STI results online, completing an online treatment consultation and accessing treatment. We extracted and tabularised B&Fs to each element of the care pathway. Results Barriers included lack of familiarity with online services; perceived impersonal nature of online sexual healthcare; concerns about ability to self-sample correctly and about misunderstanding questions/information leading to incorrect treatment. Facilitators included perceived anonymity and protection from judgement; convenience; many sexual healthcare needs being met discretely in one place; and perception that online NHS services could be trusted. Discussion Among disadvantaged populations, the eSHC could overcome some barriers to using sexual healthcare, such as embarrassment. However, it introduces novel barriers, including important concerns about misunderstanding information or questions leading to incorrect care and online services feeling too impersonal. Further analysis will develop theory-and-evidence-based recommendations to overcome modifiable barriers and optimise online sexual healthcare for inclusivity. References Robinson L, Schulz J, Blank G, Ragnedda M, Ono H, Hogan B, Mesch G, Cotten SR, Kretchmer SB, Hale TM, Yan P. Digital inequalities 2.0: Legacy inequalities in the information age. First Monday, University of Illinois at Chicago Library, 2020; 25(7): 10.5210/fm.v25i7.10842. halshs-02889893 Estcourt CS, Gibbs J, Sutcliffe LJ, Gkatzidou V, Tickle L, Hone K, Aicken C, Harding-Esch EM, Eaton S, Oakeshott P, Szczepura A. The eSexual Health clinic system for sexually transmitted infection management, prevention and control: exploratory studies demonstrating safety, feasibility and public health utility. The Lancet Public Health. 2017 Mar 18; 2(4): e182-e190. https://doi.org/10.1016/S2468-2667(17)30034-8 O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, Evans T, Pardo Pardo J, Waters E, White H, Tugwell P. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. Journal of Clinical Epidemiology. 2014; 67(1): 56-64. http://doi.org/10.1016/j.jclinepi.2013.08.005

Introduction In an increasingly digitalised world where people seek and first contact sex partners online, digital interventions offer the potential to enhance PN for STIs and HIV. However, the ways in which they could improve PN outcomes are unknown. Methods We conducted a systematic review of digital PN interventions for STIs/HIV in 8 databases to understand barriers and facilitators to such interventions. We used narrative synthesis to summarise the literature. We extracted barriers and facilitators for the behavioural foci: general notification (including but not differentiating between traditional and digital methods); digital notification (e.g., email, SMS, phone application); and partner management (sex partner testing/treatment). We then conducted a frequency analysis. Results Eight studies fulfilled the inclusion criteria. They were heterogeneous in participants, digital interventions, and STIs/HIV considered. Unique to digital notification, barriers included problems with accessing technology. Facilitators included effective app functionality and apps enabling PN when contact details are unknown. These occurred alongside barriers and facilitators to notification in general, such as concerns about negative partner reactions and fear of shame (barriers) and social appropriateness of notification modality (e.g., email appropriate if face-to-face is not available) (facilitator). Discussion Digital PN interventions are heterogenous and the differences are not clearly distinguished. Most interventions focus on notifying partners. Partner testing and treatment remains underexplored. There is a dearth of evidence on the barriers and facilitators to digital PN and further research is required. However, current evidence suggests that digital interventions can reduce some barriers to notification, but major barriers to PN in general endure. References Balán, I. C., Rios, J. L., Lentz, C., Arumugam, S., Dolezal, C., Kutner, B., Rael, C. T., Ying, A. W., Macar, O. U., & Sia, S. K. (2022). Acceptability and Use of a Dual HIV/Syphilis Rapid Test and Accompanying Smartphone App to Facilitate Self- and Partner-Testing Among Cisgender Men and Transgender Women Who Have Sex with Men. AIDS and Behavior, 26(1), 35–46. https://doi.org/10.1007/s10461-021-03322-9 Bilardi, J. E., Fairley, C. K., Hopkins, C. A., Hocking, J. S., Temple-Smith, M. J., Bowden, F. J., Russell, D. B., Pitts, M., Tomnay, J. E., Parker, R. M., Pavlin, N. L., & Chen, M. Y. (2010). Experiences and outcomes of partner notification among men and women recently diagnosed with chlamydia and their views on innovative resources aimed at improving notification rates. Sexually Transmitted Diseases, 37(4), 253–258. https://doi.org/10.1097/OLQ.0b013e3181d012e0 Carnicer-Pont, D., Barbera-Gracia, M. J., Fernández-Dávila, P., García de Olalla, P., Muñoz, R., Jacques-Aviñó, C., Saladié-Martí, M. P., Gosch-Elcoso, M., Arellano Muñoz, E., & Casabona, J. (2015). Use of new technologies to notify possible contagion of sexually-transmitted infections among men. Gaceta Sanitaria, 29(3), 190–197. https://doi.org/10.1016/j.gaceta.2015.01.003 Contesse, M. G., Fredericksen, R. J., Wohlfeiler, D., Hecht, J., Kachur, R., Strona, F. V., & Katz, D. A. (2019). Attitudes about the use of geosocial networking applications for HIV/STD partner notification: A qualitative study. AIDS Education and Prevention, 31(3), 273–285. https://doi.org/10.1521/aeap.2019.31.3.273 Hopkins, C. A., Temple-Smith, M. J., Fairley, C. K., Pavlin, N. L., Tomnay, J. E., Parker, R. M., Bowden, F. J., Russell, D. B., Hocking, J. S., & Chen, M. Y. (2010). Telling partners about chlamydia: How acceptable are the new technologies? BMC Infectious Diseases, 10(58). http://www.biomedcentral.com/1471-2334/10/58%5Cnhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed9&NEWS=N&AN=2010205630 Kutner, B. A., Pho, A. T., López-Rios, J., Lentz, C., Dolezal, C., & Balán, I. C. (2021). Attitudes and perceptions about disclosing HIV and syphilis results using Smarttest, a smartphone app dedicated to self-and partner testing. AIDS Education and Prevention, 33(3), 234–248. https://doi.org/10.1521/aeap.2021.33.3.234 Lessard, D., Aslan, A., Zeggagh, J., Morel, S., Michels, D., & Lebouché, B. (2019). Acceptability of a digital patient notification and linkage-to-care tool for French PrEPers (WeFLASH©): Key stakeholders’ perspectives. International Journal of STD and AIDS, 30(14), 1397–1407. https://doi.org/10.1177/0956462419878043 Wang, A. L., Peng, R. R., Tucker, J. D., Chakraborty, H., Cohen, M. S., & Chen, X. S. (2016). Optimizing partner notification programs for men who have sex with men: Factorial survey results from South China. PLoS ONE, 11(7), 1–14. https://doi.org/10.1371/journal.pone.0157749

Background Accelerated partner therapy has shown promise in improving contact tracing. We aimed to evaluate the effectiveness of accelerated partner therapy in addition to usual contact tracing compared with usual practice alone in heterosexual people with chlamydia, using a biological primary outcome measure. Methods We did a crossover cluster-randomised controlled trial in 17 sexual health clinics (clusters) across England and Scotland. Participants were heterosexual people aged 16 years or older with a positive Chlamydia trachomatis test result, or a clinical diagnosis of conditions for which presumptive chlamydia treatment and contact tracing are initially provided, and their sexual partners. We allocated phase order for clinics through random permutation within strata. In the control phase, participants received usual care (health-care professional advised the index patient to tell their sexual partner[s] to attend clinic for sexually transmitted infection screening and treatment). In the intervention phase, participants received usual care plus an offer of accelerated partner therapy (health-care professional assessed sexual partner's] by telephone, then sent or gave the index patient antibiotics and sexually transmitted infection selfsampling kits for their sexual partner[s]). Each phase lasted 6 months, with a 2-week washout at crossover. The primary outcome was the proportion of index patients with a positive C trachomatis test result at 12-24 weeks after contact tracing consultation. Secondary outcomes included proportions and types of sexual partners treated. Analysis was done by intention-to-treat, fitting random effects logistic regression models. This trial is registered with the ISRCTN registry, 15996256. Findings Between Oct 24,2018, and Nov 17,2019,1536 patients were enrolled in the intervention phase and 1724 were enrolled in the control phase. All clinics completed both phases. In total, 4807 sexual partners were reported, of whom 1636 (34%) were steady established partners. Overall, 293 (19%) of 1536 index patients chose accelerated partner therapy for a total of 305 partners, of whom 248 (81%) accepted. 666 (43%) of 1536 index patients in the intervention phase and 800 (46%) of 1724 in the control phase were tested for C trachomatis at 12-24 weeks after contact tracing consultation; 31 (4.7%) in the intervention phase and 53 (6.6%) in the control phase had a positive C trachomatis test result (adjusted odds ratio [OR] 0.66 [95% CI 0.41 to 1.04]; p=0.071; marginal absolute difference -2.2% [95% CI -4.7 to 0-3]). Among index patients with treatment status recorded, 775 (88.0%) of 881 patients in the intervention phase and 760 (84.6%) of 898 in the control phase had at least one treated sexual partner at 2-4 weeks after contact tracing consultation (adjusted OR 1.27 [95% CI 0.96 to 1.68]; p=0.10; marginal absolute difference 2.7% [95% CI -0.5 to 6.0]). No clinically significant harms were reported. Interpretation Although the evidence that the intervention reduces repeat infection was not conclusive, the trial results suggest that accelerated partner therapy can be safely offered as a contact tracing option and is also likely to be cost saving. Future research should find ways to increase uptake of accelerated partner therapy and develop alternative interventions for one-off sexual partners. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Background Whole genome sequencing (WGS) for managing healthcare associated infections (HCAIs) has developed considerably through experiences with SARS-CoV-2. We interviewed various healthcare professionals (HCPs) with direct experience of using WGS in hospitals (within the COG-UK Hospital Onset COVID-19 Infection (HOCI) study) to explore its acceptability and future use. Method An exploratory, cross-sectional, qualitative design employed semi-structured interviews with 39 diverse HCPs between December 2020 and June 2021. Participants were recruited from five sites within the larger clinical study of a novel genome sequencing reporting tool for SARS-CoV-2 (the HOCI study). All had experience, in their diverse roles, of using sequencing data to manage nosocomial SARS-CoV-2 infection. Deductive and inductive thematic analysis identified themes exploring aspects of the acceptability of sequencing. Findings The analysis highlighted the overall acceptability of rapid WGS for infectious disease using SARS-CoV-2 as a case study. Diverse professionals were largely very positive about its future use and believed that it could become a valuable and routine tool for managing HCAIs. We identified three key themes ‘1) ‘Proof of concept achieved’; 2) ‘Novel insights and implications’; and 3) ‘Challenges and demands’. Conclusion Our qualitative analysis, drawn from five diverse hospitals, shows the broad acceptability of rapid sequencing and its potential. Participants believed it could and should become an everyday technology capable of being embedded within typical hospital processes and systems. However, its future integration into existing healthcare systems will not be without challenges (e.g., resource, multi-level change) warranting further mixed methods research. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) [grant code: MC\_PC\_19027], and Genome Research Limited, operating as the Wellcome Sanger Institute. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was given by Cambridge South Research Ethics Committee (20/EE/0118). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data is not available given it is qualitative and anonymity of participants must be protected

Purpose: This paper describes the process of optimising a widely offered intervention - the self-sampling pack for sexually transmitted infections (STIs) and blood born viruses (BBVs). We drew upon the BCW approach, incorporating the theoretical domains framework (TDF) and the behaviour change technique taxonomy (BCTT) to systematically specify potential intervention components that may optimise the packs. Methods: A behaviour change wheel analysis built upon prior thematic analyses of qualitative data collected through focus groups and interviews with members of the public and people recruited from sexual health clinics in Glasgow and London (n=56). Salient barriers and facilitators to specific sequential behavioural domains associated with wider behavioural system of pack-use were subjected to further analyses, coding them in relation to the TDF, the BCWs intervention functions, and finally specifying potential optimisation in relation to behaviour change techniques (BCTs). Results: Our TDF analysis suggested that across the overall behavioural system of pack use the most important theoretical domains were beliefs about consequences and memory, attention and decision-making. BCW analysis on the overall pack suggested useful intervention functions should focus on environmental restructuring, persuasion, enablement, education and modelling. Ways of optimising the intervention were also specified in relation to potentially useful behaviour change techniques (BCTs). Conclusions: A detailed behavioural analysis building on earlier qualitative work using the TDF and the BCW provided a systematic approach to optimising an existing intervention. The approach enabled the specification of highly specific, evidence-based, and theoretically informed recommendations for intervention optimisation.

Introduction Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. Methods We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data-collection period, followed by intervention periods comprising 8 weeks of ‘rapid’ (<48h) and 4 weeks of ‘longer-turnaround’ (5-10 day) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital onset COVID-19 infections (HOCIs; detected ≥48h from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on incidence of probable/definite hospital-acquired infections (HAIs) was evaluated. Results A total of 2170 HOCI cases were recorded from October 2020-April 2021, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (IRR 1.60, 95%CI 0.85-3.01; P= 0.14) or rapid (0.85, 0.48-1.50; P= 0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8% and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2% and 11.6% of cases where the report was returned. In a per-protocol sensitivity analysis there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Conclusion While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days.

Objectives Nosocomial transmission of SARS-CoV-2 has been a significant cause of mortality in National Health Service (NHS) hospitals during the COVID-19 pandemic. The COG-UK Consortium Hospital-Onset COVID-19 Infections (COG-UK HOCI) study aims to evaluate whether the use of rapid whole-genome sequencing of SARS-CoV-2, supported by a novel probabilistic reporting methodology, can inform infection prevention and control (IPC) practice within NHS hospital settings. Design Multicentre, prospective, interventional, superiority study. Setting 14 participating NHS hospitals over winter–spring 2020/2021 in the UK. Participants Eligible patients must be admitted to hospital with first-confirmed SARS-CoV-2 PCR-positive test result >48 hour from time of admission, where COVID-19 diagnosis not suspected on admission. The projected sample size is 2380 patients. Intervention The intervention is the return of a sequence report, within 48 hours in one phase (rapid local lab processing) and within 5–10 days in a second phase (mimicking central lab), comparing the viral genome from an eligible study participant with others within and outside the hospital site. Primary and secondary outcome measures The primary outcomes are incidence of Public Health England (PHE)/IPC-defined SARS-CoV-2 hospital-acquired infection during the baseline and two interventional phases, and proportion of hospital-onset cases with genomic evidence of transmission linkage following implementation of the intervention where such linkage was not suspected by initial IPC investigation. Secondary outcomes include incidence of hospital outbreaks, with and without sequencing data; actual and desirable changes to IPC actions; periods of healthcare worker (HCW) absence. Health economic analysis will be conducted to determine cost benefit of the intervention. A process evaluation using qualitative interviews with HCWs will be conducted alongside the study. Trial registration number ISRCTN50212645 . Pre-results stage. This manuscript is based on protocol V.6.0. 2 September 2021.

Background: Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. Methods: We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data collection period, followed by intervention periods comprising 8 weeks of ‘rapid’ (<48 hr) and 4 weeks of ‘longer-turnaround’ (5–10 days) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital-onset COVID-19 infections (HOCIs; detected ≥48 hr from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on the incidence of probable/definite hospital-acquired infections (HAIs), was evaluated. Results: A total of 2170 HOCI cases were recorded from October 2020 to April 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (incidence rate ratio 1.60, 95% CI 0.85–3.01; p = 0.14) or rapid (0.85, 0.48–1.50; p = 0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8 and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2 and 11.6% of cases where the report was returned. In a ‘per-protocol’ sensitivity analysis, there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources. Conclusions: While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days. Funding: COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) (grant code: MC_PC_19027), and Genome Research Limited, operating as the Wellcome Sanger Institute. Clinical trial number: NCT04405934 .