How can we increase notification of exposure to STIs between gay and bisexual men?: intervention development using stakeholder engagement, qualitative methods and behavioural science

Rationale: The first key step in contact tracing for sexually transmitted infections (STIs) is to notify recent exposed sex partners. Gay and bisexual men and other men who have sex with men (GBMSM) bear a high burden of STIs and one-off partners contribute disproportionately to community transmission, posing a particular challenge to contact tracing. Here we explore and theorise the barriers and facilitators of GBMSM telling their one-off sexual partners about their exposure to STIs. Design: Using focus groups with diverse GBMSM from Leeds, Glasgow, London and on-line (n=28) we used a multi-level approach to intervention development to enhance contact tracing. This framework included initial stakeholder engagement; deductive thematic analysis to identify key barriers and facilitators to contact tracing with one-off partners; the use of the theoretical domains framework (TDF) to theorise these barriers and facilitators and subsequently the use of the behaviour change wheel (BCW), incorporating the behaviour change technique taxonomy (BCTT), to suggest intervention content to enhance the key step of notifying partners; and final stakeholder input to ensure this content was fit for purpose and satisfied the APEASE criteria. Results: In relation to the TDF, the barriers and facilitators primarily related to beliefs about consequences. Having used the BCW and further stakeholder engagement, our final intervention recommendations related to focussed efforts to change the culture and corresponding norms and social practice of notifying sex partners about the risk of infection in GBMSM communities. This could usefully be achieved through dedicated community engagement and partnership work, through focussed mass and social media interventions twinned with focussed peer-led work to normalise and destigmatise contact tracing. Conclusion: Through systematically working with key stakeholders, GBMSM communities and using a range of tools from the behavioural sciences, we have developed a suite of evidence-based and theoretically informed intervention content which, if developed further, could enhance GBMSMs willingness to notify sex partners about their risk of infection.