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

T. Charles Witzel, Peter Weatherburn, Adam Bourne, Alison J. Rodger, Chris Bonell, Mitzy Gafos, Roy Trevelion, Andrew Speakman, Fiona Lampe, Denise Ward, David T. Dunn, Michelle M. Gabriel, Leanne McCabe, Justin Harbottle, Yolanda Collaco Moraes, Susan Michie, Andrew N. Phillips, Sheena McCormack and Fiona M. Burns
Additional contact information
T. Charles Witzel: Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
Peter Weatherburn: Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
Adam Bourne: Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne 3086, Australia
Alison J. Rodger: Institute for Global Health, University College London, London NW3 2PF, UK
Chris Bonell: Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
Mitzy Gafos: Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1h 9SH, UK
Roy Trevelion: HIV i-Base, London SE1 3LJ, UK
Andrew Speakman: Institute for Global Health, University College London, London NW3 2PF, UK
Fiona Lampe: Institute for Global Health, University College London, London NW3 2PF, UK
Denise Ward: Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
David T. Dunn: Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
Michelle M. Gabriel: Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
Leanne McCabe: Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
Justin Harbottle: SH:24, London SE1 7JB, UK
Yolanda Collaco Moraes: Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
Susan Michie: Centre for Behaviour Change, University College London, London WC1N 3AZ, UK
Andrew N. Phillips: Institute for Global Health, University College London, London NW3 2PF, UK
Sheena McCormack: Medical Research Council Clinical Trials Unit, University College London, London, WC1V 6LJ, UK
Fiona M. Burns: Institute for Global Health, University College London, London NW3 2PF, UK

IJERPH, 2020, vol. 17, issue 2, 1-17

Abstract: 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.

Keywords: HIV testing; self-testing; men who have sex with men; COM-B; evaluation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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