{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T08:02:48Z","timestamp":1784448168588,"version":"3.55.0"},"reference-count":30,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T00:00:00Z","timestamp":1619654400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Self-testing for STIs such as HIV and syphilis may empower sexual minorities and expand uptake of STI testing. While much is known about HIV self-testing (HIVST), less is known about syphilis self-testing, particularly in low-income settings. The objective of this study is to determine context-specific facilitators and barriers for self-testing and to assess the usability of syphilis self-testing in Zimbabwe among men who have sex with men (MSM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This mixed methods study was conducted in Harare as part of a larger syphilis self-testing trial. The study included in-depth interviews (phase I) followed by usability testing and a second interview (phase II). In-depth interviews were conducted with MSM and key informants prior to syphilis self-testing. The same MSM then used the syphilis self-test, quantitatively assessed its usability and participated in a second in-depth interview. Phase I data were analysed using a thematic approach, guided by an adapted social ecological model conceptual framework. Phase II interviews were analysed using rapid assessment procedure methodology, and usability was assessed using a pre-established index, adapted from existing HIVST scales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty MSM and 10 key informants were recruited for phase I in-depth interviews, and 16 of these MSM participated in phase II by completing a syphilis self-test kit. Facilitating factors for self-testing included the potential for increased privacy, convenience, autonomy, and avoidance of social and healthcare provider stigma. Barriers included the fear to test and uncertainty about linkage to care and treatment. Data from the Usability Index suggested high usability (89.6% on a 0\u2013100 scale) among the men who received the self-test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MSM in Zimbabwe were willing to use syphilis self-test kits and many of the barriers and facilitators were similar to those observed for HIVST. Syphilis self-testing may increase syphilis test uptake among sexual minorities in Zimbabwe and other low-income and middle-income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2020-054911","type":"journal-article","created":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T13:22:40Z","timestamp":1619702560000},"page":"197-202","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Syphilis self-testing to expand test uptake among men who have sex with men: a theoretically informed mixed methods study in Zimbabwe"],"prefix":"10.1136","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9273-695X","authenticated-orcid":false,"given":"Clarisse","family":"Sri-Pathmanathan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Definate","family":"Nhamo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takudzwa","family":"Mamvuto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwendoline","family":"Chapwanya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fern","family":"Terris-Prestholt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imelda","family":"Mahaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7585-4743","authenticated-orcid":false,"given":"Michael","family":"Marks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2804-1181","authenticated-orcid":false,"given":"Joseph D","family":"Tucker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,4,29]]},"reference":[{"key":"2022100410401136000_98.3.197.1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.18.228486"},{"key":"2022100410401136000_98.3.197.2","unstructured":"World Health Organization . Global health sector strategy on sexually transmitted infections 2016\u20132021, 2016. http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/246296\/WHO-RHR-16.09-eng.pdf?sequence=1"},{"key":"2022100410401136000_98.3.197.3","unstructured":"WHO . Report on global sexually transmitted infection surveillance. World Health Organization, 2018: 6\u20137. http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/277258\/9789241565691-eng.pdf?ua=1"},{"key":"2022100410401136000_98.3.197.4","unstructured":"ICAP at Columbia University . Hiv and STI Biobehavioral survey among men who have sex with men, transgender women and genderqueer individuals in Zimbabwe - final report, 2020. https:\/\/icap.columbia.edu\/wp-content\/uploads\/Zimbabwe-IBBS-Report_Final_17Aug20.pdf"},{"key":"2022100410401136000_98.3.197.5","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000423"},{"key":"2022100410401136000_98.3.197.6","unstructured":"World Health Organization . Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. WHO Guidel [Internet], 2014. Available: http:\/\/apps.who.int\/iris\/bitstream\/10665\/128048\/1\/9789241507431_eng.pdf?ua=1"},{"key":"2022100410401136000_98.3.197.7","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1071\/SH18191","article-title":"Providing competent, comprehensive and inclusive sexual health services for men who have sex with men in low- and middle-income countries: a scoping review","volume":"16","author":"Bien-Gund","year":"2019","journal-title":"Sex Health"},{"key":"2022100410401136000_98.3.197.8","doi-asserted-by":"crossref","first-page":"155798831882388","DOI":"10.1177\/1557988318823883","article-title":"Multilayered stigma and vulnerabilities for HIV infection and transmission: a qualitative study on male sex workers in Zimbabwe","volume":"13","author":"Tsang","year":"2019","journal-title":"Am J Mens Health"},{"key":"2022100410401136000_98.3.197.9","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/COH.0000000000000568","article-title":"Strategies to improve access for MSM in low-income and middle-income countries","volume":"14","author":"Rebe","year":"2019","journal-title":"Curr Opin HIV AIDS"},{"key":"2022100410401136000_98.3.197.10","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1080\/14787210.2018.1463846","article-title":"Expanding syphilis testing: a scoping review of syphilis testing interventions among key populations","volume":"16","author":"Ong","year":"2018","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2022100410401136000_98.3.197.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016609"},{"key":"2022100410401136000_98.3.197.12","doi-asserted-by":"crossref","first-page":"2178","DOI":"10.1093\/cid\/ciz603","article-title":"Syphilis self-testing: a nationwide pragmatic study among men who have sex with men in China","volume":"70","author":"Wang","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2022100410401136000_98.3.197.13","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/QAD.0000000000001705","article-title":"Experiences using and organizing HIV self-testing","volume":"32","author":"Qin","year":"2018","journal-title":"AIDS"},{"key":"2022100410401136000_98.3.197.14","unstructured":"Ministry of Child and Healthcare . 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