Research Question:
- What are the most effective interventions for reducing inequalities in the prevention and diagnosis of sexually transmitted infections?
The NICE guideline ‘Reducing sexually transmitted infections’ [NG221] was published in June 2022, and covers interventions to reduce the risk of sexually transmitted infections (STIs) in people aged 16 years and over. The guideline aims to reduce the transmission of all STIs including HIV, and includes ways to help increase the uptake of STI testing, access to treatment services, and uptake of vaccinations relevant to STI prevention.
STIs have a direct impact on health and wellbeing. Undiagnosed and untreated, STIs can cause complications and long-term health problems, such as infertility, cancers, and adverse pregnancy outcomes. Increasing drug resistance further highlights the importance of effective sexual health interventions. Prevention is central to achieving good sexual health outcomes, and includes education, condom use, and vaccination – including against human papillomavirus (HPV) and hepatitis A and B. Early diagnosis offers the best opportunity for effective treatment, and consequently for preventing complications and further transmission; screening and routine testing are also available for specific STIs and circumstances.
Within the UK population, sexual health and access needs may vary by age, ethnicity, gender, sexuality, socioeconomic status, and other factors – with interconnecting identities and experiences within groups further influencing needs. A key issue is the necessity to tailor interventions and services to meet the needs of specific groups, communities, and cultures – but this is impeded by a lack of UK-based evidence. Changes in sexual health services that were accelerated during the COVID-19 pandemic may also alter uptake, such as a rapid shift in service delivery toward online, remote, and outreach provision.
During development of the guideline [NG221], NICE found limited evidence of how to tailor outreach services to best meet the needs of specific groups to improve their access to sexual health services and their uptake of STI testing. NICE noted the risk of widening health inequalities through variable access to remote testing, for example due to the ‘digital divide’. There is limited evidence for improving the uptake of testing in people from very high-risk groups, such as sex workers and men who engage in group sex under the influence of stimulant drugs (also referred to as chemsex). Further research is also needed to understand and identify methods for reducing the stigma associated with accessing sexual health services. These represent important evidence gaps that need to be addressed if health inequalities are to be reduced.
The Public Health Research (PHR) Programme wishes to commission research to address the identified evidence gaps. Suggested research areas of interest could include (but are not limited to):
- The tailoring of outreach interventions to meet the needs of specific groups, including rigorous assessment and evaluation of existing approaches.
- Reducing the stigma associated with accessing sexual health services.
- Addressing the impact of remote self-sampling on health inequalities.
- Improving the uptake of testing in very high-risk groups.
- Reducing inequalities in access to, and use of, sexual health services and preventive schemes (including the impact of geographic location on access).
- Assessing the role of incentives in increasing STI testing and diagnosis, including potential adverse and unintended consequences.
- Delivering tailored sexual health interventions within (or linked to) other services – such as drug, alcohol, or mental health services – with local organisations working in partnership to provide holistic, community-led care.
The PHR Programme acknowledges that there is a lack of data on the sexual health needs of inclusion health groups, particularly asylum seekers and refugees. Because of this, the programme is willing to consider epidemiological research or expanded development of an intervention. Please contact the programme to discuss before applying. Research may address any inclusion health group, but applicants’ reasoning must be clear, with choices reflected in the intervention and study design.
In keeping with the NICE research recommendations, researchers must ensure that interventions are culturally competent and are planned, designed and implemented with the people who will be using them (co-produced). Interventions should be sex- and identity-positive and should consider the intersections of identities and experiences. Researchers are encouraged to consult available guidance on supporting inclusion health groups’ involvement in research and for accessing care.
A range of study designs and outcome measures can be used. Researchers will need to clearly describe and justify their choice of target population group, as well as their chosen methodological approach. Primary outcomes must be health related. Researchers will also need to specify key outcomes and how these will be measured in the short, medium, and long term.
Understanding the value of public health interventions – whether the outcomes justify their use of resources – is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include an economic component should provide appropriate justification.
Researchers must ensure that service users or people with lived experience from the target audience, and decision-makers, are involved in the design and planning of the intervention and/or as potential costed members of the research team. Researchers should demonstrate the relevance of their proposed research and are encouraged to explain how they will share their findings with policy makers, public health officers, special interest groups, charities, community audiences, and other relevant stakeholders. Researchers are expected to be aware of other studies in this area and ensure their proposed research is complementary.
For further information on submitting an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information. These can be found by clicking on the relevant commissioned call on the main funding opportunities page. This also includes closing dates and details about how to apply.