021 PP: Dual theoretical synergy framework: Developing and refining a method for stakeholder engagement in intervention development

Stakeholder engagement and patient and public involvement (PPI) is now a key expectation within healthcare policy and in securing research funding and often needs to be evident throughout the research process. While systematic reviews and meta-analyses synthesise the best evidence for the content of behaviour change interventions, engaging stakeholders in a collaborative process of co-production could identify the best ways of implementing interventions. We developed the Dual Theoretical Synergy (DTS) Framework to work with stakeholders via expert events to identify the major systemic and psychosocial barriers and facilitators to implementing interventions in practice. The method uses facilitated group exercises to assess the acceptability of the design, content and proposed delivery mechanisms of an intervention to examine systemic, psychosocial and/or contextual barriers and facilitators to implementation, using the Theoretical Domains Framework and Normalisation Process Theory. Qualitative content analysis is used to record the key recurrent issues and to map similarities and differences in responses by domain to create a matrix of key barriers and facilitators to implementation of the candidate intervention. The matrix and a narrative summary are sent to participants for review and comment and to seek consensus on the interpretation of the data. The benefit of the method is in empowering stakeholders to think through and detail key ways of enhancing implementation of the candidate intervention, using standard theoretical constructs, and to engage in collaborative co-production of an intervention that is more likely to be adopted in the ‘real world’

Sexually transmitted infection testing and self-reported diagnoses among a community sample of men who have sex with men, in Scotland

Introduction To examine sexually transmitted infection (STI) testing and self-reported diagnoses among men who have sex with men (MSM), in Scotland. Methods Cross-sectional survey of seven Glasgow gay bars in July 2010 (n=822, 62% response rate); 693 are included in the analyses. Results 81.8% reported ever having had an STI test; 37.4% had tested in the previous 6 months; 13.2% reported having an STI in the previous 12 months. The adjusted odds of having ever tested were significantly higher for men who had 6+ sexual partners in the previous 12 months (adjusted OR=2.66), a maximum sexual health knowledge score (2.23), and had talked to an outreach worker/participated in counselling (1.96), and lower for men reporting any high-risk unprotected anal intercourse (UAI) in the previous 12 months (0.51). Adjusted odds of recent testing were higher for men who had 6+ sexual partners (2.10), talked to an outreach worker/participated in counselling (1.66), maximum sexual health knowledge (1.59), and higher condom use knowledge (1.04), and lower for men aged ≥25 years (0.46). Adjusted odds of having had an STI in the previous 12 months were higher for men who had 6+ sexual partners (3.96) and any high-risk UAI in the previous 12 months (2.24) and lower for men aged ≥25 years (0.57). Conclusions STI testing rates were relatively high, yet still below the minimum recommended for MSM at high risk. Consideration should be given to initiating recall systems for men who test positive for STIs, and to developing behavioural interventions which seek to address STI transmission

Double-standards in reporting of risk and responsibility for sexual health: a qualitative content analysis of negatively toned UK newsprint articles

Background: The need to challenge messages that reinforce harmful negative discourses around sexual risk and responsibility is a priority in improving sexual health. The mass media are an important source of information regularly alerting, updating and influencing public opinions and the way in which sexual health issues are framed may play a crucial role in shaping expectations of who is responsible for sexual health risks and healthy sexual practices. Methods: We conducted an in-depth, qualitative analysis of 85 negatively toned newspaper articles reporting on sexual health topics to examine how risk and responsibility have been framed within these in relation to gender. Articles published in 2010 in seven UK and three Scottish national newspapers were included. A latent content analysis approach was taken, focusing on interpreting the underlying meaning of text. Results: A key theme in the articles was men being framed as a risk to women's sexual health, whilst it was part of a women's role to "resist" men's advances. Such discourses tended to portray a power imbalance in sexual relationships between women and men. A number of articles argued that it was women who needed to take more responsibility for sexual health. Articles repeatedly suggested that women and teenage girls in particular, lacked the skills and confidence to negotiate safer sex and sex education programmes were often presented as having failed. Men were frequently portrayed as being more promiscuous and engaging in more risky sexual health behaviours than women, yet just one article drew attention to the lack of focus on male responsibility for sexual health. Gay men were used as a bench mark against which rates were measured and framed as being a risk and at risk Conclusions: The framing of men as a risk to women, whilst women are presented at the same time as responsible for patrolling sexual encounters, organising contraception and preventing sexual ill health reinforces gender stereotypes and undermines efforts to promote a collective responsibility for sexual health. This has implications for sexual ill health prevention and could continue to reinforce a negative culture around sex, relationships and sexual health in the UK

Has testing been normalized? An analysis of changes in barriers to HIV testing among men who have sex with men between 2000 and 2010 in Scotland, UK

Objectives: This paper examines changes in barriers to HIV testing amongst gay men. We compared data collected in 2000 and 2010 to assess changes in HIV testing behaviours, in community-level perceptions of barriers to HIV testing, and in the relative contributions of barrier measures. Methods: Cross-sectional surveys were conducted within the commercial gay scene in Glasgow with good response rates (78% and 62%) using a form of time and location sampling. Results: Major changes in HIV testing behaviours were observed between 2000 and 2010 (30.6% increase in testing within previous year). At the community level, the perceived benefits of testing [t (1284) = –8.46; P <0.001] and the norm for HIV testing [t (1236) = –11.62; P < 0.001] increased; however, other perceived barriers did not change (fear of a positive result, clinic-related barriers and attitudes to sex with HIV-positive men). Multinomial logistic regression showed that fear of a positive test result remained a key barrier to HIV testing; however, a significant fear × year of survey interaction indicated that fear played a lesser role in differentiating those who had never been tested from those who had been tested in 2010 than it had in 2000. Conclusions: These findings suggest the partial normalization of HIV testing. While some barriers have reduced, other key barriers remain important. Interventions should be designed and evaluated that attend to both the biomedical and the psychosocial aspects of HIV testing (e.g. the meaning of positive test results, the sexual exclusion of positive men, and HIV-related stigma)

Key factors in the acceptability of treatment as prevention (TasP) in Scotland : a qualitative study with communities affected by HIV

Objectives There is a clear need to understand the factors that might prevent and/or facilitate the effective use of HIV treatment as prevention (TasP) at an individual level. This paper reports on findings from the first qualitative study in the UK exploring the acceptability of TasP among gay, bisexual and/or men who have sex with men (MSM) and migrant African communities in Scotland. Methods We conducted seven exploratory focus group discussions (FGDs) with convenience samples of MSM (five FGDs, n=22) and mixed-gender African (two FGDs, n=11) participants. Of these, three FGDs were conducted with HIV-positive MSM (n=14) and one FGD with HIV-positive Africans (n=8). We then conducted 34 in-depth interviews (IDIs) with a purposive sample of MSM (n=20) and Africans (n=14, women=10). Half were HIV-positive (MSM, n=10; African, n=7). FGD and IDI data were analysed thematically drawing on predetermined and emergent themes. Results We found that inequalities in HIV literacy could be a barrier to TasP, as could social constraints, such as criminalisation of transmission, increased risk of sexually transmitted infection and increased burden of treatment. We also identified psychological barriers such as perceptions of risk. However, relationships and shared decision making were identified as potential facilitators for TasP. Conclusions Our results suggest that potential use and management of TasP may not be straightforward. It could be contingent on reducing inequalities in HIV literacy, minimising the perceived burden of treatment and other potential risks, and addressing the dynamics of existing and socially acceptable risk management strategies, especially in relation to long-term serodiscordant relationships

Food Numeracy: Definition and Application Across the Australian Secondary School Curriculum

Introduction: The poor dietary intake among adolescents and the consequential health, economic and environmental concerns associated with poor intakes have been established in the literature. This calls for strengthening of school-based food and nutrition education interventions as recommended in the Australian National Action Plan for the Health of Children and Young People (2020-2030). One researched intervention, by the authors, is the integration of food literacy and food numeracy (FL&FN) across Australian secondary school curriculum. Aim: Food numeracy is a newly introduced term by the authors; this paper provides its substantiated definition, key elements, and an example pedagogy as an approach for integration and application across the curriculum. Methods: Methodologically, a review of scholarly peer-reviewed and grey litearture, and thematic analysis of all secondary school curriculum documents (years 7-10) have been conducted. Results: Food numeracy is defined as the ability to use mathematical skills effectively to partake of daily requirements and be aware of its value from farm to fork. Additionally, two food numeracy key elements of food production and food consumption with several sub-elements with their corresponding curriculum descriptors have been deduced from the curriculum documents. Finally, practical application and integration of food numeracy across all subjects has been demonstrated using deduced food numeracy and relevant numeracy elements from the Australian curriculum. Conclusion/future implication: It is anticipated that integration of food numeracy across the curriculum can strengthen adolescents’ knowledge and skills in both food and nutrition, and numeracy which has a direct correlation with enhanced health status. Introduction and application of food numeracy aligns with contemporary teaching practices which aim to inspire students to use analytical thinking to solve food-related problems and become conscientious global citizens

HIV prevalence and undiagnosed infection among a community sample of gay and bisexual men in Scotland, 2005-2011: implications for HIV testing policy and prevention

<b>Objective</b><p></p> To examine HIV prevalence, HIV testing behaviour, undiagnosed infection and risk factors for HIV positivity among a community sample of gay men in Scotland.<p></p> <b>Methods</b><p></p> Cross-sectional survey of gay and bisexual men attending commercial gay venues in Glasgow and Edinburgh, Scotland with voluntary anonymous HIV testing of oral fluid samples in 2011. A response rate of 65.2% was achieved (1515 participants).<p></p> <b>Results</b><p></p> HIV prevalence (4.8%, 95% confidence interval, CI 3.8% to 6.2%) remained stable compared to previous survey years (2005 and 2008) and the proportion of undiagnosed infection among HIV-positive men (25.4%) remained similar to that recorded in 2008. Half of the participants who provided an oral fluid sample stated that they had had an HIV test in the previous 12 months; this proportion is significantly higher when compared to previous study years (50.7% versus 33.8% in 2005, p<0.001). Older age (>25 years) was associated with HIV positivity (1.8% in those <25 versus 6.4% in older ages group) as was a sexually transmitted infection (STI) diagnosis within the previous 12 months (adjusted odds ratio 2.13, 95% CI 1.09–4.14). There was no significant association between age and having an STI or age and any of the sexual behaviours recorded.<p></p> <b>Conclusion</b><p></p> HIV transmission continues to occur among gay and bisexual men in Scotland. Despite evidence of recent testing within the previous six months, suggesting a willingness to test, the current opt-out policy may have reached its limit with regards to maximising HIV test uptake. Novel strategies are required to improve regular testing opportunities and more frequent testing as there are implications for the use of other biomedical HIV interventions.<p></p&gt

The Long and Winding Road: Archiving and Re-Using Qualitative Data from 12 Research Projects Spanning 16 Years

We describe a pilot project designed to assess the feasibility of re-use across 12 diverse qualitative datasets related to Human Immunodeficiency Virus (HIV) in the UK, from research projects undertaken between 1997 and 2013 – an approach which is chronically underused. First, we consider the sweeping biomedical changes and imperatives relating to HIV in this time frame, offering a rationale for data re-use at this point in the epidemic. We then reflexively situate the processes and procedures we devised for this study with reference to relevant methodological literature. Hammersley’s and Leonelli’s contributions have been particularly instructive through this process, and following their lead, we conclude with further considerations for those undertaking qualitative data re-use, reflecting on the extent to which qualitative data re-use as a practice requires attention to both the given and the constructed aspects of data when assembled as evidence

Preparedness for use of the rapid result HIV self-test by gay men and other men who have sex with men (MSM): a mixed methods exploratory study among MSM and those involved in HIV prevention and care

Objectives: The aim of the study was to explore preparedness for the HIV self-test among men who have sex with men (MSM) and those involved in HIV prevention and care. Methods: A mixed methods exploratory research design was employed, detailing awareness and willingness to use the self-test and the perceived barriers and facilitators to implementation. Quantitative and qualitative data collection and analysis were completed in parallel. Descriptive and inferential analysis of cross-sectional bar-based survey data collected from MSM through a self-completed questionnaire and oral fluid specimen collection (n = 999) was combined with qualitative, thematic, analysis of data collected through 12 expert focus groups (n = 55) consisting of gay men, National Health Service (NHS) staff, community organizations, entrepreneurs and activists. Findings were subsequently combined and assessed for synergies. Results: Among MSM, self-test awareness was moderate (55%). Greater awareness was associated with increased educational attainment [adjusted odds ratio 1.51; 95% confidence interval (CI) 1.00–2.30; P = 0.05] and previous history of sexually transmitted infection (STI) testing (adjusted odds ratio 1.63; 95% CI 1.11–2.39; P = 0.01). Willingness to use the test was high (89%) and associated with meeting sexual partners online (unadjusted odds ratio 1.96; 95% CI 1.31–2.94; P < 0.001). Experts highlighted the overall acceptability of self-testing; it was understood as convenient, discreet, accessible, and with a low burden to services. However, some ambivalence towards self-testing was reported; it could reduce opportunities to engage with wider services, wider health issues and the determinants of risk. Conclusions: Self-testing represents an opportunity to reduce barriers to HIV testing and enhance prevention and access to care. Levels of awareness are moderate but willingness to use is high. Self-testing may amplify health inequalities

A Spiking Neural Network Model of the Medial Superior Olive Using Spike Timing Dependent Plasticity for Sound Localization

Sound localization can be defined as the ability to identify the position of an input sound source and is considered a powerful aspect of mammalian perception. For low frequency sounds, i.e., in the range 270 Hz–1.5 KHz, the mammalian auditory pathway achieves this by extracting the Interaural Time Difference between sound signals being received by the left and right ear. This processing is performed in a region of the brain known as the Medial Superior Olive (MSO). This paper presents a Spiking Neural Network (SNN) based model of the MSO. The network model is trained using the Spike Timing Dependent Plasticity learning rule using experimentally observed Head Related Transfer Function data in an adult domestic cat. The results presented demonstrate how the proposed SNN model is able to perform sound localization with an accuracy of 91.82% when an error tolerance of ±10° is used. For angular resolutions down to 2.5°, it will be demonstrated how software based simulations of the model incur significant computation times. The paper thus also addresses preliminary implementation on a Field Programmable Gate Array based hardware platform to accelerate system performance