Increasing STI Testing Uptake Among African and Caribbean Communities in the UK: Intervention Development Using the ACE Framework

Background: STI rates in the UK have increased by 10-15% since 2020 with the highest burden among ethnic minorities (1).

For example, chlamydia diagnoses were twice as high and HIV three times higher among people of Black Caribbean descent versus White British counterparts (2).

There is a 2-5 times higher HIV acquisition risk with untreated STIs ​(1) and ​late diagnosis propagates the STI epidemic, enabling ongoing transmission among African communities in the UK (2).

However, these groups face greater barriers to accessing services, including knowledge gaps, stigma concerns, and underutilization of health resources (3).

Lack of early STI detection enables ongoing transmission, worsened outcomes like infertility and cancer risks, and substantial costs estimated at £360,000 per HIV case (4).

Evidence-based, tailored interventions addressing recognized disparities in STI testing are urgently needed and represent a policy priority for addressing health equities.

Aim: To co-design and pilot a behaviour change intervention to increase sexually transmitted infection (STI) testing uptake among Africans and Caribbeans in the UK using the ACE framework.

Objectives: Systematically review existing interventions promoting STI testing uptake among Africans and Caribbeans in high-income countries.

Qualitatively explore multi-level facilitators at personal, community, and health systems levels inhibiting testing among AC communities.

Co-produce a targeted behaviour change intervention embedding evidence-based techniques to reduce identified barriers through participatory workshops. Evaluate the acceptability and uptake of the resulting intervention in a real-world pilot.

Methods: Following the ACE framework, the project involves four studies including: 1) Systematic Review: I will conduct a systematic review following PRISMA guidelines to identify and synthesize interventions that aim to increase testing uptake among marginalized African/Caribbean groups in high-income countries to inform later co-design priorities. 2) Qualitative study of AC community members and Clinicians: I will conduct semi-structured interviews with 25 African/Caribbean community members and 10 clinicians to understand multi-level barriers/enablers influencing testing decisions across socio-ecological levels.

This is the first objective in the Agile Co-Production and Evaluation (ACE) framework, to conduct participatory needs assessments. 3) Co-produce Intervention content: This includes a series of 3 iterative co-design workshops engaging approximately 30 stakeholders to collaboratively develop targeted interventions, messages, and outreach strategies addressing identified challenges. 4) Mixed-methods Evaluation of Pilot study: The intervention will be rolled out among 50 people.

Mixed methods will be used to explore changes in testing intentions post-intervention exposure and acceptability. Integrating user feedback and metrics aligns with equitable principles in ACE.

Timeline: A three-year program involving planning (months 1), a systematic review (months 2-6), qualitative study (months 6-13), intervention development (months 13-18), pilot and evaluation (months 18-26), analysis (months 27-30), dissemination and writing (months 30-36).

Impact: This co-designed intervention aims to enhance access to sexual health services for AC communities in the UK, fostering earlier STI detection and treatment.

This will inform postdoctoral research to conduct a randomized controlled trial to assess the co-designed program's impact on STI testing and infection reduction among marginalized groups compared to standard care.

The ACE framework provides a transferable model for stakeholders engaging minority communities, addressing broader health disparities.