Barriers to syphilis testing among men who have sex with men: a systematic review of the literature
Rodman Turpin A C , Andre D. Rosario B and Typhanye Dyer AA University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, 4200 Valley Drive #2242, College Park, MD 20742, USA.
B Howard University Hospital, Psychiatry and Behavioral Sciences, 2041 Georgia Avenue NW, Washington, D.C. 20060, USA.
C Corresponding author. Email: RTurpin@umd.edu
Sexual Health 17(3) 201-213 https://doi.org/10.1071/SH19044
Submitted: 9 March 2019 Accepted: 11 April 2020 Published: 26 June 2020
Abstract
Men who have sex with men (MSM) represent the highest risk group for syphilis in the United States and several other countries. Improving uptake of syphilis testing among MSM requires understanding key barriers to testing in this population. Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic review to assess proportions of syphilis testing among MSM and identify social, structural, and individual barriers to syphilis testing was conducted. All searches were conducted through the University of Maryland world catalogue search engine. Studies that measured syphilis testing in a sample of MSM were included. All studies were assessed for bias using JBI-MAStARI instruments. Studies were synthesised based on sample size, years of data collection, study selection method (e.g. hospital or clinic-based, community/venue-based), location (e.g. USA-based, other countries) and results of the bias assessment. For studies measuring barriers associated with testing, the measure of association, point estimate and statistical significance was assessed. Of 848 studies found in the initial search, 24 were included in the final review. The largest difference in syphilis testing proportions was based on hospital or clinic-based sampling (50–87%) compared with venue/community-based and online sampling (31–38%). Socioeconomic factors (four items, four studies, OR 0.23 to 0.68), healthcare interactions six items, five studies, OR 0.09 to 0.69) and community/interpersonal factors (seven items, five studies, OR 0.07 to 0.58) were identified as barriers to testing. Barriers to syphilis testing among MSM include socioeconomic factors, healthcare-related factors and community/interpersonal factors. Improving overall routine utilisation of healthcare services is an especially important focal point in testing promotion.
Additional keywords: gay men, health services, public health.
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