Syphilis incidence in men who have sex with men with human immunodeficiency virus comorbidity and the importance of integrating sexually transmitted infection prevention into HIV care

Figures & data

Table 1. Strategies to eliminate patient- and provider-level barriers to sexually transmitted infection (STI) screening and prompt treatment in human immunodeficiency virus (HIV) care settings for men who have sex with men.

	Potential barriers	Strategies
Before HIV provider visit	Patient Inconvenience (e.g. need more frequent testing, want easier testing) Forgetting to get tested Desiring more anonymity Insurance coverage Provider Lack of knowledge of: STI testing guidelines, nucleic acid amplification testing availability	Alternative testing locations: nurse-led STI clinics within HIV clinics, STI clinics available to the general population, non-clinic based local outreaches Alternative testing options: telehealth-based testing, home-based testing Automated patient reminders (e.g. text message, e-mail, smartphone applications) Provider reminders to test patient via electronic health record system Provider education via alerts or formal training sessions
During HIV provider visit	Patient Patient privacy Stigma Provider Lack of time, competing priorities Discomfort discussing sexual practices and doing genital exam Afraid of being perceived as judgmental	Improving sexual behavior risk assessment (e.g. standardized sexual history interview and provider training; self-administered computer-, tablet-, or smartphone-based platforms) More efficient specimen collection (e.g. nurse-collection before physician visits patient, patient-collection) Standing lab orders for syphilis serology in 4–6 month intervals Automated addition of syphilis serology to routine HIV monitoring labs Strategic placement of specimen collection materials as a reminder to providers Universal collection of genital and extragenital specimens regardless of sexual history
After HIV provider visit	Patient Duration of time to receiving results Not receiving results Provider Time required to deliver results	Point-of-care testing Faster delivery of results (e.g. text messaging, smartphone applications) Shifting away from the ‘no news is good news’ provider mentality