Intervention Mapping has been used to develop a web-based outreach strategy, named SafeFriend, for Ct testing in young people at risk. The intervention will be used to target high risk young people as opposed to the current wider web-based Ct screening strategies which have used a more opportunistic [6, 9] or population approach [8, 10]. It is believed that the current research project is the first web-based outreach screening strategy that combines a web-based RDS method with the delivering of targeted Ct screening to high risk young people using peer influence, starting from young Ct positive sexual health care centre clients. The sexual health care setting acts as a sustainable source of Ct positive young people and thereby provides continued access to more hard-to-reach group of high-risk young people in their networks. Specifically, this strategy aims to extend Ct prevention beyond sexual networks by also recruiting high-risk young people within social networks.
The attitudes and behaviours of young people in respect of sexual behaviour and STIs are strongly influenced by their peers [15, 17, 32]. Peer influence regarding STI screening is therefore an important strategy to reach high risk young people for STI testing. The Ct positive young people, who begin the web-based chain referral sampling in the proposed intervention, will have experiences with Ct testing and treatment. Their specific knowledge and positive attitudes about Ct testing could make them ideal peers to communicate messages within their sexual and social networks. However, the reliance on the success of motivation and engaging peer networks using peer influence could be reason for some concern. Personal and social sensitivities regarding STI (i.e., stigmatization, confidentiality and privacy) can be important barriers and can counter the success of peer influence. To ensure medical confidentiality and provide a secure web-based screening strategy, we enable persons to decide for themselves which personal information they reveal to their own chosen sex partners and/or friends; personal information will, in all cases, be completely invisible to all other peers. Having said this, STI is a sensitive and personal topic, especially if a STI is diagnosed, still other studies have found that youngsters did share their results with peers (i.e., 93% in CSI) .
The use of online Ct testing of larger populations and associated home-based test kits is increasing worldwide and proved already feasible and acceptable among young people [7, 9, 40, 41, 47]. It creates easy access to testing and overcomes barriers such as the time required for travelling, transportation and fear of anonymity loss . Despite these advantages, the cost per case detected and treated is high due to low participation and Ct positivity rates [8, 10], caused by targeting sexual networks only (i.e., thereby missing non-sexual high-risk contacts) or by taking a population based approach (i.e., including lower risk individuals). The developed strategy, is expected to be more targeted and cost-effective for Ct control starting from high risk young people (i.e., Ct positive sexual health care clients) and also including social networks (i.e., non sexual high-risk individuals).
In addition, the intervention should increase re-infection control by facilitating also web-based PN. Using a web-based RDS method will respectively reduce the delay of sex partner’s testing and increases the number of detected Ct infections among sex partners and friends . For an actual reduction of Ct transmission and re-infection effective Ct treatment is necessary. In two previous studies, more than 90% of sex partners and positive patients being tested with home-based test kits received treatment [40, 41].
Although web-based PN systems are emerging [43, 49], comprehensive evaluations to determine the effectiveness of these systems are limited: data regarding socio-demographics and actual outcomes (i.e., testing and treatment of partners) are not systematically collected. To obtain more insight into infection patterns and partner management, sexual and social contacts should be linked with socio-demographics at the individual and network level. The proposed intervention will yield systematic data on infections patterns and PN. The methodology in this paper (i.e., web-based RDS) in combination with social network techniques can structurally identify network clusters and the socially prominent characteristics associated with the clusters. Identifying and understanding the boundaries and bridges within a network will also be possible and can provide useful information about the extent of network penetration. Furthermore, available data show that current PN practices, which are mainly by patient referral [50, 51], could be improved significantly when there is more provider-oversight and support [34, 42, 47], a strategy that is also accommodated in our intervention.
The intervention will be developed, tested and implemented within a public health care service involved in STI control. An important pillar of public healthcare is the support of vulnerable groups in society. If a patient is less capable to warn his/her partner, due to low self-efficacy or misperceived severity, public health care professionals may be inclined to take responsibility in the interest of both the patient and his/her sex partner (i.e., prevention and re-infection control). However, tension exists between achieving benefits for whole populations and protecting the individual’s rights . The intervention therefore facilitates both patient and provider referral, creating a digital environment where clients can voluntarily, but with the support and oversight of sexual health care nurses motivate peers to get tested.