'It does fill me with a bit of unease': a qualitative study of the acceptability, facilitators and barriers to reducing the frequency of screening for asymptomatic sexually transmitted infections among gay, bisexual and other men who have sex with men.

Objectives: The study aimed to explore the acceptability of reducing the frequency of asymptomatic Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) screening among gay, bisexual, and other men who have sex with men (GBMSM)(Although the term GBMSM is used for convenience, the study also includes nonbinary people who were assigned male at birth who have sex with men.). Additionally, it sought to identify barriers and facilitators to implementing such changes and to develop potential interventions that could support a shift in current screening guidelines.

Methods: This qualitative study explored stakeholder perspectives on reducing screening frequency and identified potential interventions that could support future guideline changes of this kind. Semistructured interviews were conducted with 22 GBMSM and 8 professional stakeholders. Data were thematically analysed using the Capabilty, Opportunity, Motivation - Behaviour (COM-B) and Theoretical Domains Framework (TDF). TDF domains were mapped to behaviour change techniques to inform intervention development. Candidate interventions were refined based on acceptability, practicability, effectiveness, affordability, side effects, equity.

Results: Overall, GBMSM stakeholder responses to discontinuing asymptomatic Ng and Ct screening tended to be negative, while professional stakeholder opinions were mixed. Reducing the recommended screening frequency to 6 monthly was generally more acceptable to both groups. Barriers and facilitators to guideline changes included issues of knowledge and trust, social influence and identity, context and resources, concerns about consequences and emotional responses and habit. Ten candidate interventions were suggested. These involve providing information, social support, behavioural substitutions and feedback as well as facilitating discussions to resolve concerns.

Conclusion: Any reduction in the recommended frequency of asymptomatic screening will encounter a range of interrelated barriers, including knowledge gaps, social influences and emotional factors. We identified evidence-based interventions that could improve acceptance and minimise unintended consequences. Future research should incorporate stakeholder workshops to refine these strategies.