Exploring the feasibility and acceptability of using Neisseria gonorrhoeae whole genome sequencing to inform patient care: qualitative findings from patient interviews and sexual health clinician focus groups

Whole genome sequencing (WGS) of Neisseria gonorrhoeae has been used to identify sexual networks that included both heterosexual-identifying men (HM) and gay, bisexual and other men who have sex with men (GBMSM). Near real-time genomics data could therefore inform clinical risk assessment, for example, by identifying HM diagnosed with gonorrhoea who might benefit from additional risk reduction interventions offered to GBMSM, such as HIV pre-exposure prophylaxis and hepatitis vaccinations. We explored the feasibility and acceptability of using N. gonorrhoeae WGS to inform individual clinical management. We conducted seven semi-structured interviews with HM with a history of gonorrhoea diagnosis who were recruited from sexual health services and online, and four focus group discussions with 12 sexual health clinicians (doctors, nurses, and health advisors). We combined inductive thematic and deductive framework analysis approaches using the Theoretical Framework of Acceptability (TFA) to analyse the data. Patient and clinicians recognised the potential for improved individual health outcomes and public health benefits from using WGS to inform risk assessment and management (TFA construct Affective attitude) . They raised ethical concerns (e.g., risk of identification), emphasising the need for robust privacy and confidentiality processes (Ethicality). Scope for offending HM who share sexual networks with GBMSM was identified by patients and clinicians, particularly through inferring of sexual behaviours ( Ethicality) . Clinicians raised concerns about the impact on clinician-patient relationships, particularly future patient engagement and trust; views that were not shared by patients (Opportunity costs) . Patients and clinicians discussed preferences for communicating and interpreting WGS data and strategies to minimise misinterpretation, including that explanations should be accompanied by supplementary resources, such as infographics and videos ( Intervention coherence) . Our findings suggest that risk stratification using WGS data could be an acceptable intervention as part of gonorrhoea management and provide insight into how this intervention could be implemented in a sensitive and acceptable manner and how results could be communicated. Future clinical trials might assess the cost-effectiveness of using WGS to inform clinical risk assessment in sexual health services.