Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial

Population Council, New York, USA.
Sexually transmitted infections (Impact Factor: 3.4). 01/2008; 83(7):552-7. DOI: 10.1136/sti.2007.027060
Source: PubMed

ABSTRACT To test whether more women are screened for sexually transmitted infections when offered home-based versus clinic-based testing and to evaluate the feasibility and acceptability of self-sampling and self-testing in home and clinic settings in a resource-poor community.
Women aged 14-25 were randomised to receive a home kit with a pre-paid addressed envelope for mailing specimens or a clinic appointment, in Gugulethu, South Africa. Self-collected vaginal swabs were tested for gonorrhoea, chlamydia and trichomoniasis using PCR and self-tested for trichomoniasis using a rapid dipstick test. All women were interviewed at enrollment on sociodemographic and sexual history, and at the 6-week follow-up on feasibility and acceptability.
626 women were enrolled in the study, with 313 in each group; 569 (91%) completed their 6-week follow-up visit. Forty-seven per cent of the women in the home group successfully mailed their packages, and 13% reported performing the rapid test and/or mailing the kit (partial responders), versus 42% of women in the clinic group who kept their appointment. Excluding partial responders, women in the home group were 1.3 (95% CI 1.1 to 1.5) times as likely to respond to the initiative as women in the clinic group. Among the 44% who were tested, 22% tested positive for chlamydia, 10% for trichomoniasis, and 8% for gonorrhoea.
Self-sampling and self-testing are feasible and acceptable options in low-income communities such as Gugulethu. As rapid diagnostic tests become available and laboratory infrastructure improves, these methodologies should be integrated into services, especially services aimed at young women.

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Available from: Taryn Young, Sep 28, 2015
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    • "Nonetheless, uptake of home-based testing is generally low[9]. Response rates for home-testing kits distributed by mail in the Netherlands, Sweden, the UK, South Africa, and Brazil ranged from 24-80%[11,12,18-20]. Previous researchers distributed home-testing kits at pharmacies, gyms and other community settings, with return rates of 3-38%[13,15,21,22]. "
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    ABSTRACT: Chlamydia is most common among young people, but only a small proportion of Australian young people are tested annually. Home-based chlamydia testing has been piloted in several countries to increase testing rates, but uptake has been low. We aimed to identify predictors of uptake of home-based chlamydia testing to inform future testing programs. We offered home-based chlamydia testing kits to participants in a sexual behaviour cross-sectional survey conducted at a music festival in Melbourne, Australia. Those who consented received a testing kit and were asked to return their urine or vaginal swab sample via post. Nine hundred and two sexually active music festival attendees aged 16-29 completed the survey; 313 (35%) opted to receive chlamydia testing kits, and 67 of 313 (21%) returned a specimen for testing. One participant was infected with chlamydia (1% prevalence). Independent predictors of consenting to receive a testing kit included older age, knowing that chlamydia can make women infertile, reporting more than three lifetime sexual partners and inconsistent condom use. Independent predictors of returning a sample to the laboratory included knowing that chlamydia can be asymptomatic, not having had an STI test in the past six months and not living with parents. A low proportion of participants returned their chlamydia test, suggesting that this model is not ideal for reaching young people. Home-based chlamydia testing is most attractive to those who report engaging in sexual risk behaviours and are aware of the often asymptomatic nature and potential sequelae of chlamydia infection.
    BMC Public Health 06/2010; 10(1):376. DOI:10.1186/1471-2458-10-376 · 2.26 Impact Factor
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    Sexually transmitted infections 01/2008; 83(7):501-2. DOI:10.1136/sti.2007.028928 · 3.40 Impact Factor
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    ABSTRACT: The control of curable STIs in countries with high disease burden has been hampered by the lack of accessible STI laboratory services. Rapid tests that are sensitive, specific and easy to use have the potential to increase the specificity of syndromic management of STIs in symptomatic patients and increase access to screening of asymptomatic infection to prevent the development of long-term complications and to interrupt the chain of transmission of STIs in the population. Although most rapid tests for chlamydia and gonorrhoea have sub-optimal sensitivity, and are neither simple nor affordable, some rapid syphilis tests have been shown to have acceptable performance. These can be deployed to increase access to screening in settings where testing is not previously possible or where laboratory services are inconsistent. With more political commitment and technological advances made possible by increased funding and public and private product development partnerships, there is much optimism in the near future for point of care tests for STIs that can improve patient management and disease control. The WHO estimates that more than 380 million new cases of sexually transmitted chlamydia, gonorrhea, syphilis and trichomoniasis occur worldwide every year [1]. An equal or greater number of viral sexually transmitted infections (STIs) such as those caused by herpes simplex virus and human papilloma virus also occur every year but efforts to estimate the annual incidence of these infections on a global basis have been limited.
    The Open Infectious Diseases Journal 01/2009; 3(1):156-163. DOI:10.2174/1874279300903020156
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