Comparative effectiveness and acceptability of home-based and clinic-based sampling methods for sexually transmissible infections screening in females aged 14–50 years: a systematic review and meta-analysis
Tolulope Y. Odesanmi A C , Sharada P. Wasti A , Omolola S. Odesanmi B , Omololu Adegbola B , Olubukola O. Oguntuase A and Sajid Mahmood A
+ Author Affiliations
- Author Affiliations
A School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
B Departments of Biochemistry, Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-araba, Lagos PMB 12003, Nigeria.
C Corresponding author. Email: todesanmi@yahoo.com
Sexual Health 10(6) 559-569 https://doi.org/10.1071/SH13029
Submitted: 12 March 2013 Accepted: 9 September 2013 Published: 28 October 2013
Abstract
Background: Home-based sampling is a strategy to enhance uptake of sexually transmissible infection (STI) screening. This review aimed to compare the screening uptake levels of home-based self-sampling and clinic-based specimen collection for STIs (chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and trichomoniasis) in females aged 14–50 years. Acceptability and effect on specimen quality were determined. Methods: Sixteen electronic databases were searched from inception to September 2012. Randomised controlled trials (RCTs) comparing the uptake levels of home-based self-sampling and clinic-based sampling for chlamydia, gonorrhoea and trichomoniasis in females aged 14–50 years were eligible for inclusion. The risk of bias in the trials was assessed. Risk ratios (RRs) for dichotomous outcomes were meta-analysed. Results: Of 3065 papers, six studies with seven RCTs contributed to the final review. Compared with clinic-based methods, home-based screening increased uptake significantly (P = 0.001–0.05) in five trials and was substantiated in a meta-analysis (RR: 1.55; 95% confidence interval: 1.30–1.85; P = 0.00001) of two trials. In three trials, a significant preference for home-based testing (P = 0.001–0.05) was expressed. No significant difference was observed in specimen quality. Sampling was rated as easy by a significantly higher number of women (P = 0.01) in the clinic group in one trial. Conclusions: The review provides evidence that home-based testing results in greater uptake of STI screening in females (14–50 years) than clinic-based testing without compromising quality in the developed world. Home collection strategies should be added to clinic-based screening programs to enhance uptake.
Additional keywords: chlamydia, gonorrhoea, mass screening, trichomonas.
References
[1] World Health Organisation (WHO). Sexually transmitted infections. Geneva: WHO; 2011.Available online at: http://www.who.int/mediacentre/factsheets/fs110/en/ [verified July 2012].[2] Hollblad-Fadiman K, Goldman SM. American college of preventive medicine practice policy statement: screening for Chlamydia trachomatis. Am J Prev Med 2003; 24 287–92.
| American college of preventive medicine practice policy statement: screening for Chlamydia trachomatis.Crossref | GoogleScholarGoogle Scholar | 12657352PubMed |
[3] Centre for Disease Control. Sexually transmitted disease surveillance 2010. Atlanta: US. Department of Health and Human Services; 2011. Available online at: http://www.cdc.gov/std/stats10/surv2010.pdf [verified July 2012].
[4] Nelson HD, Helfand M. Screening for chlamydial infection. Am J Prev Med 2001; 20 95–107.
| Screening for chlamydial infection.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FgvVaisw%3D%3D&md5=e2d1f1a7374b597602125279425afbb6CAS | 11306238PubMed |
[5] Fenton KA, Lowndes CM. Recent trends in the epidemiology of sexually transmitted infections in the European Union. Sex Transm Infect 2004; 80 255–63.
| Recent trends in the epidemiology of sexually transmitted infections in the European Union.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2czptFOrtw%3D%3D&md5=2151a03e653addc59dc073a4a3463f91CAS | 15295121PubMed |
[6] Aledort JE, Ronald A, Rafael ME, Girosi F, Vickerman P, Le Blancq SM, et al Reducing the burden of sexually transmitted infections in resource-limited settings: the role of improved diagnostics. Nature 2006; 444 59–72.
| 17159895PubMed |
[7] Senok A, Wilson P, Reid M. Can we evaluate population screening strategies in UK general practice? A pilot randomised controlled trial comparing postal and opportunistic screening for genital chlamydial infection. J Epidemiol Community Health 2005; 59 198–204.
| Can we evaluate population screening strategies in UK general practice? A pilot randomised controlled trial comparing postal and opportunistic screening for genital chlamydial infection.Crossref | GoogleScholarGoogle Scholar | 15709078PubMed |
[8] Dehne K, Riedner G. Sexually transmitted infections among adolescents: the need for adequate health services. Geneva: World Health Organisation; 2005.
[9] Adler M, Cowan F, French P. ABC of sexually transmitted infections. 5th edn. London: BMJ Books; 2004.
[10] Low N, Broutet N, Adu-Sarkodie Y, Barton P, Hossain M, Hawkes S. Global control of sexually transmitted infections. Lancet 2006; 368 2001–16.
| Global control of sexually transmitted infections.Crossref | GoogleScholarGoogle Scholar | 17141708PubMed |
[11] World Health Organisation (WHO). Global prevalence and incidence of selected curable sexually transmitted infections overview and estimates. Geneva: WHO; 2001.
[12] Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA, eds. Manual of clinical microbiology. 9th ed. Washington, DC: ASM Press; 2007.
[13] Mandell GL, Douglas RG, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 7th ed. New York: Elsevier Churchill Livingstone; 2010.
[14] Pillay A, Lewis J, Ballard RC. Evaluation of Xenostrip-TV, a rapid diagnostic test for Trichomonas vaginalis infection. J Clin Microbiol 2004; 42 3853–6.
| Evaluation of Xenostrip-TV, a rapid diagnostic test for Trichomonas vaginalis infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXnt1Onsr8%3D&md5=3681933d892906aad01ad94a4a409fedCAS | 15297548PubMed |
[15] Winn WC, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P. et al., eds. Koneman’s color atlas and textbook of diagnostic microbiology. Philadelphia: Lippincott Williams & Wilkins; 2006.
[16] Cook RL, Hutchison SL, Ostergaard L, Braithwaite RS, Ness RB. Systematic review: non-invasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med 2005; 142 914–25.
| Systematic review: non-invasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae.Crossref | GoogleScholarGoogle Scholar | 15941699PubMed |
[17] Lazenby GB. Trichomonas vaginalis screening and prevention in order to impact the HIV pandemic: isn’t it time we take this infection seriously? Infectious Disease Reports 2011; 3 13–5.
| Trichomonas vaginalis screening and prevention in order to impact the HIV pandemic: isn’t it time we take this infection seriously?Crossref | GoogleScholarGoogle Scholar |
[18] Mayaud P, Mccormick D. Interventions against sexually transmitted infections to prevent HIV infection. Br Med Bull 2001; 58 129–53.
| Interventions against sexually transmitted infections to prevent HIV infection.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MnmvFamug%3D%3D&md5=f6f148780a20027cfb2ec3ec799bf580CAS | 11714628PubMed |
[19] Walker CK, Sweet RL. Gonorrhea infection in women: prevalence, effects, screening, and management. Int J Womens Health. 2011; 3 197–206.
| 21845064PubMed |
[20] Pultorak E, Wong W, Rabins C, Mehta SD. Economic burden of sexually transmitted infections: incidence and direct medical cost of chlamydia, gonorrhoea, and syphilis among Illinois adolescents and young adults, 2005–2006. Sex Transm Dis 2009; 36 629–36.
| Economic burden of sexually transmitted infections: incidence and direct medical cost of chlamydia, gonorrhoea, and syphilis among Illinois adolescents and young adults, 2005–2006.Crossref | GoogleScholarGoogle Scholar | 19955874PubMed |
[21] Mayaud P, Mabey D. Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges. Sex Transm Infect 2004; 80 174–82.
| Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c3ntFWisA%3D%3D&md5=f9dec0cba28502a913b357ece580422cCAS | 15169997PubMed |
[22] Weinstock H, Berman S, Cates WJ. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36 6–10.
| 14982671PubMed |
[23] Low N, Bender N, Nartey L, Redmond S, Shang A, Stephenson JM. Revised rapid review of evidence for the effectiveness of screening for genital chlamydial infection in sexually active young women and men. London: National Institute for Clinical Excellence; 2006. Available online at: http://www.nice.org.uk/nicemedia/pdf/Chlamydia_Screening_Revised_Review_of_Effectiveness.pdf [verified July 2012].
[24] Andersen B, Olesen F, Moller JK, Ostergaard L. Population-based strategies for outreach screening of urogenital Chlamydia trachomatis infections: a randomised, controlled trial. J Infect Dis 2002; 185 252–8.
| Population-based strategies for outreach screening of urogenital Chlamydia trachomatis infections: a randomised, controlled trial.Crossref | GoogleScholarGoogle Scholar | 11807700PubMed |
[25] Hodgins S, Peeling RW, Dery S, Bernier F, LaBrecque A, Proulx JF, et al The value of mass screening for chlamydia control in high prevalence communities. Sex Transm Infect 2002; 78 i64–8.
| The value of mass screening for chlamydia control in high prevalence communities.Crossref | GoogleScholarGoogle Scholar | 12083449PubMed |
[26] United Nations Population Fund (UNFPA). Breaking the cycle of transmission of sexually transmitted infection. New York: UNFPA; 2004.
[27] Ross JDC, Ison C, Radcliffe KW. A paradigm shift in testing for sexually transmitted infections. Sex Transm Infect 2006; 82 424–5.
| A paradigm shift in testing for sexually transmitted infections.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28jhsVKitg%3D%3D&md5=13ef88b8e189cddcdba6783fb1f173f1CAS |
[28] World Health Organisation (WHO). Global strategy for the prevention and control of sexually transmitted infections 2006–2015: breaking the chain of transmission. Geneva: WHO; 2007.
[29] Pavlin NL, Gunn JM, Parker R, Fairley CK, Hocking J. Implementing chlamydia screening: what do women think? A systematic review of the literature. BMC Public Health 2006; 6 221
| Implementing chlamydia screening: what do women think? A systematic review of the literature.Crossref | GoogleScholarGoogle Scholar | 16948838PubMed |
[30] Graseck A, Shih SL, Peipert JF. Home versus clinic-based specimen collection for Chlamydia trachomatis and Neisseria gonorrhoeae. Expert Rev Anti Infect Ther 2011; 9 183–94.
| Home versus clinic-based specimen collection for Chlamydia trachomatis and Neisseria gonorrhoeae.Crossref | GoogleScholarGoogle Scholar | 21342066PubMed |
[31] Sparks R, Helmers J. Rescreening for gonorrhea and chlamydial infection through the mail: a randomised trial. Sex Transm Dis 2004; 31 113–6.
| Rescreening for gonorrhea and chlamydial infection through the mail: a randomised trial.Crossref | GoogleScholarGoogle Scholar | 14743074PubMed |
[32] Tilson EC, Sanchez V, Ford CL, Smurzynski M, Leone PA, Fox KK, et al Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions. BMC Public Health 2004; 4 21
| Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions.Crossref | GoogleScholarGoogle Scholar | 15189565PubMed |
[33] Serlin M, Shafer MA, Tebb K, Gyamfi AA, Moncada J, Schachter J, et al What sexually transmitted disease screening method does the adolescent prefer? Adolescents’ attitudes toward first-void urine, self-collected vaginal swab, and pelvic examination. Arch Pediatr Adolesc Med 2002; 156 588–91.
| What sexually transmitted disease screening method does the adolescent prefer? Adolescents’ attitudes toward first-void urine, self-collected vaginal swab, and pelvic examination.Crossref | GoogleScholarGoogle Scholar | 12038892PubMed |
[34] Garrow SC, Smith DW, Harnett GB. The diagnosis of chlamydia, gonorrhoea, and trichomonas infections by self obtained low vaginal swabs, in remote northern Australian clinical practice. Sex Transm Infect 2002; 78 278–81.
| The diagnosis of chlamydia, gonorrhoea, and trichomonas infections by self obtained low vaginal swabs, in remote northern Australian clinical practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38visVyrsg%3D%3D&md5=4712036120c0bf2cfe13aaea566967f8CAS | 12181467PubMed |
[35] Gaydos CA, Rizzo-Price PA, Barnes M, Dwyer K, Wood BJ, Hogan MT. The use of focus groups to design an internet-based program for chlamydia screening with self-administered vaginal swabs: what women want. Sex Health 2006; 3 209–15.
| The use of focus groups to design an internet-based program for chlamydia screening with self-administered vaginal swabs: what women want.Crossref | GoogleScholarGoogle Scholar | 17112429PubMed |
[36] Østergaard L, Andersen B, Moller JK, Olesen F. Home sampling versus conventional swab sampling for screening of Chlamydia trachomatis in women: a cluster-randomised 1-year follow-up study. Clin Infect Dis 2000; 31 951–7.
| Home sampling versus conventional swab sampling for screening of Chlamydia trachomatis in women: a cluster-randomised 1-year follow-up study.Crossref | GoogleScholarGoogle Scholar | 11049776PubMed |
[37] Health Protection Agency (HPA). Sexually transmitted infections in England, 2011 report. London: HPA; 2012. Available online at: http://www.hpa.org.uk/hpr/archives/2012/hpr2212.pdf [verified July 2012].
[38] Ross J, Ison C, Carder C, Lewis D, Mercey D. Sexually transmitted infections: UK national screening and testing guidelines. London: British Association for Sexual Health; 2006.
[39] Knox J, Tabrizi S, Miller P, Petoumenos K, Law M, Chen S, et al Evaluation of self-collected samples in contrast to practitioner-collected samples for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by polymerase chain reaction among women living in remote areas. Sex Transm Dis 2002; 29 647–54.
| Evaluation of self-collected samples in contrast to practitioner-collected samples for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by polymerase chain reaction among women living in remote areas.Crossref | GoogleScholarGoogle Scholar | 12438900PubMed |
[40] Peeling R. Utilisation of rapid tests for sexually transmitted infections: promises and challenges. Open Infect Dis J 2009; 3 156–163.
[41] van de Wijgert JH, Altini L, Jones HE, de Kock A, Young T, Williamson AL, et al Two methods of self-sampling compared to clinician-sampling to detect reproductive tract infections in Gugulethu, South Africa. Sex Transm Dis 2006; 33 516–523.
| Two methods of self-sampling compared to clinician-sampling to detect reproductive tract infections in Gugulethu, South Africa.Crossref | GoogleScholarGoogle Scholar |
[42] Garland SM, Tabrizi SN. Diagnosis of sexually transmitted infections (STI) using self-collected non-invasive specimens. Sex Health 2004; 1 121–6.
| Diagnosis of sexually transmitted infections (STI) using self-collected non-invasive specimens.Crossref | GoogleScholarGoogle Scholar | 16334994PubMed |
[43] Shafer MA, Moncada J, Boyer CB, Betsinger K, Flinn SD, Schachter J. Comparing first-void urine specimens, self-collected vaginal swabs, and endocervical specimens to detect Chlamydia trachomatis and Neisseria gonorrhoeae by a nucleic acid amplification test. J Clin Microbiol 2003; 41 4395–9.
| Comparing first-void urine specimens, self-collected vaginal swabs, and endocervical specimens to detect Chlamydia trachomatis and Neisseria gonorrhoeae by a nucleic acid amplification test.Crossref | GoogleScholarGoogle Scholar | 12958275PubMed |
[44] Morre SA, van Valkengoed IG, de Jong A, Boeke AJ, van Eijk JT, Meijer CJ, et al Mailed, home-obtained urine specimens: a reliable screening approach for detecting asymptomatic Chlamydia trachomatis infections. J Clin Microbiol 1999; 37 976–80.
| 1:STN:280:DyaK1M7nsFalsw%3D%3D&md5=2ba265135a236f53ee570040150e559cCAS | 10074512PubMed |
[45] Low N, McCarthy A, Macleod J, Salisbury C, Horner PJ, Roberts TE, et al The chlamydia screening studies: rationale and design. Sex Transm Infect 2004; 80 342–8.
| The chlamydia screening studies: rationale and design.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2cvptFansA%3D%3D&md5=123584976775a964d20e3b413a7f39d9CAS | 15459400PubMed |
[46] Shih SL, Graseck AS, Secura GM, Peipert JF. Screening for sexually transmitted infections at home or in the clinic? Curr Opin Infect Dis 2011; 24 78–84.
| Screening for sexually transmitted infections at home or in the clinic?Crossref | GoogleScholarGoogle Scholar | 21124216PubMed |
[47] Fortenberry JD, McFarlane M, Bleakley A, Bull S, Fishbein M, Grimley DM, et al Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health 2002; 92 378–81.
| Relationships of stigma and shame to gonorrhea and HIV screening.Crossref | GoogleScholarGoogle Scholar | 11867314PubMed |
[48] Holland-Hall CM, Wiesenfeld HC, Murray PJ. Self-collected vaginal swabs for the detection of multiple sexually transmitted infections in adolescent girls. J Pediatr Adolesc Gynecol 2002; 15 307–13.
| Self-collected vaginal swabs for the detection of multiple sexually transmitted infections in adolescent girls.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3s%2FktVaqtw%3D%3D&md5=8b4e3ff48225e8b58429d50a75fa6921CAS | 12547662PubMed |
[49] Lippman SA, Jones HE, Luppi CG, Pinho AA, Veras MA, van de Wijgert JH. Home-based self -sampling and self-testing for sexually transmitted infections: acceptable and feasible alternatives to provider-based screening in low-income women in Sao Paulo, Brazil. Sex Transm Dis 2007; 34 421–8.
| 17091118PubMed |
[50] Centre for Disease Control. Sexually transmitted disease surveillance 2010. Atlanta: US. Department of Health and Human Services; 2011. Available online at: http://www.cdc.gov/std/stats10/surv2010.pdf [verified July 2012].
[51] Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration; 2011. Available online at: www.cochrane-handbook.org. [verified July 2012].
[52] Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62 e1–34.
| The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.Crossref | GoogleScholarGoogle Scholar | 19631507PubMed |
[53] Jepson R, Clegg A, Forbes C, Lewis R, Sowden A, Kleijnen J. The determinants of screening uptake and interventions for increasing uptake: a systematic review. Health Technol Assess 2000; 4 1–133.
[54] Mulrow CD, Cook D, eds. Systematic reviews synthesis of best evidence for health care decisions. Philadelphia: American College of Physicians; 1998.
[55] Torgerson C. Systematic reviews. London: Continuum; 2003.
[56] Centre for Reviews and Dissemination (CRD). Systematic reviews: CRD’s guidance for undertaking reviews in health care. York: CRD; 2009.
[57] Jones HE, Altini L, de Kock A, Young T, van de Wijgert JH. Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial. Sex Transm Infect 2007; 83 552–7.
| Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2snotlOksg%3D%3D&md5=51d1a6f4c94369d23ef8a38724844ce5CAS | 17901084PubMed |
[58] Graseck AS, Secura GM, Allsworth JE, Madden T, Peipert JF. Home screening compared with clinic-based screening for sexually transmitted infections. Obstet Gynecol 2010; 115 745–52.
| Home screening compared with clinic-based screening for sexually transmitted infections.Crossref | GoogleScholarGoogle Scholar | 20308834PubMed |
[59] Cook RL, Ostergaard L, Hillier SL, Murray PJ, Chang CH, Comer DM, et al Home screening for sexually transmitted diseases in high-risk young women: randomised controlled trial. Sex Transm Infect 2007; 83 286–91.
| Home screening for sexually transmitted diseases in high-risk young women: randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 17301105PubMed |
[60] Ostergaard L, Andersen B, Olesen F, Moller JK. Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study. BMJ 1998; 317 26–7.
| Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1czhs1Wqsg%3D%3D&md5=c6e5c7a758703f787bc6f0b555f4e6c4CAS | 9651263PubMed |
[61] Xu F, Stoner BP, Taylor S, Mena L, Tian LH, Papp J, et al Use of home-obtained vaginal swabs to facilitate rescreening for Chlamydia trachomatis infections: two randomised controlled trials. Obstet Gynecol 2011; 118 231–9.
| Use of home-obtained vaginal swabs to facilitate rescreening for Chlamydia trachomatis infections: two randomised controlled trials.Crossref | GoogleScholarGoogle Scholar | 21775837PubMed |
[62] van den Broek IV, van Bergen JE, Brouwers EE, Fennema JS, Gotz HM, Hoebe CJ, et al Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation. BMJ 2012; 345 e4316
| Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation.Crossref | GoogleScholarGoogle Scholar | 22767614PubMed |
