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Zhang Y, Du H, Wang C, Huang X, Qu X, Wu R. Feasibility and applicability of self-sampling based online cervical cancer screening: findings from the China online cervical cancer screening trial. Infect Agent Cancer 2024; 19:16. [PMID: 38664748 PMCID: PMC11046965 DOI: 10.1186/s13027-024-00583-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE This study aims to evaluate the feasibility and applicability of an online cervical cancer screening program using a website as the public platform and self-collected HPV testing as the primary screening method. METHODS A website (mcareu.com) was developed to facilitate the online cervical cancer screening program by Peking University Shenzhen Hospital (PUSH). Women in Shenzhen could register for participation on the website by providing essential demographic data. Sampling kits and specimens were delivered through regular logistics. Eligible women collected vaginal samples by themselves using the provided kits and in referring of the graphic guidance. The specimens were tested for HPV at PUSH or a reference lab, and the results were accessible on the website through participants' personal accounts. Participants who tested positive for high-risk HPV were scheduled for colposcopy and biopsies. The demographic and social background data of the eligible participants were analyzed to evaluate the feasibility and applicability of the online screening approach. RESULTS A total of 1712 applicants registered for participation, with 99.9% (1710/1712) completing registration with full data. The analysis included 1560 applicants aged 30-59, with an average age of 41.1 (± 7.6) years. Among them, 83.3% (1299/1560) provided self-collected samples for testing. Age-group analysis revealed an overall sample provision rate (SPR) exceeded 80% in all age groups. A significant difference in SPR was observed only between the 30-34 and 45-49 age groups (p < 0.05), while no significant differences were found among other age groups. 99.7% of the samples were tested qualified, and there was no significant difference in sampling failure rate among age groups. Analysis of demographic and social elements showed no significant impact on the rates of sample provision among groups in most of the social elements but the medical insurance and the monthly family-incomes. CONCLUSION The findings demonstrate that online cervical cancer screening is reliable for self-registration, self-sampling, and self-ordering for specimen transportation. It is suitable for women of all ages needing to be screened, irrespective of social elements, and effectively facilitates screening for women with limited access to medical resources. Therefore, online screening holds promise as an effective approach to increase screening coverage.
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Affiliation(s)
- Yi Zhang
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China
| | - Hui Du
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China
| | - Chun Wang
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China
| | - Xia Huang
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China
| | - Xinfeng Qu
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China.
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China.
| | - Ruifang Wu
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China.
- Shenzhen Key Laboratory On Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, 518036, People's Republic of China.
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Shih P, Ding P, Carter SM, Stanaway F, Horvath AR, Langguth D, Saad M, St John A, Bell K. Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility. BMJ Open 2023; 13:e074205. [PMID: 38151277 PMCID: PMC10759116 DOI: 10.1136/bmjopen-2023-074205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/30/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES The objective of this study is to map the range and variety of direct-to-consumer (DTC) tests advertised online in Australia and analyse their potential clinical utility and implications for medical overuse. DESIGN Systematic online search of DTC test products in Google and Google Shopping. DTC test advertisements data were collected and analysed to develop a typology of potential clinical utility of the tests at population level, assessing their potential benefits and harms using available evidence, informed by concepts of medical overuse. RESULTS We identified 484 DTC tests (103 unique products), ranging from $A12.99 to $A1947 in cost (mean $A197.83; median $A148.50). Using our typology, we assigned the tests into one of four categories: tests with potential clinical utility (10.7%); tests with limited clinical utility (30.6%); non-evidence-based commercial 'health checks' (41.9%); and tests whose methods and/or target conditions are not recognised by the general medical community (16.7%). Of the products identified, 56% did not state that they offered pretest or post-test consultation, and 51% did not report analytical performance of the test or laboratory accreditation. CONCLUSIONS This first-in-Australia study shows most DTC tests sold online have low potential clinical utility, with healthy consumers constituting the main target market. Harms may be caused by overdiagnosis, high rates of false positives and treatment decisions led by non-evidence-based tests, as well as financial costs of unnecessary and inappropriate testing. Regulatory mechanisms should demand a higher standard of evidence of clinical utility and efficacy for DTC tests. Better transparency and reporting of health outcomes, and the development of decision-support resources for consumers are needed.
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Affiliation(s)
- Patti Shih
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pauline Ding
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Stacy M Carter
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Fiona Stanaway
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrea R Horvath
- NSW Health Pathology, Sydney, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
| | - Daman Langguth
- Sullivan Nicolaides Pathology, Wesley Hospital, Brisbane, Queensland, Australia
| | - Mirette Saad
- Australian Clinical Labs, Victorian Central Laboratory Headquarters, Clayton, Victoria, Australia
| | | | - Katy Bell
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Iyamu I, Sierra-Rosales R, Estcourt CS, Salmon A, Koehoorn M, Gilbert M. Differential uptake and effects of digital sexually transmitted and bloodborne infection testing interventions among equity-seeking groups: a scoping review. Sex Transm Infect 2023; 99:554-560. [PMID: 37402569 PMCID: PMC10715539 DOI: 10.1136/sextrans-2023-055749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Digital sexually transmitted and bloodborne infection (STBBI) testing interventions have gained popularity. However, evidence of their health equity effects remains sparse. We conducted a review of the health equity effects of these interventions on uptake of STBBI testing and explored design and implementation factors contributing to reported effects. METHODS We followed Arksey and O'Malley's framework for scoping reviews (2005) integrating adaptations by Levac et al (2010). We searched OVID Medline, Embase, CINAHL, Scopus, Web of Science, Google Scholar and health agency websites for peer-reviewed articles and grey literature comparing uptake of digital STBBI testing with in-person models and/or comparing uptake of digital STBBI testing among sociodemographic strata, published in English between 2010 and 2022. We extracted data using the Place of residence, Race, Occupation, Gender/Sex, Religion, Education, Socioeconomic status (SES), Social capital and other disadvantaged characteristics (PROGRESS-Plus) framework, reporting differences in uptake of digital STBBI testing by these characteristics. RESULTS We included 27 articles from 7914 titles and abstracts. Among these, 20 of 27 (74.1%) were observational studies, 23 of 27 (85.2%) described web-based interventions and 18 of 27 (66.7%) involved postal-based self-sample collection. Only three articles compared uptake of digital STBBI testing with in-person models stratified by PROGRESS-Plus factors. While most studies demonstrated increased uptake of digital STBBI testing across sociodemographic strata, uptake was higher among women, white people with higher SES, urban residents and heterosexual people. Co-design, representative user recruitment, and emphasis on privacy and security were highlighted as factors contributing to health equity in these interventions. CONCLUSION Evidence of health equity effects of digital STBBI testing remains limited. While digital STBBI testing interventions increase testing across sociodemographic strata, increases are lower among historically disadvantaged populations with higher prevalence of STBBIs. Findings challenge assumptions about the inherent equity of digital STBBI testing interventions, emphasising the need to prioritise health equity in their design and evaluation.
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Affiliation(s)
- Ihoghosa Iyamu
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Rodrigo Sierra-Rosales
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Claudia S Estcourt
- Department of Nursing and Community Health, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - Amy Salmon
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Mieke Koehoorn
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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Rahib D, Lydié N. Dispositifs de dépistage des infections sexuellement transmissibles à domicile : quelle prise en compte des populations LGBT ? SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:179-188. [PMID: 37336732 DOI: 10.3917/spub.hs2.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Every days, more than one million people are infected with a sexually transmitted infection worlwide. In France, screening mainly rely on medical laboratories, private or public, with e prescription. Those tests face structural ans social barriers for LGBT people that could be partially lifted using at home self sampling. Using a narrative review, we will study how the needs of those populations are adressed in existing at home self sampling interventions. PURPOSE OF RESEARCH Describe the adaptation of home sampling system to MSM, WSW and transgender peoples. RESULTS Nine interventions met our inclusion criteria, eight in English spoken countries. Studies did not systematically reported data on sexual orientation. Transgender people, when identified, were rarely a larger group enough to be the subject of sub-analysis. Infections tested were CT and NG for three intervention, HIV only for one, CT,NG and HIV for five, and one also add HCV. CONCLUSIONS Standing as a complement to physical testing services, at home self-sampling intervention could benefit from an advertisement to WSW and from the integration of wider sexual health services.
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Peuchant O, Lhomme E, Martinet P, Grob A, Baïta D, Bernier C, Gibaud SA, Le Hen I, Le Naour E, Trignol-Viguier N, Lanotte P, Lefebvre P, Vachée A, Girard T, Loubinoux J, Bébéar C, Ghezzoul B, Roussillon C, Kret M, de Barbeyrac B. Doxycycline versus azithromycin for the treatment of anorectal Chlamydia trachomatis infection in women concurrent with vaginal infection (CHLAZIDOXY study): a multicentre, open-label, randomised, controlled, superiority trial. THE LANCET. INFECTIOUS DISEASES 2022; 22:1221-1230. [PMID: 35550262 DOI: 10.1016/s1473-3099(22)00148-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Anorectal infections with Chlamydia trachomatis are commonly found in women. Although the efficacy of doxycycline and azithromycin is comparable in the treatment of urogenital infection, their efficacies toward anorectal infection remain unclear. We therefore aimed to compare a single dose of azithromycin with a 7-day course of doxycycline for the treatment of anorectal C trachomatis infection in women with concurrent vaginal infection. METHODS We did a multicentre, open-label, randomised, controlled, superiority trial involving four sexually transmitted infection screening centres and three pregnancy termination centres in France. We included sexually active adult women (≥18 years) with a positive C trachomatis vaginal swab who agreed to provide self-collected anorectal swabs for C trachomatis detection. Participants were randomly assigned (1:1), using block sizes of six and eight and stratification by each investigating centre, to orally receive either azithromycin (a single 1-g dose, with or without food) or doxycycline (100 mg in the morning and evening at mealtimes for 7 days [ie, 100 mg of doxycycline twice per day for 7 days]). All laboratory staff who did the bacteriological analyses, but not the participants and the investigators, were masked to the treatment groups. The primary outcome was the microbiological anorectal cure rate defined as a C trachomatis-negative nucleic acid amplification test (NAAT) result in anorectal specimens 6 weeks after treatment initiation among women who had a baseline C trachomatis-positive anorectal NAAT result. The primary analysis was done in the modified intention-to-treat population, with multiple imputation, which included all women who underwent randomisation and had a C trachomatis-positive vaginal and anorectal NAAT result at baseline. Adverse events were reported in all women who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT03532464. FINDINGS Between Oct 19, 2018, and April 17, 2020, we randomly assigned a total of 460 participants to either the doxycycline group (n=230) or the azithromycin group (n=230). Four (1%) of 460 participants were excluded because they refused to take doxycycline or were found to be ineligible after randomisation. Among the 456 participants, 357 (78%) had a concurrent C trachomatis-positive anorectal NAAT result at baseline; 184 (52%) of 357 were in the doxycycline group and 173 (48%) were in the azithromycin group (ie, the modified intention-to-treat population). Microbiological anorectal cure occurred in 147 (94%) of 156 participants in the doxycycline group (28 missing values) versus 120 (85%) of 142 in the azithromycin group (31 missing values; adjusted odds ratio with imputation of missing values 0·43 [95% CI 0·21-0·91]; p=0·0274). Reported adverse events possibly related to treatment were notified in 53 (12%) of 456 women: 24 (11%) of 228 in the doxycycline group and 29 (13%) of 228 in the azithromycin group. Gastrointestinal disorders were the most frequently occurring, in 43 (9%) of 456 women: 17 (8%) of 228 in the doxycycline group and 26 (11%) of 228 in the azithromycin group. INTERPRETATION The microbiological anorectal cure rate was significantly lower among women who received a single dose of azithromycin than among those who received a 1-week course of doxycycline. This finding suggests that doxycycline should be the first-line therapy for C trachomatis infection in women. FUNDING French Ministry of Health. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Olivia Peuchant
- Laboratoire de Bactériologie, Centre National de Référence des Infections Sexuellement Transmissibles Bactériennes, CHU Bordeaux, Bordeaux, France
| | - Edouard Lhomme
- Pôle Santé Publique, Service d'information Médicale, CHU Bordeaux, Bordeaux, France
| | | | - Anne Grob
- CeGIDD, Département des Bouches du Rhône, Marseille, France
| | - Dounia Baïta
- Centre d'Orthogénie, CHU Bordeaux, Bordeaux, France
| | - Claire Bernier
- CeGIDD, Department des Maladies Infectieuses, INSERM UIC 1413, CHU Nantes, Nantes, France
| | | | | | | | | | | | | | - Anne Vachée
- Laboratoire de Bactériologie, CH Roubaix, Roubaix, France
| | - Thomas Girard
- Espace Santé Jeunes Guy Moquet, Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Julien Loubinoux
- Service de Bactériologie, Hôpital Cochin, AP-HP Centre-Université de Paris, Paris, France
| | - Cécile Bébéar
- Laboratoire de Bactériologie, Centre National de Référence des Infections Sexuellement Transmissibles Bactériennes, CHU Bordeaux, Bordeaux, France
| | | | - Caroline Roussillon
- Direction de la Recherche Clinique et de l'innovation, Unité de Sécurité et Vigilance des Essais Cliniques, CHU Bordeaux, Bordeaux, France
| | - Marion Kret
- Pôle Santé Publique, Service d'information Médicale, CHU Bordeaux, Bordeaux, France
| | - Bertille de Barbeyrac
- Laboratoire de Bactériologie, Centre National de Référence des Infections Sexuellement Transmissibles Bactériennes, CHU Bordeaux, Bordeaux, France.
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Sumray K, Lloyd KC, Estcourt CS, Burns F, Gibbs J. Access to, usage and clinic outcomes of, online postal sexually transmitted infection services: a scoping review. Sex Transm Infect 2022; 98:sextrans-2021-055376. [PMID: 35701146 PMCID: PMC9613868 DOI: 10.1136/sextrans-2021-055376] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/01/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There has been considerable expansion in online postal self-sampling (OPSS) STI services in many parts of the UK, driven by increasing demand on sexual health services and developments in diagnostics and digital health provision. This shift in service delivery has occurred against a backdrop of reduced funding and service fragmentation and the impact is unknown. We explored characteristics of people accessing and using OPSS services for STIs in the UK, the acceptability of these services and their impact on sexual health inequalities. METHODS A scoping review was conducted of studies published in English-language based on pre-agreed inclusion/exclusion criteria, between 01 January 2010 and 07 July 2021. Nine databases were searched, and 23 studies that met the eligibility criteria were included. Studies were appraised using the Mixed Methods Appraisal Tool. RESULTS Study designs were heterogeneous, including quantitative, qualitative and mixed-methods analyses. The majority were either evaluating a single-site/self-sampling provider, exploratory or observational and of variable quality. Few studies collected comprehensive user demographic data. Individuals accessing OPSS tended to be asymptomatic, of white ethnicity, women, over 20 years and from less deprived areas. OPSS tended to increase overall STI testing demand and access, although return rates for blood samples were low, as was test positivity. There were varied results on whether services reduced time to treatment. OPSS services were acceptable to the majority of users. Qualitative studies showed the importance of trust, confidentiality, discretion, reliability, convenience and improved patient choice. CONCLUSION OPSS services appear highly acceptable to users. However, uptake appears to be socially patterned and some groups who bear a disproportionate burden of poor sexual health in the UK are under-represented among users. Current provision of online self-sampling could widen health inequalities, particularly where other options for testing are limited. Work is needed to fully evaluate the impact and cost-effectiveness of OPSS services.
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Affiliation(s)
- Kirsi Sumray
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Karen C Lloyd
- Centre for Population Research in Sexual Health and HIV, University College London, London, UK
| | - Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Burns
- Centre for Clinical Research in Infection and Sexual Health, University College London, London, UK
| | - Jo Gibbs
- Centre for Population Research in Sexual Health and HIV, University College London, London, UK
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8
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Versluis A, Schnoor K, Chavannes NH, Talboom-Kamp EP. Direct Access for Patients to Diagnostic Testing and Results Using eHealth: Systematic Review on eHealth and Diagnostics. J Med Internet Res 2022; 24:e29303. [PMID: 35019848 PMCID: PMC8792777 DOI: 10.2196/29303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/14/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The number of people with chronic diseases and the subsequent pressure on health care is increasing. eHealth technology for diagnostic testing can contribute to more efficient health care and lower workload. OBJECTIVE This systematic review examines the available methods for direct web-based access for patients to diagnostic testing and results in the absence of a health care professional in primary care. METHODS We searched the PubMed, Embase, Web of Sciences, Cochrane Library, Emcare, and Academic Search Premier databases in August 2019 and updated in July 2021. The included studies focused on direct patient access to web-based triage leading to diagnostic testing, self-sampling or testing, or web-based communication of test results. A total of 45 studies were included. The quality was assessed using the Mixed Methods Appraisal Tool. RESULTS Most studies had a quantitative descriptive design and discussed a combination of services. Diagnostic test services mainly focused on sexually transmitted infections. Overall, the use was high for web-based triage (3046/5000, >50%, who used a triage booked a test), for self-sampling or self-testing kits (83%), and the result service (85%). The acceptability of the test services was high, with 81% preferring home-based testing over clinic-based testing. There was a high rate of follow-up testing or treatment after a positive test (93%). CONCLUSIONS The results show that direct access to testing and result services had high use rates, was positively evaluated, and led to high rates of follow-up treatment. More research on cost-effectiveness is needed to determine the potential for other diseases. Direct access to diagnostic testing can lower the threshold for testing in users, potentially increase efficiency, and lower the workload in primary care.
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Affiliation(s)
- Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Kyma Schnoor
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands.,Saltro Diagnostic Center, Utrecht, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Esther Pwa Talboom-Kamp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands.,Saltro Diagnostic Center, Utrecht, Netherlands
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9
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Cannon CA, Piraino AK, Golden MR, Barbee LA. Sexually Transmitted Infection Testing Using Online Companies: Benefits, Drawbacks, and Call for Official Guidance. Sex Transm Dis 2021; 48:e168-e170. [PMID: 33633071 DOI: 10.1097/olq.0000000000001401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT In this brief case series, we outline issues with some online sexually transmitted infection services and delayed reporting of results. Commercial entities providing sexually transmitted infection testing should ensure that all results are reported to local public health jurisdictions and that procedures exist to link persons to appropriate treatment and follow-up.
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Affiliation(s)
- Chase A Cannon
- From the Department of Medicine, University of Washington, Seattle
| | - Alyssa K Piraino
- Public Health-Seattle & King County, HIV/STD Program, King County, WA
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10
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Exten C, Pinto CN, Gaynor AM, Meyerson B, Griner SB, Van Der Pol B. Direct-to-Consumer Sexually Transmitted Infection Testing Services: A Position Statement from the American Sexually Transmitted Diseases Association. Sex Transm Dis 2021; 48:e155-e159. [PMID: 34030157 PMCID: PMC8505153 DOI: 10.1097/olq.0000000000001475] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Direct-to-consumer test services have gained popularity for sexually transmitted infections in recent years, with substantially increased use as a result of the SARS-CoV-2 (CoVID-19) global pandemic. This method of access has been variously known as "self-testing," "home testing," and "direct access testing." Although these online services may be offered through different mechanisms, here we focus on those that are consumer-driven and require self-collected samples, and sample shipment to a centralized laboratory without involvement of health care providers and/or local health departments. We provide the American Sexually Transmitted Diseases Association's position on utilization of these services and recommendations for both consumers and health care providers.
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Affiliation(s)
- Cara Exten
- From the The Pennsylvania State University College of Nursing, University Park
| | - Casey N. Pinto
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA
| | - Anne M. Gaynor
- Association of Public Health Laboratories, Silver Spring, MD
| | - Beth Meyerson
- College of Social and Behavioral Sciences, Southwest Institute for Research on Women, University of Arizona, Tucson, AZ
| | - Stacey B. Griner
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX
| | - Barbara Van Der Pol
- Schools of Medicine
- Public Health, University of Alabama at Birmingham, Birmingham, AL
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11
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Debonnet C, Robin G, Prasivoravong J, Vuotto F, Catteau-Jonard S, Faure K, Dessein R, Robin C. [Update of Chlamydia trachomatis infection]. ACTA ACUST UNITED AC 2021; 49:608-616. [PMID: 33434747 DOI: 10.1016/j.gofs.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Indexed: 12/25/2022]
Abstract
Chlamydia trachomatis (CT) is the most common sexually transmitted bacterial infection worldwide. It is asymptomatic in most cases and mainly affects young women, with potential long term sequelae (pelvic inflammatory disease, tubal infertility, obstetric complications). The impact on male fertility is controversial. Screening methods as well as antibiotics use have recently been reassessed due to resistance phenomena and the negative effect on the urogenital microbiota. Positive CT serology may be indicative of tuboperitoneal pathology, which may not be noticed on hysterosalpingography. New research on single-nucleotide polymorphisms (SNPs) aims to establish a patient profile at higher risk of infectious tubal damage due to CT. CT seropositivity is also associated with decreased spontaneous pregnancy rates and is a predictive factor for obstetrical complications.
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Affiliation(s)
- C Debonnet
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France.
| | - G Robin
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France; Service d'andrologie, université de Lille, CHU Lille, 59000 Lille, France
| | - J Prasivoravong
- Service d'andrologie, université de Lille, CHU Lille, 59000 Lille, France
| | - F Vuotto
- Service de maladies infectieuses, université de Lille, CHU Lille, 59000 Lille, France
| | - S Catteau-Jonard
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France
| | - K Faure
- Service de maladies infectieuses, université de Lille, CHU Lille, 59000 Lille, France
| | - R Dessein
- Institut de microbiologie et service de bactériologie, université de Lille, CHU Lille, 59000 Lille, France
| | - C Robin
- Service de médecine de la reproduction, université de Lille, CHU Lille, 59000 Lille, France
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12
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Rahib D, Delagreverie H, Gabassi A, Le Thi TT, Vassel E, Vodosin P, Leveau B, Pisoni A, Tuaillon E, Digne J, Icard V, Delaugerre C, Lydié N. Online self-sampling kits to screen multipartner MSM for HIV and other STIs: participant characteristics and factors associated with kit use in the first 3 months of the MemoDepistages programme, France, 2018. Sex Transm Infect 2021; 97:134-140. [PMID: 33397802 DOI: 10.1136/sextrans-2020-054790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In 2017, to reduce the proportion of men who have sex with men (MSM) in the undiagnosed HIV population in France (38%), HIV screening is advised each 3 months and STI screening is advised each year in multipartner MSM. Despite the range of testing solutions, over 40% of MSM were not tested for HIV and over 50% for STIs in the past year. Based on international experiments that offer screening solutions via online advertising, the French National Health Agency launched a programme (MemoDepistages) to provide a free self-sampling kit (SSK) for HIV and STIs. This article analyses the sociodemographic and behavioural characteristics of MSM in terms of kit acceptance and sample return. METHODS Participants were registered for the programme online after ordering an SSK. The study included men aged over 18 years, living in one of the four selected French regions, and willing to disclose their postal and email address; they had health insurance, acknowledged more than one male partner in the past year, indicated a seronegative or unknown HIV status and were not taking medically prescribed pre-exposure prophylaxis drugs. Samples were collected by users and posted directly to the laboratory. Characteristics associated with kit acceptance and sample return were analysed using logistic regression. RESULTS Overall, 7158 eligible MSM were offered to participate in the programme, with 3428 ordering the kit (47.9%) and 1948 returning their sample, leading to a return rate of 56.8% and an overall participation rate of 27.2%. Acceptance and return rates were strongly associated with sociodemographic characteristics, mainly education level but not with behavioural characteristics. Non-college graduates had lower acceptance (44.2%) and return rates (47.7%). CONCLUSION The programme rapidly recruited a large number of MSM. It removed geographical inequalities related to screening access.
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Affiliation(s)
- Delphine Rahib
- Sexual Health Unit, Santé publique France, Saint Maurice, France .,iPLESP UMRS1136, INSERM, Paris, France
| | | | - Audrey Gabassi
- Microbiology Department, Hopital Saint-Louis, Paris, France
| | - Thanh-Thuy Le Thi
- Centre de ressources biologiques Nord, Hospices Civils de Lyon, Lyon, France
| | - Eleonore Vassel
- Centre de ressources biologiques Nord, Hospices Civils de Lyon, Lyon, France
| | - Pierre Vodosin
- Centre de ressources biologiques Nord, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Leveau
- Centre de ressources biologiques Nord, Hospices Civils de Lyon, Lyon, France
| | - Amandine Pisoni
- Département de bactériologie-virologie, Inserm UMR 1058, CHRU de Montpellier, Montpellier, France
| | - Edouard Tuaillon
- Département de bactériologie-virologie, Inserm UMR 1058, CHRU de Montpellier, Montpellier, France
| | | | - Vinca Icard
- Centre de ressources biologiques Nord, Hospices Civils de Lyon, Lyon, France
| | | | - Nathalie Lydié
- Sexual Health Unit, Santé publique France, Saint Maurice, France
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13
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Biello KB, Horvitz C, Mullin S, Mayer KH, Scott H, Coleman K, Dormitzer J, Norelli J, Hightow-Weidman L, Sullivan P, Mimiaga MJ, Buchbinder S, Bojan K, Futterman D, Emmanuel P, Liu A. HIV self-testing and STI self-collection via mobile apps: experiences from two pilot randomized controlled trials of young men who have sex with men. Mhealth 2021; 7:26. [PMID: 33898595 PMCID: PMC8063023 DOI: 10.21037/mhealth-20-70] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/15/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Young men who have sex with men (YMSM) are disproportionately impacted by HIV and other sexually transmitted infections (STIs) in the United States (US) and have low rates of HIV/STI testing. Provision of HIV self-testing and STI self-collection can increase testing rates, and access to these kits through mobile applications (apps) could help facilitate YMSM using HIV self-testing and STI self-collection. METHODS Data for this study comes from two pilot randomized controlled trials (RCTs) of mobile apps within the Adolescent Trials Network-LYNX and MyChoices-aimed to increase HIV/STI testing among YMSM (age 15-24) who had not recently tested for HIV and were at high risk for HIV acquisition across five US cities. Both apps include the ability to order a HIV self-test with rapid results and a kit for STI self-collection and mailing of samples for syphilis, gonorrhea and chlamydia to a lab for testing. Using assessments of app users (n=80) at pre-randomization and at 3- and 6-months post-randomization and online interview data from a purposive sample of app users (n=37), we report on experiences and lessons learned with HIV self-testing and STI self-collection kits ordered via the apps. RESULTS Participants were on average 20.7 years of age (SD =2.4), and 49% were non-White or multiple race/ethnicity. Sixty-three percent had a prior HIV test. Over half (58%) had a prior STI test, but only 3% had tested within the past 3 months. Nearly two-thirds ordered an HIV self-testing kit; of whom, 75% reported using at least one self-test kit over the study period. STI self-collection kit ordering rates were also high (54%); however, STI self-collection kit return rates were lower (13%), but with a high positivity rate (5.3%). Both HIV self-testing and STI self-collection kits were highly acceptable, and 87% reported that it was extremely/very helpful to be able to order these kits through the apps. The most common reason for not ordering the HIV/STI kits was preferring to test at a clinic. In interviews, participants expressed feeling empowered by being able to test at home; however, they also raised concerns around STI sample collection. CONCLUSIONS HIV self-testing and STI self-collection kit ordering via mobile apps is feasible, acceptable and may show promise in increasing testing rates among YMSM. The LYNX and MyChoices apps are currently being tested in a full-scale efficacy trial, and if successful, these innovative mobile apps could be scaled up to efficiently increase HIV/STI testing among youth across the US.
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Affiliation(s)
- Katie B. Biello
- Departments of Behavioral & Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Casey Horvitz
- Institute for Global Health & Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Shelby Mullin
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Global Health and Population, Harvard T.C. Chan School of Public Health, Boston, MA, USA
- Department of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
| | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | | | - Jenna Norelli
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Hightow-Weidman
- Institute for Global Health & Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matthew J. Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
| | - Kelly Bojan
- Division of Adolescent Medicine, The Ruth M. Rothstein CORE Center, Chicago, IL, USA
| | - Donna Futterman
- Adolescent AIDS Program, Children’s Hospital at Montefiore, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patricia Emmanuel
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Albert Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
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14
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Day S, Singh GJ, Jones S, Kinsella R. Sexual assault reporting amongst users of online sexual health services. Int J STD AIDS 2020; 32:280-285. [DOI: 10.1177/0956462420963940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sexual assault (SA) survivors often attend sexual health clinics (SHC) for care relating to their assault. Reported rates of SA amongst SHC attendees can be high. Online sexual health services are becoming increasingly popular. Sexual Health London (SHL) is a large online sexual transmitted infection (STI) screening service. Between 1.1.20– 8.2.20, 0.5% (242/45841) (54% female, 45.6% male) of adults disclosed a recent SA when ordering an online STI testing kit. 79% (192/242) users engaged in a call back discussion initiated by the SHL team: 45% (87/192) users confirmed a SA had occurred and 53% (101/242) users denied an assault (particularly men) stating they had reported this in error. 18% (16/87) users had already reported their SA to the police/sexual assault centre, and one user accepted an onward referral. This study found a low reporting rate of SA amongst SHL users, but despite a high response rate to call backs, >50% cited they reported in error, 25% (22/87) didn’t want to discuss their SA and few accepted onward referrals. Using e-triage to screen for SA followed by service-initiated telephonic support to everyone who discloses, may not be acceptable or offer utility to all. Further evaluation of ways to engage these individuals is required.
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Affiliation(s)
- Sara Day
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Sophie Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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15
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Day S, Kinsella R, Jones S, Tittle V, Suchak T, Forbes K. Safeguarding outcomes of 16 and 17-year-old service users of Sexual Health London (SHL.uk), a pan-London online sexual health service. Int J STD AIDS 2020; 31:1373-1379. [PMID: 33103583 DOI: 10.1177/0956462420933462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guidance around how to safeguard young people using online sexual health services (e-SHSs) is limited. Sexual Health London (SHL.uk) is an e-SHS, integrated with London's sexual health clinics (SHCs), offering users aged 16 years and above sexually transmitted infection (STI) testing. For a safeguarding risk assessment, under 18s must complete a safeguarding e-triage, and any concern raised results in a 'call back' (CB) by the SHL.uk team. The safeguarding outcomes of CBs between 8 January 2018 and 18 September 2018 were reviewed; 261/454 (57.5%) users never triggered a CB on their e-triage (non-CB group) and 193/454 (42.5%) users triggered one or more CB(s) (CB group). Safeguarding concerns disclosed predominantly related to drug/alcohol use and partner's age imbalance. Successful telephonic risk assessment took place in 84.5% CB cases. Safeguarding outcomes comprised referrals to: SHC in 35.5%; child protection team in 8.5%; social services in 7%. STI positivity was 16.4% and 15.2% in the CB and non-CB groups, respectively. Although a high number of safeguarding triggers were disclosed, only a small proportion warranted referral for further support/intervention. Using e-triage with telephony support to screen and safeguard adolescents accessing an e-SHS was acceptable to users and enabled their clinical and safeguarding needs to be safely met. e-SHS integration within a network of SHCs further supported this model.
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Affiliation(s)
- Sara Day
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Sophie Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Victoria Tittle
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Tara Suchak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Kimberley Forbes
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Kpokiri EE, Marley G, Tang W, Fongwen N, Wu D, Berendes S, Ambil B, Loveday SJ, Sampath R, Walker JS, Matovu JKB, Boehme C, Pai NP, Tucker JD. Diagnostic Infectious Diseases Testing Outside Clinics: A Global Systematic Review and Meta-analysis. Open Forum Infect Dis 2020; 7:ofaa360. [PMID: 33072806 PMCID: PMC7545117 DOI: 10.1093/ofid/ofaa360] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Most people around the world do not have access to facility-based diagnostic testing, and the gap in availability of diagnostic tests is a major public health challenge. Self-testing, self-sampling, and institutional testing outside conventional clinical settings are transforming infectious disease diagnostic testing in a wide range of low- and middle-income countries (LMICs). We examined the delivery models of infectious disease diagnostic testing outside clinics to assess the impact on test uptake and linkage to care. METHODS We conducted a systematic review and meta-analysis, searching 6 databases and including original research manuscripts comparing testing outside clinics with conventional testing. The main outcomes were test uptake and linkage to care, delivery models, and adverse outcomes. Data from studies with similar interventions and outcomes within thematic areas of interest were pooled, and the quality of evidence was assessed using GRADE. This study was registered in PROSPERO (CRD42019140828).We identified 10 386 de-duplicated citations, and 76 studies were included. Data from 18 studies were pooled in meta-analyses. Studies focused on HIV (48 studies), chlamydia (8 studies), and multiple diseases (20 studies). HIV self-testing increased test uptake compared with facility-based testing (9 studies: pooled odds ratio [OR], 2.59; 95% CI, 1.06-6.29; moderate quality). Self-sampling for sexually transmitted infections increased test uptake compared with facility-based testing (7 studies: pooled OR, 1.74; 95% CI, 0.97-3.12; moderate quality). Conclusions. Testing outside of clinics increased test uptake without significant adverse outcomes. These testing approaches provide an opportunity to expand access and empower patients. Further implementation research, scale-up of effective service delivery models, and policies in LMIC settings are needed.
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Affiliation(s)
- Eneyi E Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Gifty Marley
- School of Public Health, Nanjing Medical University, Jiangsu, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill, Project-China, Chapel Hill, North Carolina, USA
| | - Noah Fongwen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Dan Wu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sima Berendes
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Bhavana Ambil
- Department of Global Health, North Carolina State University, Raleigh, North Carolina, USA
| | | | - Ranga Sampath
- Foundation for Innovative New Diagnostics, Switzerland
| | - Jennifer S Walker
- Health Sciences Library, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Nitika Pant Pai
- CORE, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Division of Clinical Epidemiology & Infectious Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
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Ngangro NN, Velter A, Lydie N, Lot F. Authors' response: Prevention of bacterial sexually transmitted infections (STI) in France: a comprehensive approach. ACTA ACUST UNITED AC 2020; 24. [PMID: 30914074 PMCID: PMC6440583 DOI: 10.2807/1560-7917.es.2019.24.12.1900187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Söderqvist J, Gullsby K, Stark L, Wikman M, Karlsson R, Herrmann B. Internet-based self-sampling for Chlamydia trachomatis testing: a national evaluation in Sweden. Sex Transm Infect 2020; 96:160-165. [PMID: 31932359 PMCID: PMC7231453 DOI: 10.1136/sextrans-2019-054256] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/22/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Internet-based testing for Chlamydia trachomatis (CT) with self-sampling at home has gradually been implemented in Sweden since 2006 as a free-of-charge service within the public healthcare system. This study evaluated the national diagnostic outcome of this service. METHODS Requests for data on both self-sampling at home and clinic-based sampling for CT testing were sent to the laboratories in 18 of 21 counties. Four laboratories were also asked to provide data on testing patterns at the individual level for the years 2013-2017. RESULTS The proportion of self-sampling increased gradually from 2013, comprising 22.0% of all CT tests in Sweden in 2017. In an analysis of 14 counties (representing 83% of the population), self-sampling increased by 115% between 2013 and 2017 for women, compared with 71% for men, while test volumes for clinic-based sampling were fairly constant for both sexes (1.8% increase for women, 15% increase for men). In 2017 self-sampling accounted for 20.3% of all detected CT cases, and the detection rate was higher than, but similar to, clinic-based testing (5.5% vs 5.1%). The proportion of self-sampling men was also higher, but similar (33.7% vs 30.8%). Analysis of individual testing patterns in four counties over 5 years showed a higher proportion of men using self-sampling only (67%, n=10 533) compared with women (40%, n=8885). CONCLUSIONS Self-sampling has increased substantially in recent years, especially among women. This service is at least as beneficial as clinic-based screening for detection of CT, and self-sampling reaches men more than clinic-based testing.
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Affiliation(s)
- Joakim Söderqvist
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karolina Gullsby
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Lisa Stark
- Department of Laboratory Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Maria Wikman
- Department of Virology, University of Umeå, Umeå, Sweden
| | - Roger Karlsson
- Department of Public Health and Clinical Medicine, University of Umeå, Umeå, Sweden
| | - Bjőrn Herrmann
- Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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19
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Gilbert M, Salway T, Haag D, Elliot E, Fairley C, Krajden M, Grennan T, Shoveller J, Ogilvie GS. A cohort study comparing rate of repeat testing for sexually transmitted and blood-borne infections between clients of an internet-based testing programme and of sexually transmitted infection clinics in Vancouver, Canada. Sex Transm Infect 2019; 95:540-546. [PMID: 31467134 PMCID: PMC6860414 DOI: 10.1136/sextrans-2019-054071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/23/2019] [Accepted: 08/12/2019] [Indexed: 12/05/2022] Open
Abstract
Objectives Internet-based sexually transmitted and blood-borne infection (STBBI) testing services reduce testing barriers through bypassing face-to-face clinical encounters, potentially enabling clients at ongoing sexual risk to test more frequently. To our knowledge, this hypothesis has not been previously tested. We compared the frequency of repeat testing between Vancouver-based clients of GetCheckedOnline (GCO)—an internet-based STBBI testing service in British Columbia, Canada—and clients of three sexually transmitted infection (STI) clinics in Vancouver for 29 months after GCO launched. Methods An administrative data cohort (n=19 497) was assembled using GCO, clinical and laboratory databases. We included all individuals who tested for HIV, gonorrhoea/chlamydia, syphilis or hepatitis C at three STI clinics or using GCO, between September 2014 and February 2017. The rate of repeat testing (>30 days after first episode) was compared between clients who used GCO at least once and those who tested only in STI clinics. Poisson regression was used to generate relative rate (RR) for repeat testing, with adjustment for age, gender/sexual orientation, risk factors (eg, history of STI diagnosis) and rate of testing before GCO launched. Results 1093 GCO clients were identified, of whom 434 (40%) had repeat test episodes; 8200/18 404 (45%) of clinic clients tested more than once. During the 29-month analysis period, GCO clients repeat tested 1.87 times per person-year, whereas clinic clients repeat tested 1.53 times per person-year, resulting in a crude RR of 1.22 (95% CI: 1.14 to 1.31). Adjustment for covariates increased the RR to 1.26 (95% CI: 1.15 to 1.37). Conclusions In this cohort, individuals using internet-based STBBI testing had a rate of repeat testing 22% greater than clinic-based clients. This effect was increased after adjusting for characteristics associated with higher test frequency. The online interface of GCO may facilitate more frequent testing and may therefore contribute to earlier STBBI diagnosis.
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Affiliation(s)
- Mark Gilbert
- BC Centre for Disease Control, Vancouver, British Columbia, Canada .,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Devon Haag
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Elizabeth Elliot
- British Columbia Colleage of Nursing Professionals, Vancouver, British Columbia, Canada
| | | | - Mel Krajden
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Shoveller
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gina Suzanne Ogilvie
- BC Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Burchell AN, Lisk R, Yeung A, Rana J, Bacon J, Brunetta J, Gilbert M, Gesink D, Grewal R, Guiang CB, Kwag M, Logie CH, Mitterni L, Shahin R, Tan DH. Community-Directed Bacterial Sexually Transmitted Infection Testing Interventions Among Men Who Have Sex With Men: Protocol for an E-Delphi Study in Toronto, Canada. JMIR Res Protoc 2019; 8:e13801. [PMID: 31274111 PMCID: PMC6637728 DOI: 10.2196/13801] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 01/17/2023] Open
Abstract
Background HIV-positive and HIV-negative (gay, bisexual, and other) men who have sex with men (MSM) have experienced a dramatic increase in bacterial sexually transmitted infections (STIs)—syphilis, gonorrhea, and chlamydia. STI testing and treatment mitigate adverse health outcomes and substantially reduce transmission; yet, testing rates remain below recommended levels. Innovation is needed to produce the required increases in testing levels, frequency, and the use of appropriate testing technologies in ways that are engaging, nonstigmatizing, and acceptable to men. Objective The aim of this study is to build consensus with regard to interventions with the greatest potential for improving local STI testing services for MSM communities in Toronto, Canada. Methods Following a literature review of evidence regarding the effectiveness of novel testing interventions, and focus groups, and surveys to describe local barriers and facilitators of testing among MSM, we will conduct a Web-based, modified Delphi study (e-Delphi). We will form expert panels of community members and STI test providers. Panelists will rate potential interventions in terms of their priority, using a 7-point Likert scale from definitely not a priority to definitely a priority. They will also rank their preferences by selecting their top 3 preferred interventions. Surveys will be distributed in 3 rounds, with feedback on the distribution of responses from preceding rounds provided in rounds 2 and 3. We will define consensus as having ≥60% (18/30) members indicate a preference within 2 adjacent response points. Qualitative data on disagreements will be obtained using open-ended text responses to explain for ratings and rankings that are different from the majority. Results On the basis of a literature review and identification of barriers and facilitators to STI testing among community members and test providers in Toronto, we have selected 8 potential interventions for inclusion in the e-Delphi panel surveys. These include 4 interventions that streamline STI testing for asymptomatic individuals, 2 interventions that are targeted at clients and 2 interventions that are targeted at providers. Conclusions Findings will provide community direction for informed decision making regarding the implementation of STI testing interventions in this setting. They will characterize the intervention climate for innovation to STI testing services, including perceived needs for changes to test delivery, relative priorities for change, and readiness for implementation. These methods may be transferable to other urban jurisdictions experiencing similar epidemics and for other contexts where stakeholder input is needed to manage sensitive areas of concern. International Registered Report Identifier (IRRID) PRR1-10.2196/13801
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Affiliation(s)
- Ann N Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada
| | | | - Anna Yeung
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Jayoti Rana
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Jean Bacon
- Ontario HIV Treatment Network, Toronto, ON, Canada
| | | | - Mark Gilbert
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ramandip Grewal
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Charlie B Guiang
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.,Hassle Free Clinic, Toronto, ON, Canada
| | - Michael Kwag
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | | | - Darrell Hs Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
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21
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Wilson E, Leyrat C, Baraitser P, Free C. Does internet-accessed STI (e-STI) testing increase testing uptake for chlamydia and other STIs among a young population who have never tested? Secondary analyses of data from a randomised controlled trial. Sex Transm Infect 2019; 95:569-574. [PMID: 31175210 PMCID: PMC6902059 DOI: 10.1136/sextrans-2019-053992] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/01/2019] [Accepted: 05/05/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of an internet-accessed STI (e-STI) testing and results service on testing uptake among young adults (16-30 years) who have never tested for STIs in London, England. METHODS We conducted secondary analyses on data from a randomised controlled trial. In the trial, participants were randomly allocated to receive a text message with the web link of an e-STI testing and results service (intervention group) or a text message with the link of a website listing the locations, contact details and websites of seven local sexual health clinics (control group). We analysed a subsample of 528 trial participants who reported never testing for STIs at baseline. Outcomes were self-reported STI testing at 6 weeks, verified by patient record checks, and time from randomisation to completion of an STI test. RESULTS Uptake of STI testing among 'never testers' almost doubled. At 6 weeks, 45.3% of the intervention completed at least one test (chlamydia, gonorrhoea, syphilis and HIV), compared with 24.1% of the control (relative risk [RR] 1.88, 95% CI 1.47 to 2.40, p<0.001). For chlamydia and gonorrhoea testing combined, uptake was 44.3% in the intervention versus 24.1% in controls (RR 1.84, 95% CI 1.44 to 2.36, p<0.001). The intervention reduced time to any STI test (restricted mean survival time: 29.0 days vs 36.3 days, p<0.001) at a time horizon of 42 days. CONCLUSIONS : e-STI testing increased uptake of STI testing and reduced time to test among a young population of 'never testers' recruited in community settings. Although encouraging, questions remain on how best to manage the additional demand generated by e-STI testing in a challenging funding environment. Larger studies are required to assess the effects later in the cascade of care, including STI diagnoses and cases treated.
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Affiliation(s)
- Emma Wilson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clémence Leyrat
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paula Baraitser
- Department of Sexual Health and HIV, King's College Hospital NHS Foundation Trust, London, UK.,School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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22
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Cazanave C, de Barbeyrac B. [Pelvic inflammatory diseases: Microbiologic diagnosis - CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. ACTA ACUST UNITED AC 2019; 47:409-417. [PMID: 30878688 DOI: 10.1016/j.gofs.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the microorganisms potentially involved in pelvic inflammatory diseases (PIDs) and the different diagnostic methods of PID. METHODS PubMed and International Guidelines search. RESULTS PIDs have various microbial causes. The pathogenic role of the main agents of sexually transmitted infections (STIs), Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium is well demonstrated (NP1). C. trachomatis is the most commonly described bacterium in PID (NP1), especially in women under 30 years old. PIDs also occur in situations that decrease the effectiveness of the cervix microbiological lock, such as bacterial vaginosis, allowing facultative vaginal bacteria such as Escherichia coli, Streptococcus agalactiae and anaerobes to ascend to the uterine cavity. Nevertheless, participation of the diverse bacteria of the vaginal microbiota, in particular anaerobes, and the polymicrobial character of PIDs are still differently appreciated. In the case of uncomplicated PID, to obtain a microbiological diagnosis, endocervical sampling is recommended during gynecological examination under speculum (grade B). A first swab allows for a smear on a slide for direct examination (Gram, MGG). A second swab, in an adapted transport medium, is useful for standard culture with N. gonorrhoeae and facultative vaginal flora bacteria cultures, with antibiotic susceptibility testing. A third swab, in an appropriate transport medium, allows for the search for N. gonorrhoeae, C. trachomatis, and if possible M. genitalium by nucleic acid amplification techniques (NAATs), (NP1). It is possible to only use one swab in a transport medium suitable for (i) survival of bacteria and (ii) NAATs. When the diagnosis of PID is clinically compatible, a positive NAAT for one or more of the three STI-associated bacteria on a genital sample supports the PID diagnosis (NP1). On the other hand, a negative NAAT does not allow the exclusion of an STI agent for PID diagnosis (NP1). In situations where speculum use is not possible, vaginal sampling will be performed by default. In case of complicated IGH, tuboperitoneal samples can be performed either radiologically or surgically. Since these sites are sterile, any bacteria present will be considered pathogenic (NP2). C. trachomatis serology is not interesting as a first line diagnostic tool for PID diagnosis and is not useful for monitoring the evolution of PID (NP1).
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Affiliation(s)
- C Cazanave
- Service des maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Infections humaines à mycoplasmes et chlamydiae, USC EA 3671, Institut national de la recherche agronomique, université Bordeaux, 33000 Bordeaux, France; Centre national de référence des infections sexuellement transmissibles bactériennes, CHU de Bordeaux, 33000 Bordeaux, France.
| | - B de Barbeyrac
- Infections humaines à mycoplasmes et chlamydiae, USC EA 3671, Institut national de la recherche agronomique, université Bordeaux, 33000 Bordeaux, France; Centre national de référence des infections sexuellement transmissibles bactériennes, CHU de Bordeaux, 33000 Bordeaux, France; Laboratoire de bactériologie, groupe hospitalier Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
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23
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Peuchant O, Lhomme E, Krêt M, Ghezzoul B, Roussillon C, Bébéar C, Perry F, de Barbeyrac B. Randomized, open-label, multicenter study of azithromycin compared with doxycycline for treating anorectal Chlamydia trachomatis infection concomitant to a vaginal infection (CHLAZIDOXY study). Medicine (Baltimore) 2019; 98:e14572. [PMID: 30762806 PMCID: PMC6408020 DOI: 10.1097/md.0000000000014572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis can lead to a persistent infection in the lower gastrointestinal tract, suggesting a potential role of autoinoculation of cervical chlamydial infection from the rectal site, contributing to repeat infections. Moreover, around 75% of women with urogenital C. trachomatis have concurrent anorectal infection. Current treatment guidelines for urogenital C. trachomatis infection recommend either a single 1 g dose of azithromycin or doxycycline 100 mg twice daily for 7 days. Doxycycline appears to be more effective in treating anorectal infections as suggested in a population of men who have sex with men, but no randomized controlled trial (RCT) had directly compared azithromycin with doxycycline for the treatment of rectal infections. We propose an open-label RCT to compare the microbial cure obtained with a single 1 g dose of azithromycin versus 100 mg of doxycycline twice daily for 7 days, for the treatment of anorectal C. trachomatis infection concurrent to urogenital infection in women. METHODS AND STUDY DESIGN A total of 460 women with C. trachomatis urogenital infection will be enrolled in the study. Women will be asked to provide self-collected anorectal swabs and will be randomized to receive either a 1 g single dose of azithromycin or doxycycline 100 mg twice daily for 7 days. Clinical and biological data will be collected and patients will complete questionnaires about their sexual behavior. The primary outcome is the microbial cure rate, defined as a C. trachomatis negative nucleic acid amplification test (NAAT) result in the anorectal specimens 6 weeks after treatment initiation among women with a C. trachomatis positive urogenital and anorectal NAAT result at the baseline. The secondary outcome is autoinoculation from the rectum to the vagina, which will be evaluated based on the number of women with the same C. trachomatis genotype profile that will be identified in an anorectal-positive specimen obtained 6 weeks after treatment initiation and in a vaginal-positive specimen obtained four months after treatment. DISCUSSION The results of this trial will establish which treatment is more efficacious against anorectal infection and could affect recommendations for the treatment of urogenital C. trachomatis infection, taking into account concurrent anorectal infection. TRIAL REGISTRATION NUMBERS EudraCT number: 2017-002595-15. CLINICALTRIALS. GOV IDENTIFIER NCT03532464. Date of registration: May 31, 2018. WORLD HEALTH ORGANISATION INTERNATIONAL CLINICAL TRIALS REGISTRY NTC03532464. Secondary ID: CHUBX 2016/26. Date of registration: May 09, 2018.
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Affiliation(s)
- Olivia Peuchant
- University Bordeaux
- INRA, USC EA 3671, Mycoplasmal and Chlamydial Infections in Humans
- CHU de Bordeaux, Bacteriology department, French National Reference Center for bacterial STI, Bordeaux, France
| | | | - Marion Krêt
- CHU de Bordeaux, Pôle de santé publique, CIC1401-EC
| | | | | | - Cécile Bébéar
- University Bordeaux
- INRA, USC EA 3671, Mycoplasmal and Chlamydial Infections in Humans
- CHU de Bordeaux, Bacteriology department, French National Reference Center for bacterial STI, Bordeaux, France
| | - Frédéric Perry
- CHU de Bordeaux, Research and Clinical Study Department, Bordeaux, France
| | - Bertille de Barbeyrac
- University Bordeaux
- INRA, USC EA 3671, Mycoplasmal and Chlamydial Infections in Humans
- CHU de Bordeaux, Bacteriology department, French National Reference Center for bacterial STI, Bordeaux, France
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24
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Rondeau P, Valin N, Decré D, Girard PM, Lacombe K, Surgers L. Chlamydia trachomatis screening in urine among asymptomatic men attending an STI clinic in Paris: a cross-sectional study. BMC Infect Dis 2019; 19:31. [PMID: 30621621 PMCID: PMC6325815 DOI: 10.1186/s12879-018-3595-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 12/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of Chlamydia trachomatis (Ct) urethritis has been increasing for the past 10 years. There is little data regarding the screening of Ct infection in asymptomatic men in France, despite the national recommendation to screen at-risk asymptomatic men under 30 attending Sexually Transmitted Infections (STI) clinics. Recent data from the French surveillance network Rénachla show indeed that systematic screening is still focused on women. The objective of our study was to determine the prevalence and risk factors for Ct infection in asymptomatic men under 30 attending an STI clinic located in Paris, France. METHODS We performed a cross-sectional study between April 4, and December 31, 2016 in the database of the software DIAMM Client V8 used in our STI clinic. We extracted the demographic characteristics, sexual behavior and result of STI screening of all asymptomatic men who had consulted and given their consent for the use of their personal data. Those data were collected in usual care through a standardized questionnaire filled in during an appointment with a trained physician. STI screening was performed using PCR kit CT/NG Abbott Realtime® on first void urines. For MSM, a rectal swab was also collected. Risk factors for Ct infection were analyzed by univariate and multivariate modeling using STATA software 8.2. RESULTS Among 872 men who had attended the clinic, 647 were included and 37 (5.7, 95% CI 4.2 to 7.8) were positive for Ct in urine. In univariate analysis, men who had unprotected sex in the last 6 weeks (OR 2.40 (95%CI 1.16 to 4.94), p = 0.02), and those who had an infected partner (OR 7.6 (95%CI 3.03 to 20), p = 0.0001) were more likely to be infected. In the multivariate analysis having an infected partner was the only risk factor (OR 11.1(95% CI 3.7 to 33.3), p = 0.0001) that remained significant. CONCLUSION Prevalence of Ct infection is high among asymptomatic men of 30 years or less attending our urban STI clinic especially among those with an infected partner. The Ct screening among this population associated with partner notification, as recommended by the French national guidelines, should be more widely implemented.
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Affiliation(s)
- Paul Rondeau
- Department of Infectious Diseases, University Hospital Saint-Antoine, APHP, 75012, Paris, France.
| | - Nadia Valin
- Department of Infectious Diseases, University Hospital Saint-Antoine, APHP, 75012, Paris, France
| | - Dominique Decré
- Department of Bacteriology, University Hospital Saint-Antoine, APHP, 75012, Paris, France.,Sorbonne University, UPMC Univ Paris 06 CR7, Paris, France; INSERM U1135, CIMI, Team E13, 75012, Paris, France
| | - Pierre-Marie Girard
- Department of Infectious Diseases, University Hospital Saint-Antoine, APHP, 75012, Paris, France.,Sorbonne University, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France
| | - Karine Lacombe
- Department of Infectious Diseases, University Hospital Saint-Antoine, APHP, 75012, Paris, France.,Sorbonne University, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France
| | - Laure Surgers
- Department of Infectious Diseases, University Hospital Saint-Antoine, APHP, 75012, Paris, France.,Sorbonne University, UPMC Univ Paris 06 CR7, Paris, France; INSERM U1135, CIMI, Team E13, 75012, Paris, France
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25
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Oakeshott P, Kerry-Barnard S, Fleming C, Phillips R, Drennan VM, Adams EJ, Majewska W, Harding-Esch EM, Cousins EC, Planche T, Green A, Bartholomew RI, Sadiq ST, Reid F. 'Test n Treat' (TnT): a cluster randomized feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges. Clin Microbiol Infect 2018; 25:865-871. [PMID: 30391581 DOI: 10.1016/j.cmi.2018.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We conducted a cluster-randomized feasibility trial of 90-minute Chlamydia trachomatis tests and same day on-site treatment ('Test n Treat/TnT') in six technical colleges in London, England, to assess TnT uptake rates; follow-up rates; prevalence of C. trachomatis at baseline and 7 months; time to treatment; acceptability of TnT. METHODS Participants completed questionnaires and provided genitourinary samples at baseline and 7 months. Participants were informed that baseline samples would not be tested for 7 months and were advised to get screened independently. Colleges were randomly allocated 1:1 to intervention (TnT) or control (no TnT). One month and 4 months post recruitment, participants at intervention colleges were texted invitations for on-site free C. trachomatis tests. A purposive sample of students who did/did not attend for screening were interviewed (n = 26). RESULTS Five hundred and nine sexually active students were recruited: median age 17.9 years, 47% male, 50% black ethnicity, 55% reporting two or more sexual partners in the previous year. TnT uptake was 13% (33/259; 95% CI 8.9-17.4%) at 1 month and 10% (26/259; 6.7-14.4%) at 4 months with overall C. trachomatis positivity 5.1% (3/59; 1.1-14.2%). Follow-up at 7 months was 62% (317/509) for questionnaires and 52% (264/509) for samples. C. trachomatis prevalence was 6.2% (31/503) at baseline and 6.1% (16/264) at 7 months. Median time from test to treatment was 15 h. Interviews suggested low test uptake was associated with not feeling at risk, perceptions of stigma, and little knowledge of sexually transmitted infections (STIs). CONCLUSIONS Despite high C. trachomatis rates at baseline and follow-up, uptake of testing was low. Like many countries, England urgently needs better sex education, including making STI testing routine/normal. Trial registration ISRCTN58038795.
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Affiliation(s)
- P Oakeshott
- Population Health Research Institute, St George's, University of London, London UK.
| | - S Kerry-Barnard
- Population Health Research Institute, St George's, University of London, London UK
| | - C Fleming
- Population Health Research Institute, St George's, University of London, London UK
| | - R Phillips
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - V M Drennan
- Centre for Health & Social Care Research, Kingston University & St George's, University of London, London, UK
| | - E J Adams
- Aquarius Population Health Limited, London, UK
| | | | - E M Harding-Esch
- Institute for Infection and Immunity, St George's, University of London, London, UK; Public Health England, London, UK
| | - E C Cousins
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - T Planche
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - A Green
- Population Health Research Institute, St George's, University of London, London UK
| | - R I Bartholomew
- Population Health Research Institute, St George's, University of London, London UK; Institute for Infection and Immunity, St George's, University of London, London, UK
| | - S T Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - F Reid
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Banerjee P, Thorley N, Radcliffe K. A service evaluation comparing home-based testing to clinic-based testing for Chlamydia and gonorrhoea in Birmingham and Solihull. Int J STD AIDS 2018; 29:974-979. [PMID: 29690825 DOI: 10.1177/0956462418767180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Home-based testing is an alternative, convenient and cost-effective method of testing for sexually transmitted infections compared to traditional clinic-based testing, in patients who are asymptomatic and, or, would otherwise feel stigmatised about attending sexual health clinics. The sexual health service in Birmingham and Solihull, called Umbrella, provides an online home-based testing service, which has been in operation since August 2015. The aim of this study was to evaluate the uptake and return rate of home-based testing kits and compare home-based testing to clinic-based testing in terms of diagnosis and treatment rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Our study showed that home-based testing is a popular method of testing and relatively more popular amongst asymptomatic, young, heterosexual female and White patients than clinic-based testing, with a return rate of 48%. The diagnosis rates for CT/GC are comparable to patients who attend clinic for testing (8% vs. 10% in home-based and clinic-based groups, respectively, p < 0.001). The overall treatment rate was lower in the home-based compared to the clinic-based group (82% vs. 88%, p < 0.001). Umbrella will continue to provide this service within Birmingham and Solihull and aim to provide patients with alternative pathways for more convenient access to treatment.
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Turner KM, Zienkiewicz AK, Syred J, Looker KJ, de Sa J, Brady M, Free C, Holdsworth G, Baraitser P. Web-Based Activity Within a Sexual Health Economy: Observational Study. J Med Internet Res 2018. [PMID: 29514776 PMCID: PMC5863011 DOI: 10.2196/jmir.8101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits ordered online and delivered in the post may increase access, convenience, and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users toward Web-based or face-to-face services according to clinical need. Objective The aim of this paper was to investigate the impact of two interventions on testing activity across a whole sexual health economy: (1) the introduction of open access Web-based STI testing services and (2) a clinic policy of triage and signpost online where users without symptoms who attended clinics for STI testing were supported to access the Web-based service instead. Methods Data on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed, and clinical activity provided, including test results. Clinical activity was categorized as a simple STI test (could be done in a clinic or online), a complex visit (requiring face-to-face consultation), or other. Results Introduction of Web-based services increased total testing activity across the whole sexual health economy by 18.47% (from 36,373 to 43,091 in the same 6-month period—2014-2015 and 2015-2016), suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the Web-based service, with simple STI testing in the clinic decreasing from 16.90% (920/5443) to 12.25% (511/4172) of total activity, P<.001, and complex activity in the clinic increasing from 69.15% (3764/5443) to 74.86% (3123/4172) of total activity, P<.001. This intervention created a new population of online users with different demographic and clinical profiles from those who use Web-based services spontaneously. Some triage and signposted users (29.62%, 375/1266) did not complete the Web-based testing process, suggesting the potential for missed diagnoses. Conclusions This evaluation shows that users can effectively be transitioned from face-to-face to Web-based services and that this introduces a new population to Web-based service use and changes the focus of clinic-based activity. Further development is underway to optimize the triage and signposting process to support test completion.
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Affiliation(s)
- Katy Me Turner
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
| | - Adam K Zienkiewicz
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jonathan Syred
- King's Center for Global Health and Health Partnerships, King's College London, London, United Kingdom.,School of Population Health & Environmental Sciences, King's College London, London, United Kingdom
| | - Katharine J Looker
- School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Michael Brady
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Paula Baraitser
- Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust, London, United Kingdom.,King's Center for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King's College London, London, United Kingdom
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Barnard S, Free C, Bakolis I, Turner KME, Looker KJ, Baraitser P. Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis. Sex Transm Infect 2018; 94:377-383. [PMID: 29437985 PMCID: PMC6204942 DOI: 10.1136/sextrans-2017-053302] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/06/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Online services for self-sampling at home could improve access to STI testing; however, little is known about those using this new modality of care. This study describes the characteristics of users of online services and compares them with users of clinic services. Methods We conducted a cross-sectional analysis of routinely collected data on STI testing activity from online and clinic sexual health services in Lambeth and Southwark between 1January 2016 and 31March 2016. Activity was included for chlamydia, gonorrhoea, HIV and syphilis testing for residents of the boroughs aged 16 years and older. Logistic regression models were used to explore potential associations between type of service use with age group, gender, ethnic group, sexual orientation, positivity and Index of Multiple Deprivation (IMD) quintiles. We used the same methods to explore potential associations between return of complete samples for testing with age group, gender, ethnic group, sexual orientation and IMD quintiles among online users. Results 6456 STI tests were carried out by residents in the boroughs. Of these, 3582 (55.5%) were performed using clinic services and 2874 (44.5%) using the online service. In multivariate analysis, online users were more likely than clinic users to be aged between 20 and 30 years, female, white British, homosexual or bisexual, test negative for chlamydia or gonorrhoea and live in less deprived areas. Of the individuals that ordered a kit from the online service, 72.5% returned sufficient samples. In multivariate analysis, returners were more likely than non-returners to be aged >20 years and white British. Conclusion Nearly half (44.5%) of all basic STI testing was done online, although the characteristics of users of clinic and online services differed and positivity rates for those using the online service for testing were lower. Clinics remain an important point of access for some groups.
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Affiliation(s)
- Sharmani Barnard
- School of Population Health and Environmental Sciences, Centre for Global Health and Health Partnerships, King's College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Services Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katy M E Turner
- Department of Veterinary Sciences, Bristol Vet School, University of Bristol, Bath, UK
| | - Katharine J Looker
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paula Baraitser
- School of Population Health and Environmental Sciences, Centre for Global Health and Health Partnerships, King's College London, London, UK
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Wilson E, Free C, Morris TP, Syred J, Ahamed I, Menon-Johansson AS, Palmer MJ, Barnard S, Rezel E, Baraitser P. Internet-accessed sexually transmitted infection (e-STI) testing and results service: A randomised, single-blind, controlled trial. PLoS Med 2017; 14:e1002479. [PMID: 29281628 PMCID: PMC5744909 DOI: 10.1371/journal.pmed.1002479] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Internet-accessed sexually transmitted infection testing (e-STI testing) is increasingly available as an alternative to testing in clinics. Typically this testing modality enables users to order a test kit from a virtual service (via a website or app), collect their own samples, return test samples to a laboratory, and be notified of their results by short message service (SMS) or telephone. e-STI testing is assumed to increase access to testing in comparison with face-to-face services, but the evidence is unclear. We conducted a randomised controlled trial to assess the effectiveness of an e-STI testing and results service (chlamydia, gonorrhoea, HIV, and syphilis) on STI testing uptake and STI cases diagnosed. METHODS AND FINDINGS The study took place in the London boroughs of Lambeth and Southwark. Between 24 November 2014 and 31 August 2015, we recruited 2,072 participants, aged 16-30 years, who were resident in these boroughs, had at least 1 sexual partner in the last 12 months, stated willingness to take an STI test, and had access to the internet. Those unable to provide consent and unable to read English were excluded. Participants were randomly allocated to receive 1 text message with the web link of an e-STI testing and results service (intervention group) or to receive 1 text message with the web link of a bespoke website listing the locations, contact details, and websites of 7 local sexual health clinics (control group). Participants were free to use any other services or interventions during the study period. The primary outcomes were self-reported STI testing at 6 weeks, verified by patient record checks, and self-reported STI diagnosis at 6 weeks, verified by patient record checks. Secondary outcomes were the proportion of participants prescribed treatment for an STI, time from randomisation to completion of an STI test, and time from randomisation to treatment of an STI. Participants were sent a £10 cash incentive on submission of self-reported data. We completed all follow-up, including patient record checks, by 17 June 2016. Uptake of STI testing was increased in the intervention group at 6 weeks (50.0% versus 26.6%, relative risk [RR] 1.87, 95% CI 1.63 to 2.15, P < 0.001). The proportion of participants diagnosed was 2.8% in the intervention group versus 1.4% in the control group (RR 2.10, 95% CI 0.94 to 4.70, P = 0.079). No evidence of heterogeneity was observed for any of the pre-specified subgroup analyses. The proportion of participants treated was 1.1% in the intervention group versus 0.7% in the control group (RR 1.72, 95% CI 0.71 to 4.16, P = 0.231). Time to test, was shorter in the intervention group compared to the control group (28.8 days versus 36.5 days, P < 0.001, test for difference in restricted mean survival time [RMST]), but no differences were observed for time to treatment (83.2 days versus 83.5 days, P = 0.51, test for difference in RMST). We were unable to recruit the planned 3,000 participants and therefore lacked power for the analyses of STI diagnoses and STI cases treated. CONCLUSIONS The e-STI testing service increased uptake of STI testing for all groups including high-risk groups. The intervention required people to attend clinic for treatment and did not reduce time to treatment. Service innovations to improve treatment rates for those diagnosed online are required and could include e-treatment and postal treatment services. e-STI testing services require long-term monitoring and evaluation. TRIAL REGISTRATION ISRCTN Registry ISRCTN13354298.
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Affiliation(s)
- Emma Wilson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tim P. Morris
- Medical Research Council Clinical Trials Unit at UCL, London, United Kingdom
| | - Jonathan Syred
- King’s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King’s College London, London, United Kingdom
| | - Irrfan Ahamed
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Melissa J. Palmer
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sharmani Barnard
- King’s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King’s College London, London, United Kingdom
| | - Emma Rezel
- King’s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King’s College London, London, United Kingdom
| | - Paula Baraitser
- King’s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King’s College London, London, United Kingdom
- Department of Sexual Health and HIV, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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