The Acceptability and Cost of a Home-based Chlamydia Retesting Strategy

Findings From the REACT Randomised Controlled Trial

K. S. Smith; J. M. Kaldor; J. S. Hocking; M. S. Jamil; A. M. McNulty; P. Read; C. S. Bradshaw; M. Y. Chen; C. K. Fairley; H. Wand; K. Worthington; S. Blake; V. Knight; W. Rawlinson; M. Saville; S. N. Tabrizi; S. M. Garland; B. Donovan; R. Guy

Disclosures

BMC Public Health. 2016;16(83) 

In This Article

Background

Chlamydia trachomatis is the most commonly reported bacterial sexually transmissible infection (STI) in most developed countries and reported diagnoses continue to increase.[1–3] Repeat infection with chlamydia is also common. Prospective cohort studies have demonstrated that within 4–5 months, 20–30 % of young women have a repeat infection.[4,5] Routine retesting data show repeat infections are also high in men who have sex with men (MSM).[6] Repeat chlamydial infections increase the risk of chlamydia-related sequelae such as pelvic inflammatory disease and infertility, when compared with initial infection.[7] Repeat infections have been associated with increased risk of HIV transmission.[8]

Clinical guidelines in several countries recommend retesting three months after treatment for chlamydia to detect reinfections,[9–13] however retesting rates are typically low especially amongst men.[14–16] A key barrier for patients is the time and effort involved in returning to the clinic for retesting.[17] A range of single interventions (reminders or home-collection) aimed at increasing rescreening rates for chlamydial infection have been trialled but with modest impact.[18–23] Few studies have evaluated multi-faceted interventions or given people a choice of retesting options.[17,24,25]

In 2011–2013, we undertook a randomised trial known as REACT (retest after Chlamydia trachomatis), to determine if the combination of a postal home-collection kit and short message service (SMS) reminder at three months would increase the proportion of sexual health clinic patients retesting for chlamydia at 1–4 months, compared to clinic-based retesting and SMS reminder. SMS reminders were standard practice at the clinics at the time of the study. Those in the home arm were also given a choice of returning to the clinic if they preferred. Overall 61 % of participants randomised to the home arm retested within 1–4 months of chlamydia diagnosis compared with 39 % randomised to the clinic arm (p < 0.01). There were also significantly more repeat positive tests detected in the home arm compared with the clinic arm (31 cases vs 12 cases, p < 0.01). Among participants in the home arm who retested at 1–4 months, 27 % (50/184) chose to retest at the clinic. In the context of this trial we evaluated the acceptability of the home-based retesting strategy to the patient, and compared the costs between the home-based strategy and routine clinic retesting. These were secondary outcomes of the REACT trial.

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