Home Screening Compared With Clinic-Based Screening for Sexually Transmitted Infections

Graseck, Anna S.; Secura, Gina M. PhD, MPH; Allsworth, Jenifer E. PhD; Madden, Tessa MD, MPH; Peipert, Jeffrey F. MD, PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181d4450d
Original Research
Abstract

OBJECTIVE: To estimate completion rate and acceptability of home screening for sexually transmitted infections (STIs) compared with clinic-based screening in a prospective cohort study.

METHODS: The first 462 women enrolled in the Contraceptive Choice Project were screened at the 12-month follow-up for Chlamydia trachomatis and Neisseria gonorrhoeae using strand displacement analysis of self-collected vaginal swabs. In a telephone interview, participants were given a choice of no-cost screening with swabs mailed to the participant's home (home-based) or screening that was available at area family planning clinics without an appointment (clinic-based). The clinic-based group also included women who elected to screen with their regular provider according to the clinician's normal practice. We analyzed the rates of screening, including patient preference and the proportion of completed tests by testing method.

RESULTS: Women were more likely to choose to screen for STIs at home than at a clinic or with their own medical provider (75.7% compared with 16.1% compared with 8.2%, P<.001). Women choosing clinic testing were more likely to be African American than those choosing home testing. African-American women constituted 42% of the clinic group compared with 28% of the home group (relative risk [RR] 1.63, 95% confidence interval [CI] 1.14–2.31). The groups did not differ in other demographic characteristics, STI risk factors, or access to health care. Overall, 228 women (56.6%) completed screening. Women who chose home-based testing were more likely to complete a test compared with all clinic-based testers (64.6% compared with 31.6%, RR 2.04, 95% CI 1.51–2.76).

CONCLUSION: Women overwhelmingly preferred to screen for STIs at home. Future interventions to increase screening rates in young women should consider alternative screening strategies such as home-based or patient-controlled testing.

LEVEL OF EVIDENCE: II

In Brief

Home-based screening for Chlamydia trachomatis and Neisseria gonorrhoeae is preferred by women and results in higher screening rates.

Author Information

From the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.

Supported in part by an anonymous foundation; Midcareer Investigator Award in Women's Health Research (K24 HD01298); Clinical and Translational Science Awards (UL1RR024992), and awards TL1 RR024995, KL2RR024994, and K3054628 from the National Center for Research Resources, a component of the National Institutes of Health and National Institutes of Health Roadmap for Medical Research.

Presented as an oral abstract at Reproductive Health 2009, a joint annual meeting of the Association for Reproductive Health Professionals, the Planned Parenthood Federation of America, and the Society for Family Planning, September 30–October 4, 2009, Los Angeles, California.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of National Center for Research Resources or the National Institutes of Health.

Corresponding author: Jeffrey F. Peipert, MD, PhD, Campus Box 8219, Washington University in St. Louis School of Medicine, 4533 Clayton Avenue, St. Louis, MO 63110; e-mail: peipertj@wustl.edu.

Financial Disclosures Ms. Graseck received support to travel to the Association for Reproductive Health Professionals meeting to present research through National Center for Research Resources grant TL1 RR024995. The other authors did not report any potential conflicts of interest.

© 2010 The American College of Obstetricians and Gynecologists