Home screening for sexually transmitted diseases in high-risk young women: Randomised controlled trial

Abstract

Objective: Home screening tests could eliminate several barriers to testing sexually transmitted diseases (STDs). Aim: To determine whether offering repeated home screening tests would increase the rate of testing for chlamydia and gonorrhoea in a high-risk sample of young women. Methods: In this randomised controlled trial, 403 young women (mean age 18.9 years, 70% black) with a recent STD or with STD-related risk factors were enrolled. Participants were recruited from clinics and high-prevalence neighbourhoods and then randomly assigned to receive either a home testing kit or an invitation to attend a medical clinic for testing at 6, 12 and 18 months after enrollment. Over 80% of women were followed for 2 years. The trial is registered with ClinicalTrials.gov, number NCT 00177437. Results: Of 197 women in the intervention group, 140 (71%) returned at least one home test and 25 of 249 (10%) home tests were positive. Women who received home screening tests completed significantly more STD tests overall (1.94 vs 1.41 tests per woman-year, p<0.001 ) and more STD tests in the absence of symptoms (1.18 vs 0.75 tests per woman-year, p<0.001 ). More women in the intervention group completed at least one test when asymptomatic (162 (82.2%) vs 117 (61.3%), p<0.001). The intervention was most effective among women recruited outside medical clinics. There was no significant difference in the overall rate of STDs detected. Conclusions: Home screening significantly increased the utilisation of chlamydia and gonorrhoea testing in this sample of high-risk young women, and thus represents a feasible strategy to facilitate STD testing in young women.