DIAGNOSIS

Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial

H E Jones^1,2, L Altini³, A de Kock³, T Young^3,4 and J H H M van de Wijgert⁵

¹ Population Council, New York, USA
² Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, USA
³ Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
⁴ South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa
⁵ Academic Medical Center, Center for Poverty-Related Communicable Diseases, Amsterdam, the Netherlands

Correspondence to:
Correspondence to:
Ms H Jones
Division of Family Planning & Preventive Services, Department of ObGyn, Columbia University Medical Center, 622 W 168th St, PH 16-80, New York, NY 10032, USA; hej2103{at}columbia.edu

Objectives: To test whether more women are screened for sexually transmitted infections when offered home-based versus clinic-based testing and to evaluate the feasibility and acceptability of self-sampling and self-testing in home and clinic settings in a resource-poor community.

Methods: Women aged 14–25 were randomised to receive a home kit with a pre-paid addressed envelope for mailing specimens or a clinic appointment, in Gugulethu, South Africa. Self-collected vaginal swabs were tested for gonorrhoea, chlamydia and trichomoniasis using PCR and self-tested for trichomoniasis using a rapid dipstick test. All women were interviewed at enrolment on sociodemographic and sexual history, and at the 6-week follow-up on feasibility and acceptability.

Results: 626 women were enrolled in the study, with 313 in each group; 569 (91%) completed their 6-week follow-up visit. Forty-seven per cent of the women in the home group successfully mailed their packages, and 13% reported performing the rapid test and/or mailing the kit (partial responders), versus 42% of women in the clinic group who kept their appointment. Excluding partial responders, women in the home group were 1.3 (95% CI 1.1 to 1.5) times as likely to respond to the initiative as women in the clinic group. Among the 44% who were tested, 22% tested positive for chlamydia, 10% for trichomoniasis, and 8% for gonorrhoea.

Conclusions: Self-sampling and self-testing are feasible and acceptable options in low-income communities such as Gugulethu. As rapid diagnostic tests become available and laboratory infrastructure improves, these methodologies should be integrated into services, especially services aimed at young women.

Abbreviations: CT, Chlamydia trachomatis; NG, Neisseria gonorrhoea; OR, odds ratio; RD, risk difference; RR, risk rate; STI, sexually transmitted infection; TV, Trichomonas vaginalis

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