Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial
- 1Population Council, New York, USA
- 2Department of Obstetrics & Gynecology, Columbia University Medical Center, New York, USA
- 3Infectious Disease Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- 4South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa
- 5Academic Medical Center, Center for Poverty-Related Communicable Diseases, Amsterdam, the Netherlands
- 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;
- Accepted 14 September 2007
- Published Online First 27 September 2007
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.
- CT, Chlamydia trachomatis
- NG, Neisseria gonorrhoea
- OR, odds ratio
- RD, risk difference
- RR, risk rate
- STI, sexually transmitted infection
- TV, Trichomonas vaginalis
HEJ implemented data analysis, wrote the manuscript, and assisted with protocol and questionnaire design; LA wrote the initial protocol, assisted with questionnaire development, and provided editorial comments; AdeK and TY developed initial questionnaires, oversaw study implementation, and provided editorial comments; JHHMvandeW assisted with study and questionnaire development, data analysis, and provided editorial comments.
This study was funded by the Office of Population and Reproductive Health, Bureau for Global Health, US Agency for International Development, under the terms of Award No HRN-A-00-99-00010. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the US Agency for International Development. Additional funding was received from the Parthenon Trust and the William and Flora Hewlett Foundation.
Competing interests: None.