Introduction Home-based specimen collection is promoted as an innovative method to improve convenience and uptake of, and reduce barriers to clinic-based Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing. It is not known whether this strategy increases successful case management or the impact of screening programmes. The objective of this systematic review was to assess the effectiveness and safety of home-based and clinic-based specimen collection for CT and NG.
Methods We searched for randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL and LILACS databases, the Cochrane Sexually Transmitted Infections Group Specialised Register, two trials registers and grey literature up to February 2015. The primary effectiveness outcome was complete case management, defined as completed testing, diagnosis and treatment of index cases with positive test results. Secondary outcomes included testing uptake, test positivity, partner treatment and infections cured.
Results We screened 496 unique records and included 10RCTs (6,291 participants). All reported on testing uptake but only three (1,566 people) assessed the primary outcome. There was no difference in complete case management between participants with home- vs. clinic-collected specimens (RR 0.88, 95% CI 0.60 to 1.29, I2 0%). The trials were heterogeneous with respect to test uptake (I2 100%) but eight reported more participants tested with home- vs. clinic-based testing. In nine studies (2,928 participants) the pooled positive test prevalence was lower in the home-based than the clinic-based group (RR 0.73, 95% CI 0.61 to 0.86, I2 0%). No RCTs evaluated adverse events, rates of partner treatment or infection cure.
Conclusion We found no evidence that home- vs. clinic-based specimen collection increased complete case management for CT and NG infections. Testing uptake might increase with home-based specimen collection but heterogeneity between studies was high. Safety and biological outcomes, such as infection cure, of home-based specimen collection strategies need to be evaluated.
Disclosure of interest statement The Cochrane Sexually Transmitted Infections Group receives funding from the Faculty of Medicine, Universidad Nacional de Colombia. No pharmaceutical grants were received in the development of this study.