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

Abstract

Objectives: To test whether more women are screened for sexually transmitted infections when offered home- 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: We randomized women aged 14-25 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 gonorrhea, chlamydia and trichomoniasis using polymerase chain reaction and self-tested for trichomoniasis using a rapid dipstick test. All women were interviewed at enrollment on socio-demographic and sexual history, and at six week follow-up on feasibility and acceptability.

Results: 626 women enrolled in the study, with 313 in each group; 569 (91%) completed their six week follow-up visit. Forty-seven percent 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 1.1-1.5) 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 gonorrhea.

Conclusion: 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.