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Increasing chlamydia test of re-infection rates using SMS reminders and incentives
  1. Sandra Gaye Downing1,2,
  2. Colette Cashman1,
  3. Heather McNamee1,
  4. Debbie Penney1,
  5. Darren B Russell1,
  6. Margaret E Hellard2
  1. 1Cairns Sexual Health Service, Queensland Health, Cairns, Queensland, Australia
  2. 2Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
  1. Correspondence to Sandra Gaye Downing, Cairns Sexual Health Service, PO Box 902, Cairns 4870, Queensland, Australia; sandra_downing{at}


Background Clients diagnosed and treated for Chlamydia trachomatis are a recognised high-risk group for subsequent infection. An estimated 8% of clients treated for chlamydia at Cairns Sexual Health Service return for re-testing within the recommended 3–4-month period. There is no recall or reminder system in place. This study assesses the effectiveness of using short messaging service (SMS) reminders with and without incentive payments to increase re-testing rates.

Methods Eligible consenting clients were randomly allocated to one of three groups. Group 1 (controls) received the standard advice from the clinician to return for re-testing in 3–4 months. Group 2 received the standard advice and an SMS reminder at 10–12 weeks post-treatment. Group 3 received the standard advice and the SMS reminder, which also offered an incentive payment on clinic attendance.

Results 32 participants were recruited to groups 1 and 2 and 30 participants to group 3. 62 SMS reminders were sent with 13 (21.0%) reported as undelivered. Re-testing rates were 6.3%, 28.1% and 26.7% for groups 1, 2 and 3, respectively.

Conclusion SMS reminders with or without an incentive payment increased re-testing rates in our clients who were diagnosed and treated for chlamydia. However, re-testing remained less than ideal, and the high rate of undelivered SMS reminders suggest that this intervention alone will not achieve desired re-testing rates and that a range of strategies will be required to increase re-testing in this population.

  • Repeat testing
  • text messages
  • incentives
  • chlamydia
  • chlamydia infection
  • epidemiology (clinical)
  • gonorrhoea
  • attitudes
  • clinical trials
  • postexposure prophylaxis (HIV)
  • sexual behaviour
  • tropics
  • AIDS
  • STDS

Statistics from


  • Funding The Queensland Nursing Council provided funding for this study.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by Cairns and Hinterland Health Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are held at Cairns Sexual Health Service, and all authors have access to them through the corresponding author.

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