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Abstract
Objectives To meet the need for services at sexually transmitted infection (STI) clinics, self-obtained vaginal (SOV) swabs or first-catch urine (FCU) samples collected at a clinic visit have been proposed as an alternative approach for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) screening. The purpose of this clinic-based survey was to determine if non-invasive clinic-based SOV swabs and FCU samples for CT and GC screening are acceptable replacements for a traditional provider visit.
Methods Patients seen at STI clinics in three US cities completed a self-administered survey of preferences for methods of CT and GC screening under hypothetical circumstances.
Results A total of 2887 participants completed a self-administered questionnaire that contained multiple-choice questions about their preference. If there was a hypothetical long clinic wait, 58% of the survey participants preferred to wait to see a doctor. If the clinic had to turn patients away, 41% of patients preferred to come back the next business day and 46% preferred to self-collect a sample. The percentages were similar across site, demographic and clinical groups.
Conclusions Clinic-based self-collected specimens for CT and GC screening were not preferred by most patients who participated in this survey. The findings indicate that more detailed information about self-collection practices must be provided for patients to adopt this new approach.
- Chlamydia trachomatis
- gonorrhoea
- patients' views
- preferences
- screening
- self-collection
- STD
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There is an increasing interest in patient-collected specimens for the detection of sexually transmitted infections (STI) due to the convenience for both patient and provider. Self-obtained vaginal (SOV) swabs or first-catch urine (FCU) samples for STI screening have been found to be feasible,1–6 effective2–6 and acceptable to patients.4 7 SOV or FCU could be useful in the STI clinic setting, especially when there are long waits and when clinics have to turn patients away. The purpose of this survey was to determine if clinic-based SOV swabs and FCU samples for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) screening are acceptable replacements for a traditional provider visit.
Methods
Men and women who visited STI clinics in three US cities—New Orleans, Louisiana, Jackson, Mississippi, and St Louis, Missouri—between June and September 2008 were invited to complete a short survey before being seen at the clinic. Detailed explanations of the test methods were not provided. The survey was piloted at each study clinic the month before recruitment began. The study proposal was reviewed by the institutional review boards at Louisiana State University, University of Mississippi Medical Center, Washington University and US Centers for Disease Control and Prevention, and was exempted from informed consent.
The survey contained two multiple-choice questions about patients' preference concerning STI screening methods. A total of 2887 individuals completed the survey. Most patients (>90%) were African-American; 51% were women; the mean age was 27.1 years.
A site-specific analysis was conducted before combining data for descriptive statistics using SPSS package version 11.5. The χ2 test was used to compare categorical variables.
Results
The most common reasons for visiting the clinics were check-ups and STI symptoms (table 1). The majority of participants reported having previously been tested for CT. Only 21% of participants suspected that they might have CT or GC, but many participants (40.3%) reported ‘don't know’. If there was a hypothetical long wait in the clinic, 58.3% of respondents preferred to wait to see a doctor compared with 29.1% who would rather self-collect a sample for CT and GC testing (table 1). Surprisingly, patient preferences were similar in those who did and did not have symptoms and in those who did and did not think they might have GC or CT. If the clinic hypothetically had to turn patients away, 45.6% preferred self-collection and 40.7% preferred returning to see a doctor the next business day (table 1).
Patients' preferences for seeing a doctor or self-collection in the clinic
Discussion
In this survey of STI clinic clients, we found that even with hypothetical long waits to see a clinician, patients preferred this option almost 2:1 over self-collection. Moreover, when presented with the scenario of having to return the following day versus self-collection, less than half of the survey respondents chose the latter.
Our findings are somewhat surprising in light of the reported high acceptance of self-sampling as a specimen collection method for CT and GC testing in clinic populations.1 3 4 7–10 However, most other studies about patient preferences did not survey clinic patients prospectively but rather after they had undergone both clinician and specimen self-collection.
Women's preferences were similar to those of men for whom self-collection involves only the collection of a FCU specimen, suggesting that concerns over ability to obtain a specimen was not the primary reason for rejecting self-collection. The findings that patient preference did not differ greatly by CT testing experience in the past nor by present concerns for STI also suggest that many patients value ‘seeing a clinician’ for reasons other than obtaining tests for GC/CT.
It is notable that as many symptomatic patients would have chosen self-collection as asymptomatic patients. Presumably, many of the former would have received empiric treatment on the day of their visit. Therefore, a clinic-based self-collection programme based on patient choice would not be likely to improve clinic efficiency greatly because the lower-risk, asymptomatic clients were not more likely to choose self-collection.
The study was limited by an inability to determine why the respondents did not respond more favourably to the option of self-collection. It is possible that a significant number of the participants did not understand the questions being asked or the techniques of self-collection.
Our findings indicate that merely offering a self-collection protocol may not be an effective strategy. It may be that more detailed information about the comparability of test outcomes and how self-collection is done will be needed in order for patients to adopt this new approach. The development of new self-collection technology for detecting STI other than CT and GC also could improve patient preference for self-collection.
Key messages
Many patients attending public STI clinics in the USA prefer seeing a healthcare provider over specimen self-collection for STI testing.
Patients attending public STI clinics in the USA need education to adopt self-collection as an alternative to a traditional provider visit.
References
Footnotes
Funding This study was funded in part by the Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Competing interests None declared.
Ethics approval This study was conducted with the approval of the Centers for Disease Control and Prevention, Louisiana State University, New Orleans, Louisiana, USA, Washington University, St Louis, Missouri, USA and the University of Mississippi, Jackson, Mississippi, USA.
Provenance and peer review Not commissioned; externally peer reviewed.