Elsevier

The Lancet

Volume 382, Supplement 3, 29 November 2013, Page S53
The Lancet

Abstracts
Home screening compared with clinic-based screening for Chlamydiae trachomatis in France: a randomised controlled trial

https://doi.org/10.1016/S0140-6736(13)62478-2Get rights and content

Abstract

Background

The prevalence of sexually transmitted infections by Chlamydia trachomatis has increased during the past 10 years in France. In 2006, a national survey including biological samples showed that prevalence was highest for those aged 18–24 years: 3·6% in women and 2·4% in men. To increase C trachomatis screening, the French National Institute in Health Prevention and Education has decided to use web-based promotion of a self-collected and mailed specimen.

Methods

The project, named Chlamyweb, is a randomised controlled trial, with a 1:1 computer-controlled randomisation. In the control group, participants received personalised information and were invited to be screened by a health professional or in a free and anonymous screening centre. In the intervention group, a free home self-collection kit was provided. Recruitment took place through a website for prevention of sexually transmitted diseases and was supported by web advertisements from Sept 3 to Oct 16, 2012. The eligibility criteria were age 18–24 years, living in mainland France, having had sex, and having a valid email address. Sociodemographic data were obtained by a self-administered questionnaire on the website. The primary outcome was the rate of screening in each group. For the control group, outcome data were obtained with follow-up questionnaires. For the intervention group, both follow-up questionnaires and laboratory data were used. The trial is registered with the French medical authority, number 2011-A01000-41.

Findings

5544 participants were randomly assigned to the control group and 5531 to the intervention group. Independence of each group was tested and proven for all variables. More women were recruited than men (sex ratio men:women 0·87). 5935 of 11 075 (54%) were students, 2119 (19%) were employed, 1521 (14%) were unemployed, 1360 (12%) were in high school or in training, and 140 (1%) were classed as other (eg, housewives, people on sick leave). 2426 of 9289 (26%) lived in the Paris region, 4110 (44%) in an urban area, 1084 (12%) in a suburban area, and 1669 (18%) in a rural area. The median number of partners in the past year was two, and 4523 of 11 075 (41%) participants had at least one new partner in the past 3 months. Most of the participants (10 224 of 11 075 [92%]) had never had C trachomatis screening before (4926 of 5152 men [96%] and 5298 of 5923 women [89%]). Rates of screening were 29·2% (1616 of 5531) in the intervention group and 8·7% (480 of 5544) in the control group. Home screening significantly increased testing compared with clinic-based screening (odds ratio [OR] 4·4, 95% CI 3·9–4·9; p<0·0001). Subgroup analyses showed that the intervention effect was higher in men (5·7, 4·7–7·0) than in women (3·9, 3·5–4·5). It was also higher in participants living in rural areas (8·5, 5·3–13·7) than in those living in urban areas (3·9, 3·3–4·7), and in those who had never been tested (4·8, 4·3–5·5) than those who had been already tested (2·1, 1·5–2·9). In the intervention group, 110 of 1616 tests were positive (6·8%). This rate was higher in women (83 of 1002 [8·3%]) than in men (27 of 614 [4·4%]). In the control group, 30 (6·3%) of 480 participants tested positive: eight (5·9%) of 136 men and 22 (6·4%) of 344 women.

Interpretation

Home screening promoted on the internet led to an increase in the rate of chlamydia testing in 18–24-year-old people. Provision of a free of charge, easy to use, self-collection kit could also reduce territorial disparities in clinic-based chlamydia testing. Because of the high prevalence of C trachomatis in the young population, this system could help us to reach a wider population.

Funding

The Chlamyweb trial was funded by the French Institute for Health Promotion and Health Education (INPES). INPES is funded by the French Ministry of Health and National Health Insurance.

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