Impact of At-Home Versus Clinic-Based Services on Chlamydia and Gonorrhea Treatment Rates

Background: Chlamydia and gonorrhea are the 2 most commonly reported sexually transmitted infections (STIs) in the United States. Additionally, the number of reported cases is lower than the estimated total number of cases due to a variety of factors including: unawareness of infection, lack of symptoms, social stigma, and the fact that chlamydia and gonorrhea are still not routinely screened for in many clinical settings. Past studies suggest that individuals prefer at-home sampling and would even get tested more often if STI self-collection were available. Numerous studies investigating the effectiveness, screening uptake, and safety of at-home sampling have been performed. However, the question of treatment rates in relation to at-home sampling remains. Can the use of at-home STI screening for chlamydia and gonorrhea lead to increased rates of treatment compared to traditional STI screening methods in sexually active adults? Methods: An extensive search was conducted using MEDLINE-PubMed, MEDLINE-Ovid, and TRIP with the keywords: ((home OR internet access* OR specimen handling OR self-sampling ) AND (screen* OR test*) AND (gonorrhea OR chlamydia) AND (treatment OR therapy)). The eligibility criterion was applied to the results and duplications were removed. References of selected studies were considered. Quality of included studies was assessed using GRADE. Results: Two randomized controlled trials (RCTs) met the inclusion and exclusion criteria and were included in this systematic review. The first study recruited 2072 participants who were then randomly allocated to receive a text message with a link containing instructions to either complete at home screening (intervention) or clinic-based screening (control). The proportion of participants treated was 1.1% in the intervention group versus 0.7% in the control group. The second study conducted a population-based trial that included all people between ages 18-25. The intervention group, 10 000 individuals, received information on chlamydia and a mail-back urine sampling kit by post. The control group, 31 519 individuals, received nothing by mail and was not made aware of the study. The intervention led to 2.5 times more individuals receiving treatment. Conclusion: At-home chlamydia and gonorrhea sampling may lead to increased rates of treatment