ABSTRACT

Jones, Heidi E., Lydia Altini, Alana de Kock, Taryn Young, and Janneke H.H.M. van de Wijgert. 2007. "Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: Randomised controlled trial," Sexually Transmitted Infections 83(7): 552–557. 

Objectives
To test whether more women are screened for sexually transmitted infections when offered home-based 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
Women aged 14–25 were randomised 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 gonorrhoea, chlamydia, and trichomoniasis using PCR and self-tested for trichomoniasis using a rapid dipstick test. All women were interviewed at enrollment on sociodemographic and sexual history, and at the six-week follow-up on feasibility and acceptability.

Results
626 women were enrolled in the study, with 313 in each group; 569 (91 percent) completed their six-week follow-up visit. Forty-seven percent of the women in the home group successfully mailed their packages, and 13 percent reported performing the rapid test and/or mailing the kit (partial responders), versus 42 percent 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 percent who were tested, 22 percent tested positive for chlamydia, 10 percent for trichomoniasis, and 8 percent for gonorrhoea.

Conclusions
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.

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