Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: Randomised controlled trial
Jones,Heidi E.; Altini,Lydia; de Kock,Alana; Young,Taryn; van de Wijgert,Janneke
Sexually Transmitted Infections 83(7): 552-557
Publication date: 2007
To test whether more women are screened for sexually transmitted infections when offered homebasedversus clinic-based testing and to evaluate the feasibility and acceptability of self-sampling and selftesting in home and clinic settings in a resource-poor community.
Women aged 14-25 were randomised to receive a home kit with a pre-paid addressed envelopefor 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 enrolment on sociodemographic and sexual history, and at the 6-week follow-up on feasibility and acceptability.
626 women were enrolled in the study, with 313 in each group; 569 (91%) completed their 6-weekfollow-up visit. Forty-seven per cent of the women in the home group successfully mailed their packages, and 13% reported performing the rapid test and/or mailing the kit (partial responders), versus 42% 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 to 1.5) times as likely to respond to the initiative as women in the clinic group. Among the 44% who were tested, 22% tested positive for chlamydia, 10% for trichomoniasis, and 8% for gonorrhoea.
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, thesemethodologies should be integrated into services, especially services aimed at young women.