title: Internet-based screening for Chlamydia trachomatis to reach non-clinic populations with mailed self-administered vaginal swabs.
abstract: BACKGROUND
  Testing for Chlamydia trachomatis by nucleic acid amplification tests (NAATs) using self-collected vaginal swabs (VS) is acceptable and accurate. The objectives were to implement an educational Internet-based program for women to facilitate home screening, to determine whether women would request and use self-collected VS kits, to determine associated risk factors for infection, and to determine satisfaction with the process.
  
  
  METHODS
  The website, www.iwantthekit.org, was designed to encourage women > or =14 years to obtain home-sampling kits. Kits could be obtained in the community, requested by Internet/e-mail, or telephone. Users mailed the self-collected VS to the laboratory. Swabs were tested by 3 NAAT assays. Respondents called for results.
  
  
  RESULTS
  Forty-one of 400 (10.3%) women were chlamydia positive; 95.1% were treated. Questionnaires indicated 89.5% preferred self-collection, 93.5% rated collection easy/very easy, and 86.3% would use the Internet program again. Black race and age <25 years were associated independently with being chlamydia positive, while use of birth control and non-consensual sex were protective. Thirty-six of 41 (87.8%) positive samples were positive by all 3 NAATs, 5/41 (12.2%) were positive by only 2 NAATs, and none were positive by only 1 NAAT. The Internet/e-mail request method was better than the community pick-up approach because 97.2% of kit requests were e-mailed and 87.5% of kits returned for testing were e-mail requested.
  
  
  CONCLUSIONS
  Women will use the Internet to request and use home-sampling kits for chlamydia. NAAT testing performed well on dry-transported VS. High prevalence was detected and questionnaires indicated high-risk sexual behavior.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland 21205, USA. cgaydos@jhmi.edu
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
authors.forename: Karen
authors.initials: K
authors.lastname: Dwyer
authors.forename: Mathilda
authors.initials: M
authors.lastname: Barnes
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Rizzo-Price
authors.forename: Billie Jo
authors.initials: BJ
authors.lastname: Wood
authors.forename: Toni
authors.initials: T
authors.lastname: Flemming
authors.forename: M Terry
authors.initials: MT
authors.lastname: Hogan
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000235:genetics; D005260:Female; D006801:Humans; D020407:Internet; D008396:Maryland; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data*; D021141:Nucleic Acid Amplification Techniques; D010349:Patient Compliance; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011177:Postal Service; D011933:Reagent Kits, Diagnostic; D012307:Risk Factors; D012648:Self Care; D011795:Surveys and Questionnaires; D014626:Vaginal Smears / Q000379:methods
chemical_list: D011933:Reagent Kits, Diagnostic