Population-based outreach for Chlamydia screening in men: results from a randomized trial.
OBJECTIVE
To evaluate the feasibility and efficacy of population-based outreach strategies to improve genital Chlamydia trachomatis (CT) screening in men.


METHODS
In a randomized trial, male enrollees ages 21-25 (n = 8820) were selected from the automated files of Group Health Cooperative and randomized to: a letter + test-request card for a CT urine home sampling kit (arm 1, n = 2940); a letter + mail-back sampling kit (arm 2, n = 2940); or a usual care control (arm 3, n = 2940). One reminder was sent to arms 1 and 2. The outcome was CT testing rates in the 4 months postrandomization.


RESULTS
105 of 2940 (3.6%) men in arm 1 and 230 of 2940 (7.8%) in arm 2 returned mailed specimens. All 335 respondents were sexually experienced, 43% had >2 sex partners in the past year, and 80% reported no genitourinary symptoms. Compared to arm 3, the relative risk of being tested was 5.6 (95% confidence interval (CI) 3.6-8.7) for arm 1 and 11.1 (95% CI 7.3-16.9) for arm 2. Arm 2 was significantly more likely to be tested than arm 1. CT prevalence for mailed-back specimens was 1.0% (1 of 105) for arm 1 and 2.6% (6 of 230) for arm 2; 70% of all positive intervention tests were from mailed samples.


CONCLUSIONS
Both strategies resulted in significantly higher CT testing than usual care, but the intervention response rate was low (5.7% overall). Direct kit mailing performed best. In US populations, the value of mailed outreach strategies to men must be considered in the context of other CT screening priorities.
Scholes
Delia
D
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA. scholes.d@ghc.org
Heidrich
Fred E
FE
Yarbro
Patricia
P
Lindenbaum
Jeff E
JE
Marrazzo
Jeanne M
JM
D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000652:urine; D002692:Chlamydia trachomatis; D003695:Delivery of Health Care; D006801:Humans; D008297:Male; D052801:Male Urogenital Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000652:urine; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011177:Postal Service; D015995:Prevalence; D017010:Reminder Systems; D013048:Specimen Handling; D016482:Urinalysis / Q000379:methods / Q000706:statistics & numerical data; D014861:Washington / Q000453:epidemiology