Home-based versus clinic-based self-sampling and testing for sexually transmitted infections in Gugulethu, South Africa: randomised controlled trial.
OBJECTIVE
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 6-week follow-up on feasibility and acceptability.


RESULTS
626 women were enrolled in the study, with 313 in each group; 569 (91%) completed their 6-week follow-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.


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.
Jones
H E
HE
Population Council, New York, USA. hej2103@columbia.edu
Altini
L
L
de Kock
A
A
Young
T
T
van de Wijgert
J H H M
JH
D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D013019:South Africa; D013048:Specimen Handling / Q000706:statistics & numerical data; D014626:Vaginal Smears / Q000706:statistics & numerical data