title: Interventions to increase rescreening for repeat chlamydial infection.
abstract: BACKGROUND
  Repeat infection with Chlamydia trachomatis following treatment is common and increases the risk of sequelae. Despite clinical guidelines recommending rescreening within 3 months of treatment, rescreening rates remain low. We undertook a systematic review to identify studies that compared rates of rescreening for repeat chlamydial infection between patients receiving and not receiving an intervention.
  
  
  METHODS
  We searched Medline, EMBASE, and conference Web sites from 2000 to September 2010 using variations of the terms "chlamydia" and "rescreening" and "intervention." We used meta-analysis to calculate the overall relative risk (RR) effect on rescreening rates by study design and strategy type.
  
  
  RESULTS
  We identified 8 randomized controlled trials (RCTs) and 4 controlled observational studies, all conducted in the United States. Four RCTs assessed mailed screening kits ± reminders, with an average effect estimate of 1.30 (95% confidence interval [CI]: 1.01-1.50); 2 RCTs assessed motivational interviewing ± reminders with a summary effect of 2.15 (95% CI: 0.92-3.37); one RCT evaluated the effect of reminders with a RR of 9.67 (95% CI: 1.31-71.31), and another RCT assessed the effect of a $20 patient incentive with a RR of 1.16 (95% CI: 0.62-2.17). Three controlled observational studies assessed reminder strategies with RRs of 1.97 (95% CI: 1.76-2.21), 1.01 (95% CI: 0.66-1.55), and 1.88 (95% CI: 1.58-2.24)-a summary effect was not calculated due to significant heterogeneity; and one controlled observational study assessed the promotion of clinical guidelines with a RR of 1.35 (95% CI: 0.96-1.90).
  
  
  CONCLUSIONS
  The review suggests that the use of mailed screening kits is an important strategy to increase rescreening, reminder systems are promising, and motivational interviewing is worth investigation.
authors.affiliation: The Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia. Rguy@kirby.unsw.edu.au
authors.forename: Rebecca
authors.initials: R
authors.lastname: Guy
authors.forename: Jane
authors.initials: J
authors.lastname: Hocking
authors.forename: Nicola
authors.initials: N
authors.lastname: Low
authors.forename: Hammad
authors.initials: H
authors.lastname: Ali
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Bauer
authors.forename: Jenny
authors.initials: J
authors.lastname: Walker
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D011933:Reagent Kits, Diagnostic; D017010:Reminder Systems; D055502:Secondary Prevention; D055815:Young Adult
chemical_list: D011933:Reagent Kits, Diagnostic