title: Reducing barriers to testing for Chlamydia trachomatis by mailed self-collected samples.
abstract: BACKGROUND
  Chlamydia trachomatis (chlamydia) is the most commonly notified sexually transmissible bacterial infection in Australia, where distance to health services can be a barrier. This study investigated the acceptability of a self-collection kit for chlamydia testing (sent by mail) and assessed the risk profiles of participants with respect to locality.
  
  
  METHODS
  In total, 2587 self-collection kits were distributed opportunistically or sent directly to participants upon request, as was a self-administered questionnaire.
  
  
  RESULTS
  The return rate was 13.2% (n=341) for samples and questionnaires. The return rate did not differ with location (P=0.522) but with mode of distribution (opportunistic: 9.7%; by request: 27.4%; P<0.001). Although 37% of participants had previously been tested for chlamydia, 77.5% said that they would not have sought testing otherwise. The median age of participants was 22.6 years, 33.8% were male and 9.1% were of Aboriginal descent. Overall, 9.0% (95% confidence interval (CI)=6.1-12.5) of participants were chlamydia-positive. Prevalence of chlamydia and Aboriginal participation increased with remoteness (P<0.001), and self-reported condom use was significantly reduced for remote and very remote locations (P=0.008). Within remote and very remote locations, 30.8% (95% CI=9.1-61.4) of Aboriginal participants and 38.9% of non-Indigenous participants were chlamydia-positive (P=0.718; 95% CI=17.3-64.3).
  
  
  CONCLUSIONS
  Testing for chlamydia using a mailed self-collection kit opened access to a predominantly test-naïve population. The proposed model was able to reach remote populations. Actively requested kits were more likely to be returned.
authors.affiliation: James Cook University, Townsville, QLD, Australia. monika.buhrerskinner@jcu.edu.au
authors.forename: Monika
authors.initials: M
authors.lastname: Buhrer-Skinner
authors.forename: Reinhold
authors.initials: R
authors.lastname: Muller
authors.forename: Petra G
authors.initials: PG
authors.lastname: Buettner
authors.forename: Rose
authors.initials: R
authors.lastname: Gordon
authors.forename: Joseph
authors.initials: J
authors.lastname: Debattista
mesh_terms: D016009:Chi-Square Distribution; D002692:Chlamydia trachomatis; D005260:Female; D006801:Humans; D008219:Lymphogranuloma Venereum / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D010865:Pilot Projects; D011177:Postal Service; D011793:Queensland / Q000453:epidemiology; D012648:Self Care; D013048:Specimen Handling; D055815:Young Adult