title: Comparative effectiveness and acceptability of home-based and clinic-based sampling methods for sexually transmissible infections screening in females aged 14-50 years: a systematic review and meta-analysis.
abstract: BACKGROUND
  Home-based sampling is a strategy to enhance uptake of sexually transmissible infection (STI) screening. This review aimed to compare the screening uptake levels of home-based self-sampling and clinic-based specimen collection for STIs (chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and trichomoniasis) in females aged 14-50 years. Acceptability and effect on specimen quality were determined.
  
  
  METHODS
  Sixteen electronic databases were searched from inception to September 2012. Randomised controlled trials (RCTs) comparing the uptake levels of home-based self-sampling and clinic-based sampling for chlamydia, gonorrhoea and trichomoniasis in females aged 14-50 years were eligible for inclusion. The risk of bias in the trials was assessed. Risk ratios (RRs) for dichotomous outcomes were meta-analysed.
  
  
  RESULTS
  Of 3065 papers, six studies with seven RCTs contributed to the final review. Compared with clinic-based methods, home-based screening increased uptake significantly (P=0.001-0.05) in five trials and was substantiated in a meta-analysis (RR: 1.55; 95% confidence interval: 1.30-1.85; P=0.00001) of two trials. In three trials, a significant preference for home-based testing (P=0.001-0.05) was expressed. No significant difference was observed in specimen quality. Sampling was rated as easy by a significantly higher number of women (P=0.01) in the clinic group in one trial.
  
  
  CONCLUSIONS
  The review provides evidence that home-based testing results in greater uptake of STI screening in females (14-50 years) than clinic-based testing without compromising quality in the developed world. Home collection strategies should be added to clinic-based screening programs to enhance uptake.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
authors.forename: Tolulope Y
authors.initials: TY
authors.lastname: Odesanmi
authors.forename: Sharada P
authors.initials: SP
authors.lastname: Wasti
authors.forename: Omolola S
authors.initials: OS
authors.lastname: Odesanmi
authors.forename: Omololu
authors.initials: O
authors.lastname: Adegbola
authors.forename: Olubukola O
authors.initials: OO
authors.lastname: Oguntuase
authors.forename: Sajid
authors.initials: S
authors.lastname: Mahmood
mesh_terms: D000293:Adolescent; D000328:Adult; D035041:Anonymous Testing; D005260:Female; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D057240:Patient Preference; D016032:Randomized Controlled Trials as Topic; D012648:Self Care; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D055815:Young Adult