title: Dual Intervention to Increase Chlamydia Retesting: A Randomized Controlled Trial in Three Populations.
abstract: BACKGROUND
  Chlamydia retesting 3 months after treatment is recommended to detect reinfections, but retesting rates are typically low. The purpose of this study is to determine if the addition of a postal home collection kit to a short message service (SMS) reminder at 3 months increases the percentage of patients retested for chlamydia at 1-4 months, compared to SMS alone.
  
  
  METHODS
  In this unblinded randomized controlled trial, participants were randomized 1:1 to intervention (home arm) or control (clinic arm) status.
  
  
  METHODS
  Participants included 200 each of women, heterosexual men, and men who have sex with men diagnosed and treated for chlamydia at sexual health services.
  
  
  METHODS
  Three months after chlamydia diagnosis, home arm participants received an SMS reminder and postal home collection kit (women, vaginal swab; heterosexual men, Copan UriSwab; men who have sex with men, UriSwab and rectal swab).
  
  
  METHODS
  The main outcome measures were the percentage of participants retested at 1-4 months after chlamydia diagnosis and the percentage in each arm with repeat positive tests, by risk group and overall, analyzed by intention to treat. Data were collected from 2011 to 2013 and analyzed in 2014.
  
  
  RESULTS
  The percentage retested within 1-4 months of chlamydia diagnosis was significantly higher in home versus clinic arm participants among women (64% [66/103] vs 39% [38/97], p<0.001); heterosexual men (56% [57/101] vs 34% [34/99], p=0.002); men who have sex with men (62% [61/98] vs 44% [45/102], p=0.010); and overall (61% [184/302] vs 39% [117/298], p<0.001). The percentage in the home versus clinic arm with repeat positive tests was significantly higher among men who have sex with men (16% [16/98] vs 5% [5/102], p=0.021) and overall (10% [31/302] vs 4% [12/298], p=0.006).
  
  
  CONCLUSIONS
  The addition of a postal home collection kit to routine SMS reminders resulted in substantial improvements in chlamydia retesting rates in all three risk groups and detection of more repeat positive tests, compared with SMS alone. Extending the intervention to other primary care settings with low retesting rates should be considered.
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia. Electronic address: ksmith@kirby.unsw.edu.au.
authors.forename: Kirsty S
authors.initials: KS
authors.lastname: Smith
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Australia.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Hocking
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Australia; Melbourne Sexual Health Centre, Carlton, Australia.
authors.forename: Marcus Y
authors.initials: MY
authors.lastname: Chen
authors.affiliation: Melbourne Sexual Health Centre, Carlton, Australia; Central Clinical School, Monash University, Australia.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney; Sydney Sexual Health Centre, Sydney, Australia.
authors.forename: Anna M
authors.initials: AM
authors.lastname: McNulty
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia; Kirketon Road Centre, Kings Cross, Australia.
authors.forename: Phillip
authors.initials: P
authors.lastname: Read
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Australia; Melbourne Sexual Health Centre, Carlton, Australia; Central Clinical School, Monash University, Australia.
authors.forename: Catriona S
authors.initials: CS
authors.lastname: Bradshaw
authors.affiliation: Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Department of Microbiology, Royal Women's Hospital, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
authors.forename: Sepehr N
authors.initials: SN
authors.lastname: Tabrizi
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.affiliation: VCS Pathology, Carlton, Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Saville
authors.affiliation: Virology Division, SEALS Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Rawlinson
authors.affiliation: Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Department of Microbiology, Royal Women's Hospital, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Garland
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia; Sydney Sexual Health Centre, Sydney, Australia.
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: John M
authors.initials: JM
authors.lastname: Kaldor
authors.affiliation: Kirby Institute, University of New South Wales, Sydney, Australia.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Guy
mesh_terms: D000328:Adult; D001315:Australia; D002689:Chlamydia / Q000187:drug effects*; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008403:Mass Screening; D012725:Sexual Behavior / Q000145:classification*; D060145:Text Messaging / Q000706:statistics & numerical data*; D055815:Young Adult