title: Acceptance of Home-Based Chlamydia Genital and Anorectal Testing Using Short Message Service (SMS) in Previously Tested Young People and Their Social and Sexual Networks.
abstract: BACKGROUND
  Control strategies for Chlamydia trachomatis (CT) are most effective when targeting people at highest risk. We assessed test acceptance of home-collection test kits offered by short messaging services (SMS) texts, in high-risk young people, i.e. those who had previously tested CT positive (positive indices), or negative reporting more than 3 sex partners (negative indices), and their sexual and social networks.
  
  
  METHODS
  Young (16 to 25 years old) heterosexuals who previously tested positive (n=536) or negative (n=536) in our STI clinic received, 3 to 20 months after their initial screening, an SMS inviting them to re-test. They were offered a free home-collection test kit including a genital (men and women) and anorectal (women only) test, and a test kit to pass on to a friend or sex partner (peer). SMS reminders were sent in case of non-response. We assessed proportions of tests requested and returned, peers tested, and positivity. Associations with the individual's initial screening result and other factors were explored using logistic regression.
  
  
  RESULTS
  Of 1072 people invited to retest, 34.4% (n=369) requested a test. Of these, 55.8% (n=206) retested. Overall, retest participation was higher in positive (22%) than in negative indices (16%) (p<0.001); it was also higher in women and in those aged >22 years. Positivity was 13% and 7% in positive and negative indices, respectively. One in 3 retesters also had a peer tested. Of tested peers (n=87), 84% were friends, 31% were first-time testers, and 7% tested positive.
  
  
  CONCLUSIONS
  Acceptance of a relatively low-cost strategy for genital and anorectal testing, i.e. using SMS and home-collection test kits, was highest in individuals who previously tested CT positive suggesting that implementation for this group may be considered. By further including a peer-led testing component, undetected CT positives can be identified in the social networks surrounding a high-risk individual.
authors.affiliation: Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands; Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands.
authors.forename: Nicole H T M
authors.initials: NH
authors.lastname: Dukers-Muijrers
authors.affiliation: Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands.
authors.forename: Kevin A T M
authors.initials: KA
authors.lastname: Theunissen
authors.affiliation: Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands.
authors.forename: Petra T
authors.initials: PT
authors.lastname: Wolffs
authors.affiliation: Department of Work & Social Psychology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Gerjo
authors.initials: G
authors.lastname: Kok
authors.affiliation: Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands; Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands.
authors.forename: Christian J P A
authors.initials: CJ
authors.lastname: Hoebe
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000517:prevention & control; D002692:Chlamydia trachomatis; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D011933:Reagent Kits, Diagnostic; D012002:Rectal Diseases / Q000175:diagnosis* / Q000382:microbiology / Q000517:prevention & control; D012648:Self Care / Q000523:psychology; D012747:Sexual Partners; D012944:Social Support; D060145:Text Messaging; D055815:Young Adult
chemical_list: D011933:Reagent Kits, Diagnostic