Blog
About

  • Record: found
  • Abstract: found
  • Article: found
Is Open Access

Internet testing for Chlamydia trachomatis in England, 2006 to 2010

Read this article at

Bookmark
      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

      Abstract

      Background

      In recent years there has been interest in websites as a means of increasing access to free chlamydia tests through the National Chlamydia Screening Programme (NCSP) in England. We aimed to describe and evaluate online access to chlamydia testing within the NCSP.

      Methods

      We analysed NCSP chlamydia testing data (2006–2010) for 15–24 year olds from the 71/95 programme areas in England where site codes were available to identify tests ordered through the internet. The characteristics of people using online testing services in 2010 were compared with those testing in general practice (GP) or community sexual and reproductive health (SRH) services. We evaluated 58 websites offering free chlamydia tests through the NCSP, and 32 offering kits on a commercial basis for signposting to clinical service and health promotion advice offered.

      Results

      Between 2006 and 2010, 5% of all tests in the included programme areas were accessed through the internet. The number of internet tests increased from 18 (<1% of all tests) in 2006 to 59,750 in 2010 (6% of all NCSP tests). In 2010 the proportion of NCSP tests accessed online by programme area ranged from <1% to 38%. The proportion of tests with a positive result on the internet was higher than tests from general practice and comparable to those from community SRH services (internet 7.6%; GP 5.6%; Community SRH 8.2%). A higher proportion of people accessing online testing were male, aged 20–24 and reported >1 sexual partner in the past year. Provision of sexual health information and appropriate signposting for those in need of clinical services varied between websites. Service provision within the NCSP was fragmented with multiple providers serving specific geographical catchment areas.

      Conclusion

      Internet testing reaches a population with a relatively high risk of chlamydia infection and appears acceptable to young men, a group that has been difficult to engage with chlamydia testing. In order to maximise the potential benefit of these services, websites should be consistent with national guidelines and adhere to minimum standards for signposting to clinical care and health promotion information. The current system with multiple providers servicing geographically specific catchment areas is contrary to the geographically unrestricted nature of the internet and potentially confusing for clients.

      Related collections

      Most cited references 9

      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation

      Objective To evaluate the effectiveness of register based, yearly chlamydia screening. Design Controlled trial with randomised stepped wedge implementation in three blocks. Setting Three regions of the Netherlands: Amsterdam, Rotterdam, and South Limburg. Participants 317 304 women and men aged 16-29 years listed on municipal registers at start of trial. Intervention From March 2008 to February 2011, the Chlamydia Screening Implementation programme offered yearly chlamydia screening tests. Postal invitations asked people to use an internet site to request a kit for self collection of samples, which would then be sent to regional laboratories for testing. Treatment and partner notification were done by the general practitioner or at a sexually transmitted infection clinic. Main outcome measures Primary outcomes were the percentage of chlamydia tests positive (positivity), percentage of invitees returning a specimen (uptake), and estimated chlamydia prevalence. Secondary outcomes were positivity according to sex, age, region, and sociodemographic factors; adherence to screening invitations; and incidence of self reported pelvic inflammatory disease. Results The participation rate was 16.1% (43 358/269 273) after the first invitation, 10.8% after the second, and 9.5% after the third, compared with 13.0% (6223/48 031) in the control block invited at the end of round two of the intervention. Chlamydia positivity in the intervention blocks at the first invitation was the same as in the control block (4.3%) and 0.2% lower at the third invitation (odds ratio 0.96 (95% confidence interval 0.83 to 1.10)). No substantial decreases in positivity were seen after three screening rounds in any region or sociodemographic group. Among the people who participated three times (2.8% of all invitees), positivity fell from 5.9% to 2.9% (odds ratio 0.49 (0.47 to 0.50)). Conclusions There was no statistical evidence of an impact on chlamydia positivity rates or estimated population prevalence from the Chlamydia Screening Implementation programme after three years at the participation levels obtained. The current evidence does not support a national roll out of this register based chlamydia screening programme. Trial registration NTR 3071 (Netherlands Trial Register, www.trialregister.nl).
        Bookmark
        • Record: found
        • Abstract: found
        • Article: found
        Is Open Access

        Internet-Based HIV and Sexually Transmitted Infection Testing in British Columbia, Canada: Opinions and Expectations of Prospective Clients

        Background The feasibility and acceptability of Internet-based sexually transmitted infection (STI) testing have been demonstrated; however, few programs have included testing for human immunodeficiency virus (HIV). In British Columbia, Canada, a new initiative will offer online access to chlamydia, gonorrhea, syphilis, and HIV testing, integrated with existing clinic-based services. We presented the model to gay men and other men who have sex with men (MSM) and existing clinic clients through a series of focus groups. Objective To identify perceived benefits, concerns, and expectations of a new model for Internet-based STI and HIV testing among potential end users. Methods Participants were recruited through email invitations, online classifieds, and flyers in STI clinics. A structured interview guide was used. Focus groups were audio recorded, and an observer took detailed field notes. Analysts then listened to audio recordings to validate field notes. Data were coded and analyzed using a scissor-and-sort technique. Results In total, 39 people participated in six focus groups. Most were MSM, and all were active Internet users and experienced with STI/HIV testing. Perceived benefits of Internet-based STI testing included anonymity, convenience, and client-centered control. Salient concerns were reluctance to provide personal information online, distrust of security of data provided online, and the need for comprehensive pretest information and support for those receiving positive results, particularly for HIV. Suggestions emerged for mitigation of these concerns: provide up-front and detailed information about the model, ask only the minimal information required for testing, give positive results only by phone or in person, and ensure that those testing positive are referred for counseling and support. End users expected Internet testing to offer continuous online service delivery, from booking appointments, to transmitting information to the laboratory, to getting prescriptions. Most participants said they would use the service or recommend it to others. Those who indicated they would be unlikely to use it generally either lived near an STI clinic or routinely saw a family doctor with whom they were comfortable testing. Participants expected that the service would provide the greatest benefit to individuals who do not already have access to sensitive sexual health services, are reluctant to test due to stigma, or want to take immediate action (eg, because of a recent potential STI/HIV exposure). Conclusions Internet-based STI/HIV testing has the potential to reduce barriers to testing, as a complement to existing clinic-based services. Trust in the new online service, however, is a prerequisite to client uptake and may be engendered by transparency of information about the model, and by accounting for concerns related to confidentiality, data usage, and provision of positive (especially HIV) results. Ongoing evaluation of this new model will be essential to its success and to the confidence of its users.
          Bookmark
          • Record: found
          • Abstract: found
          • Article: not found

          Internet-based screening for sexually transmitted infections to reach nonclinic populations in the community: risk factors for infection in men.

          Internet-based screening for sexually transmitted infections (STIs) has been acceptable to women, and can reach high-risk populations. No prior published data describe internet-based screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in men. We studied whether internet-based screening was acceptable and reached a high-risk population, and what risk factors were associated with STI positivity. The website, www.iwantthekit.org, encouraged men ≥14 years of age to request a home self-sampling kit and a questionnaire on risk factors and acceptability of internet-based screening. Penile swabs and urine samples were tested for C. trachomatis, N. gonorrhoeae, and T. vaginalis using a nucleic acid amplification test. Risk factors and acceptability were examined using chi squared tests and logistic regression. Of 501 samples received for testing, 106 (21%) were positive for at least one STI, 64 (13%) for chlamydia, 4 (1%) for gonorrhea, and 49 (10%) for trichomonas. In multivariable analyses, age, race, household income, and frequency of condom use were independently associated with infection with at least one STI. Of the total respondents, 34% had a prior STI; 29% reported having a partner with an STI, but only 13% reported always using a condom. Among the men who participated in this study, 77% preferred a self-administered specimen versus attending a clinic, 89% reported that swab use was easy, and 89% reported that they would use internet-based screening again. Men who accessed internet-based screening had known risk factors for STIs and had a high prevalence of infection. Internet-based screening was acceptable and could reach these high-risk men who might not otherwise be reached through traditional means.
            Bookmark

            Author and article information

            Affiliations
            [1 ]Health Protection Agency, London, UK
            [2 ]Department of Sexual Health and HIV, Kings College Hospital NHS Foundation Trust, London, UK
            [3 ]Sarah Woodhall, Health Protection Agency, HIV & STI Department, 61 Colindale Avenue, London, NW9 5EQ, UK
            Contributors
            Journal
            BMC Public Health
            BMC Public Health
            BMC Public Health
            BioMed Central
            1471-2458
            2012
            19 December 2012
            : 12
            : 1095
            23253518
            3554557
            1471-2458-12-1095
            10.1186/1471-2458-12-1095
            Copyright ©2012 Woodhall et al.; licensee BioMed Central Ltd.

            This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            Research Article

            Public health

            internet, chlamydia trachomatis, screening

            Comments

            Comment on this article