A validation study of a clinical prediction rule for screening asymptomatic chlamydia and gonorrhoea infections among heterosexuals in British Columbia

Falasinnu, Titilola; Gilbert, Mark; Gustafson, Paul; Shoveller, Jean

doi:10.1136/sextrans-2014-051992

Cited by 9 publications

(21 citation statements)

References 29 publications

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“…We also made revisions to prospectively collect the necessary variables to validate clinical prediction rules (CPR) developed by our team for urine testing for chlamydia and gonorrhea, and blood testing for HIV. These CPR were developed using test results from over 30,000 asymptomatic clients at STI clinics across BC [ 55 , 56 ]. Once these are further validated using prospective GCO data, we aim to include these CPRs prior to promoting GCO outside of our target populations, where our current model for recommending tests may not be appropriate.…”

Section: Resultsmentioning

confidence: 99%

Get Checked… Where? The Development of a Comprehensive, Integrated Internet-Based Testing Program for Sexually Transmitted and Blood-Borne Infections in British Columbia, Canada

Gilbert¹,

Haag²,

Salway³

et al. 2016

JMIR Res Protoc

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BackgroundTesting for sexually transmitted and blood-borne infections (STBBI) is an effective public health strategy that can promote personal control of one’s health and prevent the spread of these infections. Multiple barriers deter access to testing including fear of stigmatization, inaccurate health care provider perceptions of risk, and reduced availability of clinic services and infrastructure. Concurrent increases in sexually transmitted infection (STI) rates and demands on existing clinical services make this an even more pressing concern. Web-based testing offers several advantages that may alleviate existing clinical pressures and facilitate appropriate testing access.ObjectiveThis paper describes the planning, development, and usability testing of a novel Web-based testing service, GetCheckedOnline (GCO), as a complementary testing option integrated within existing sexual health services within British Columbia (BC).MethodsFrom 2009 to 2014, we engaged a multidisciplinary team in the design and development of GCO. We conducted 3 initial research studies to ascertain the opinions of youth, men who have sex with men (MSM), and STI clinic clients regarding Web-based testing and elicited perspectives of sexual health care providers through focus groups. We developed an informed consent process, risk assessment questions, and test recommendations based on provincial and national guidelines and evaluated these through consultations with clinical and community stakeholders. We also conducted a preliminary health equity impact assessment whose findings also informed the GCO program mode. Finally, from April 2011 to December 2012 we gathered qualitative data from 25 participants on the functionality and usability of a GCO prototype and incorporated their recommendations into a final model.ResultsGCO launched in the fall of 2014 across 6 pilot sites in Vancouver, BC. The service involves 3 main steps: (1) create an account, complete an assessment, and print a laboratory requisition, (2) provide blood and urine specimens at participating laboratory locations, and (3) receive test results on the Internet or by phone. During this pilot phase, we promoted GCO to existing STI clinic clients and MSM in the Greater Vancouver region. A rigorous mixed-method evaluation of GCO’s uptake, acceptability, and health system impacts is currently underway.ConclusionsGCO is the first comprehensive Web-based STBBI testing program in Canada that is integrated with existing sexual health services, with the potential to reduce pressures on existing clinical services and reach populations facing the greatest barriers to testing. Our experience highlights the facilitators and challenges of developing and implementing novel complex eHealth interventions within the health care system, and underscores the importance of considering broader implementation contexts.

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Section: Resultsmentioning

confidence: 99%

Get Checked… Where? The Development of a Comprehensive, Integrated Internet-Based Testing Program for Sexually Transmitted and Blood-Borne Infections in British Columbia, Canada

Gilbert¹,

Haag²,

Salway³

et al. 2016

JMIR Res Protoc

Self Cite

View full text Add to dashboard Cite

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“… 9 Also similar to our findings, external validation of this CPR to STI clinic settings beyond Vancouver (the site of the CPR's derivation) demonstrated lower discriminative power (AUC, 0.69) within a higher CT/NG prevalence (5.3%) sample. 25 Regional differences in underlying CT/NG prevalence, as can be observed within GetCheckedOnline's provincial scope, may have impacted the CPR's performance. 26 Although we observed differences in the distribution of gender between the STI clinic and GetCheckedOnline populations, discrimination on GetCheckedOnline was similar between women (AUC, 0.63; 95% CI, 0.54–0.69) and men (AUC, 0.64; 95% CI, 0.57–0.71; data not shown).…”

Section: Discussionmentioning

confidence: 99%

Validation of a Clinical Prediction Rule to Predict Asymptomatic Chlamydia and Gonorrhea Infections Among Internet-Based Testers

Ablona

Falasinnu²,

Irvine

et al. 2020

Sexual Trans Dis

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“…HIV status was obtained from the CHIEDZA dataset. The questions in the questionnaire were informed by studies developing risk prediction tools for chlamydia and gonorrhoea infection in high-income settings [ 20 , 21 ] and studies investigating risk factors for those infections in sub-Saharan Africa [ 13 , 17 , 19 , 24 , 26 , 27 ]. The questionnaire was administered by a research assistant not involved in STI testing or delivering other CHIEDZA services.…”

Section: Methodsmentioning

confidence: 99%

“…Clinical prediction rules for STIs have been successfully developed for high-income settings to allow for a so-called “selective screening” approach [ 20 , 21 ]. This approach is aimed at minimising costs associated with testing low-risk individuals while detecting most infections.…”

Section: Introductionmentioning

confidence: 99%

Identifying youth at high risk for sexually transmitted infections in community-based settings using a risk prediction tool: a validation study

et al. 2021

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Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common bacterial sexually transmitted infections (STIs) worldwide. In the absence of affordable point-of-care STI tests, WHO recommends STI testing based on risk factors. This study aimed to develop a prediction tool with a sensitivity of > 90% and efficiency (defined as the percentage of individuals that are eligible for diagnostic testing) of < 60%. Methods This study offered CT/NG testing as part of a cluster-randomised trial of community-based delivery of sexual and reproductive health services to youth aged 16–24 years in Zimbabwe. All individuals accepting STI testing completed an STI risk factor questionnaire. The outcome was positivity for either CT or NG. Backwards-stepwise logistic regression was performed with p ≥ 0.05 as criteria for exclusion. Coefficients of variables included in the final multivariable model were multiplied by 10 to generate weights for a STI risk prediction tool. A maximum likelihood Receiver Operating Characteristics (ROC) model was fitted, with the continuous variable score divided into 15 categories of equal size. Sensitivity, efficiency and number needed to screen were calculated for different cut-points. Results From 3 December 2019 to 5 February 2020, 1007 individuals opted for STI testing, of whom 1003 (99.6%) completed the questionnaire. CT/NG prevalence was 17.5% (95% CI 15.1, 19.8) (n = 175). CT/NG positivity was independently associated with being female, number of lifetime sexual partners, relationship status, HIV status, self-assessed STI risk and past or current pregnancy. The STI risk prediction score including those variables ranged from 2 to 46 with an area under the ROC curve of 0.72 (95% CI 0.68, 0.76). Two cut-points were chosen: (i) 23 for optimised sensitivity (75.9%) and specificity (59.3%) and (ii) 19 to maximise sensitivity (82.4%) while keeping efficiency at < 60% (59.4%). Conclusions The high prevalence of STIs among youth, even in those with no or one reported risk factor, may preclude the use of risk prediction tools for selective STI testing. At a cut-point of 19 one in six young people with STIs would be missed.

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A validation study of a clinical prediction rule for screening asymptomatic chlamydia and gonorrhoea infections among heterosexuals in British Columbia

Cited by 9 publications

References 29 publications

Get Checked… Where? The Development of a Comprehensive, Integrated Internet-Based Testing Program for Sexually Transmitted and Blood-Borne Infections in British Columbia, Canada

Get Checked… Where? The Development of a Comprehensive, Integrated Internet-Based Testing Program for Sexually Transmitted and Blood-Borne Infections in British Columbia, Canada

Validation of a Clinical Prediction Rule to Predict Asymptomatic Chlamydia and Gonorrhea Infections Among Internet-Based Testers

Identifying youth at high risk for sexually transmitted infections in community-based settings using a risk prediction tool: a validation study

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