Chlamyweb Study II: a randomised controlled trial (RCT) of an online offer of home-based<i>Chlamydia trachomatis</i>sampling in France

Rahib, Delphine; Lydié, Nathalie; Leroy, Chloé; March, Laura; Bebear, Cécile; Arwidson, Pierre; Barbeyrac, Bertille de

doi:10.1136/sextrans-2015-052510

Cited by 40 publications

(57 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 9 In France, an RCT investigating an intervention to encourage chlamydia testing via an online service on uptake of testing suggested the intervention had a greater effect on men, though no other differences in the uptake between groups were observed. 23 However, this may be subject to bias due to low follow-up (30%). 23 …”

Section: Discussionmentioning

confidence: 99%

Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis

et al. 2018

View full text Add to dashboard Cite

ObjectivesOnline services for self-sampling at home could improve access to STI testing; however, little is known about those using this new modality of care. This study describes the characteristics of users of online services and compares them with users of clinic services.MethodsWe conducted a cross-sectional analysis of routinely collected data on STI testing activity from online and clinic sexual health services in Lambeth and Southwark between 1January 2016 and 31March 2016. Activity was included for chlamydia, gonorrhoea, HIV and syphilis testing for residents of the boroughs aged 16 years and older. Logistic regression models were used to explore potential associations between type of service use with age group, gender, ethnic group, sexual orientation, positivity and Index of Multiple Deprivation (IMD) quintiles. We used the same methods to explore potential associations between return of complete samples for testing with age group, gender, ethnic group, sexual orientation and IMD quintiles among online users.Results6456 STI tests were carried out by residents in the boroughs. Of these, 3582 (55.5%) were performed using clinic services and 2874 (44.5%) using the online service. In multivariate analysis, online users were more likely than clinic users to be aged between 20 and 30 years, female, white British, homosexual or bisexual, test negative for chlamydia or gonorrhoea and live in less deprived areas. Of the individuals that ordered a kit from the online service, 72.5% returned sufficient samples. In multivariate analysis, returners were more likely than non-returners to be aged >20 years and white British.ConclusionNearly half (44.5%) of all basic STI testing was done online, although the characteristics of users of clinic and online services differed and positivity rates for those using the online service for testing were lower. Clinics remain an important point of access for some groups.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis

et al. 2018

View full text Add to dashboard Cite

show abstract

“…It reports an increase in testing uptake (29.2% in the intervention group versus 8.7% in the control group, RR 3.37, 95% CI 3.05 to 3.74). However, outcomes were assessed using different measures in the intervention and control groups, and there was low and differential follow-up (47% follow-up in the intervention group versus 30% follow-up in the control group) [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Internet-accessed sexually transmitted infection (e-STI) testing and results service: A randomised, single-blind, controlled trial

et al. 2017

View full text Add to dashboard Cite

BackgroundInternet-accessed sexually transmitted infection testing (e-STI testing) is increasingly available as an alternative to testing in clinics. Typically this testing modality enables users to order a test kit from a virtual service (via a website or app), collect their own samples, return test samples to a laboratory, and be notified of their results by short message service (SMS) or telephone. e-STI testing is assumed to increase access to testing in comparison with face-to-face services, but the evidence is unclear. We conducted a randomised controlled trial to assess the effectiveness of an e-STI testing and results service (chlamydia, gonorrhoea, HIV, and syphilis) on STI testing uptake and STI cases diagnosed.Methods and findingsThe study took place in the London boroughs of Lambeth and Southwark. Between 24 November 2014 and 31 August 2015, we recruited 2,072 participants, aged 16–30 years, who were resident in these boroughs, had at least 1 sexual partner in the last 12 months, stated willingness to take an STI test, and had access to the internet. Those unable to provide consent and unable to read English were excluded. Participants were randomly allocated to receive 1 text message with the web link of an e-STI testing and results service (intervention group) or to receive 1 text message with the web link of a bespoke website listing the locations, contact details, and websites of 7 local sexual health clinics (control group). Participants were free to use any other services or interventions during the study period. The primary outcomes were self-reported STI testing at 6 weeks, verified by patient record checks, and self-reported STI diagnosis at 6 weeks, verified by patient record checks. Secondary outcomes were the proportion of participants prescribed treatment for an STI, time from randomisation to completion of an STI test, and time from randomisation to treatment of an STI. Participants were sent a £10 cash incentive on submission of self-reported data. We completed all follow-up, including patient record checks, by 17 June 2016. Uptake of STI testing was increased in the intervention group at 6 weeks (50.0% versus 26.6%, relative risk [RR] 1.87, 95% CI 1.63 to 2.15, P < 0.001). The proportion of participants diagnosed was 2.8% in the intervention group versus 1.4% in the control group (RR 2.10, 95% CI 0.94 to 4.70, P = 0.079). No evidence of heterogeneity was observed for any of the pre-specified subgroup analyses. The proportion of participants treated was 1.1% in the intervention group versus 0.7% in the control group (RR 1.72, 95% CI 0.71 to 4.16, P = 0.231). Time to test, was shorter in the intervention group compared to the control group (28.8 days versus 36.5 days, P < 0.001, test for difference in restricted mean survival time [RMST]), but no differences were observed for time to treatment (83.2 days versus 83.5 days, P = 0.51, test for difference in RMST). We were unable to recruit the planned 3,000 participants and therefore lacked power for the analyses of STI diagnoses and STI ca...

show abstract

“…Although there is increasing availability of internet-based ordering of STI tests in developed countries, such services are highly heterogeneous: some are targeted to specific risk groups (based on age, ethnicity, or sexual orientation), test for a single infection [ 10 ], may be fully integrated with existing health services [ 11 ] or completely independent. A randomized controlled trial in France reported an increase in testing uptake (29.2% in the intervention group vs 8.7% in the control group, risk ratio: 3.37, 95% CI 3.05-3.74) [ 12 ]. However, outcomes were assessed using different measures in the intervention and control group, and there was low follow-up [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Web-Based Activity Within a Sexual Health Economy: Observational Study

Turner¹,

Zienkiewicz²,

Syred³

et al. 2018

J Med Internet Res

View full text Add to dashboard Cite

BackgroundRegular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits ordered online and delivered in the post may increase access, convenience, and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users toward Web-based or face-to-face services according to clinical need.ObjectiveThe aim of this paper was to investigate the impact of two interventions on testing activity across a whole sexual health economy: (1) the introduction of open access Web-based STI testing services and (2) a clinic policy of triage and signpost online where users without symptoms who attended clinics for STI testing were supported to access the Web-based service instead.MethodsData on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed, and clinical activity provided, including test results. Clinical activity was categorized as a simple STI test (could be done in a clinic or online), a complex visit (requiring face-to-face consultation), or other.ResultsIntroduction of Web-based services increased total testing activity across the whole sexual health economy by 18.47% (from 36,373 to 43,091 in the same 6-month period—2014-2015 and 2015-2016), suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the Web-based service, with simple STI testing in the clinic decreasing from 16.90% (920/5443) to 12.25% (511/4172) of total activity, P<.001, and complex activity in the clinic increasing from 69.15% (3764/5443) to 74.86% (3123/4172) of total activity, P<.001. This intervention created a new population of online users with different demographic and clinical profiles from those who use Web-based services spontaneously. Some triage and signposted users (29.62%, 375/1266) did not complete the Web-based testing process, suggesting the potential for missed diagnoses.ConclusionsThis evaluation shows that users can effectively be transitioned from face-to-face to Web-based services and that this introduces a new population to Web-based service use and changes the focus of clinic-based activity. Further development is underway to optimize the triage and signposting process to support test completion.

show abstract

Chlamyweb Study II: a randomised controlled trial (RCT) of an online offer of home-basedChlamydia trachomatissampling in France

Abstract: AFFSAPS n° IDRCB 0211-A01000-41; Results.

Cited by 40 publications

References 19 publications

Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis

Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis

Internet-accessed sexually transmitted infection (e-STI) testing and results service: A randomised, single-blind, controlled trial

Web-Based Activity Within a Sexual Health Economy: Observational Study

Contact Info

Product

Resources

About