Rationale and design of REACT: a randomised controlled trial assessing the effectiveness of home-collection to increase chlamydia retesting and detect repeat positive tests

Smith, Kirsty; Hocking, Jane S; Chen, Marcus; Fairley, Christopher K.; McNulty, Anna; Read, Phillip; Bradshaw, Catriona; Tabrizi, Sepehr N.; Wand, Handan; Saville, Marion; Rawlinson, William D.; Garland, Suzanne M.; Donovan, Basil; Kaldor, John; Guy, Rebecca

doi:10.1186/1471-2334-14-223

Cited by 10 publications

(5 citation statements)

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“…via SMS, internet, telephone and pick up from the clinic) and returning (e.g. dropping off at the clinic) the test kits were available, depending on the diverse needs and preferences of different risk groups, as suggested by Smith et al [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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BackgroundControl 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.MethodsYoung (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.ResultsOf 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.ConclusionAcceptance 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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…Although this sampling methodology has been successful for diagnosis of sexually transmitted infections, 42,43 the detection of self-collected YSTR mixtures as a biomarker of CRAI demonstrated only 30% sensitivity. Simulated rectal ejaculation studies suggest that semen deposition occurs farther from the anal margin than our sampling reached, and it moves retrograde 10-20 cm from the anus.…”

Section: Discussionmentioning

confidence: 99%

HIV-1 Nucleic Acids Identify Rectal HIV Exposures in Self-Collected Rectal Swabs, Whereas Y-Chromosome Single Tandem Repeat Mixtures Are Not Reliable Biomarkers of Condomless Receptive Anal Intercourse

Lemos

Nandi

Dragavon³

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: To focus interventions, biomarkers of HIV-1 exposure could help in identifying subpopulations at highest risk of acquisition. We assessed whether Y-chromosome single tandem repeat (YSTR) mixtures obtained from rectal swabs could serve as a biomarker of condomless receptive anal intercourse (CRAI) among men who have sex with men and transgender women and evaluated the feasibility of detecting HIV-1 virions to assess exposures.Methods: Twenty-nine sexually active HIV-seronegative men who have sex with men and one transgender woman from New York City answered on-site and mobile app sexual behavior questionnaires. They were randomized to collecting self-administered rectal swabs every morning or after receptive anal intercourse (RAI). YSTR profiles were assessed from blood sample and swabs; HIV-1 exposure was measured by conducting quantitative polymerase chain reaction in swabs.Results: After 2 months, the daily mobile survey had 135%-201% more instances of anal sex acts and 170%-193% more RAI than onsite surveys. Daily mobile reporting had 11%-35% less CRAI events than those reported on-site (P daily = 0.001; P per-sex = 0.047). The daily swabbing arm reported less RAI (P , 0.001) and CRAI (P , 0.038) and had 2.95 lower odds of detecting YSTR mixtures (P = 0.021) than the per-sex-event arm. Surprisingly, YSTR detection was not significantly modified by report of bowel movements and lubricant, enema, or condom use. No participant became HIV-1 infected, yet HIV-1 total nucleic acids were detected in 6 independent episodes of CRAI in 2 participants taking preexposure prophylaxis.Conclusions: YSTR mixtures demonstrated 80% specificity but only 30% sensitivity as a biomarker of CRAI in self-collected rectal swabs. However, detection of HIV-1 exposures in self-collected swabs may help in identifying those needing further HIV risk reduction strategies.

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“…The REACT trial methods are described in detail elsewhere [ 26 ]. Briefly, in this unblinded RCT, individuals were randomised in a 1:1 ratio to either an SMS reminder and postal home-collection kit (intervention–home arm), or an SMS reminder and clinic testing (control–clinic arm).…”

Section: Methodsmentioning

confidence: 99%

The acceptability and cost of a home-based chlamydia retesting strategy: findings from the REACT randomised controlled trial

Smith¹,

Kaldor²,

Hocking

et al. 2015

BMC Public Health

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BackgroundChlamydia retesting three months after treatment is recommended to detect reinfections, but retesting rates are typically low. The REACT (retest after Chlamydia trachomatis) randomised trial demonstrated that home-based retesting using postal home-collection kits and SMS reminders, resulted in substantial improvements in retesting rates in women, heterosexual men and men who have sex with men (MSM), with detection of more repeat positive tests compared with SMS reminder alone. In the context of this trial, the acceptability of the home-based strategy was evaluated and the costs of the two strategies were compared.MethodsREACT participants (200 women, 200 heterosexual men, 200 MSM) were asked to complete an online survey that included home-testing acceptability and preferred methods of retesting. The demographics, sexual behaviour and acceptability of home collection were compared between those preferring home-testing versus clinic-based retesting or no preference, using a chi-square test. The costs to the health system of the clinic-based and home retesting strategies and the cost per infection for each were also compared.ResultsOverall 445/600 (74 %) participants completed the survey; 236/445 from the home-testing arm, and 141 of these (60 %) retested at home. The majority of home arm retesters were comfortable having the kit posted to their home (86 %); found it easy to follow the instructions and collect the specimens (96 %); were confident they had collected the specimens correctly (90 %); and reported no problems (70 %). Most (65 %) preferred home retesting, 21 % had no preference and 14 % preferred clinic retesting. Comparing those with a preference for home testing to those who didn’t, there were significant differences in being comfortable having a kit sent to their home (p = 0.045); not having been diagnosed with chlamydia previously (p = 0.030); and living with friends (p = 0.034). The overall cost for the home retest pathway was $154 (AUD), compared to $169 for the clinic-based retesting pathway and the cost per repeat infection detected was $1409 vs $3133.ConclusionsAmong individuals initially diagnosed with chlamydia in a sexual health clinic setting, home-based retesting was shown to be highly acceptable, preferred by most participants, and cost-efficient. However some clients preferred clinic-based testing, often due to confidentiality concerns in their home environment. Both options should be provided to maximise retesting rates.Trial registrationThe trial was registered with the Australia New Zealand Clinical Trials Registry on September 9, 2011: ACTRN12611000968976.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2727-4) contains supplementary material, which is available to authorized users.

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Rationale and design of REACT: a randomised controlled trial assessing the effectiveness of home-collection to increase chlamydia retesting and detect repeat positive tests

Cited by 10 publications

References 51 publications

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

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

HIV-1 Nucleic Acids Identify Rectal HIV Exposures in Self-Collected Rectal Swabs, Whereas Y-Chromosome Single Tandem Repeat Mixtures Are Not Reliable Biomarkers of Condomless Receptive Anal Intercourse

The acceptability and cost of a home-based chlamydia retesting strategy: findings from the REACT randomised controlled trial

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