Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis

Abstract

BackgroundSelf-collection of samples for diagnostic testing offers the advantages of patient autonomy, confidentiality and convenience. Despite data showing their feasibility and accuracy, there is a need to better understand how to implement such interventions for sexually transmitted infections (STIs). To support WHO guidelines on self-care interventions, we conducted a systematic review to investigate whether self-collection of samples should be made available as an additional approach to deliver STI testing services.MethodsPeer-reviewed studies were included if they compared individuals who self-collected samples for chlamydia, gonorrhoea, syphilis and/or trichomonas testing to individuals who had samples collected by clinicians on the following outcomes: uptake/frequency of STI testing, social harms/adverse events, positive yield (case finding), linkage to clinical assessment/treatment and reported sexual risk behaviour. We searched PubMed, CINAHL, LILACS and EMBASE for articles published through July 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-RCTs. Meta-analysis was conducted using random effects models to generate pooled estimates of relative risk (RR).ResultsEleven studies, including five RCTs and six observational studies with a total of 202 745 participants, met inclusion criteria. Studies were conducted in Australia, Denmark and the USA. Meta-analysis found that programmes offering self-collection of samples increased overall uptake of STI testing services (RR: 2.941, 95% CI 1.188 to 7.281) and case finding (RR: 2.166, 95% CI 1.043 to 4.498). No studies reported measuring STI testing frequency, social harms/adverse events, linkage to care or sexual risk behaviour.DiscussionWhile greater diversity in study designs, outcomes and settings would strengthen the evidence base, findings from this review suggest that self-collection of STI samples could be an effective additional strategy to increase STI testing uptake.Prospero registration numberPROSPERO CRD42018114866.

Comparison of Speculum and Non-speculum Vaginal Specimens in the Diagnosis of <i>Trichomonas vaginalis</i>

“…This is very exciting as we believe, it will enable healthcare facilities equipped for microscopy but who lack technical expertise and other requirements to sustain aseptic speculum use, to carry out etiologic diagnosis of trichomoniasis. This is similar to reports and recommendations by Ogale et al [30] and Shafer et al [22] among others.…”

Self-Sampling Interventions for Sexually Transmitted Infections in Women: A Scoping Review Protocol

“…Syndromic management of STIs, which is common practice in LMICs, addresses symptomatic infections. However, asymptomatic infections remain undiagnosed and untreated (10). Other barriers include stigmatization and judgement associated with issues of sexual ill-health (8,20).…”

“…According to Shrestha et al (2015) initial exposure to STIs often occurs during early days of sexual debut due to risky behaviour (7). Unfortunately, if untreated and undiagnosed at this stage, the risk of long term disease complications which include infertility; chronic pelvic pain; cervical cancer; and ectopic pregnancy; increases (9,10). Furthermore, some STIs increase the risk of HIV transmission and acquisition (11).…”

“…One such intervention is self-sampling for the diagnosis of STIs. In selfsampling, specimen collection kits are issued to individuals to collect their own specimens either at home or at a healthcare facility (10). The convenience and con dentiality offered by self-sampling interventions, make it ideal to facilitate screening and broaden STI services to populations with limited access to healthcare resources (14).…”

Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights

“…We adopted a similar methodological approach to research formulation used in two previously published WHO guidelines 11 12. Prior to the GDG meeting, a systematic review, including meta-analysis where appropriate, was conducted for each of the five selected PICO questions 13–17. The overall certainty of evidence was rated as high, moderate, low or very low according to the Grading of Evidence, Assessment, Development and Evaluation (GRADE) approach 18.…”