There’s No Place Like Home: First-Year Use of the “I Know” Home Testing Program for Chlamydia and Gonorrhea

Abstract

In response to high chlamydia and gonorrhea morbidity, particularly among young African American and Latina women, the Los Angeles County Department of Public Health launched a free home testing program for Chlamydia trachomatis and Neisseria gonorrhoeae. The primary objectives were to increase chlamydia and gonorrhea testing by removing key barriers and to motivate young women to screen routinely for these sexually transmitted diseases (STDs). The program was promoted with a social marketing campaign urging women to order home collection kits online or by telephone. In the program's first year, 2927 kits were ordered and 1543 testable specimens returned; 131 women (8.5%) had a positive test result. The strong response, high morbidity, and program scalability indicated strong potential as a new tool for STD control.

Bacterial Sexually Transmitted Disease Screening Outside the Clinic—Implications for the Modern Sexually Transmitted Disease Program

“…The volume of testing, especially in programs that are marketed to larger geographic areas, has increased where more than 1500 tests were requested in a year in one program. 46 …”

“…However, the cost savings associated with home screening were dependent on the proportion of users who were asymptomatic and would not seek out routine clinical services related to signs and symptoms of an STD, a factor that likely impacts total case yield. A preliminary cost-effectiveness analysis of the Los Angeles County Internet campaign 46 indicated that although the pilot program was probably not cost-effective given the formative and media costs, under some scenarios considered in sensitivity analysis, the program could deliver health benefits for approximately $100,000 (no formative or media costs included) to $200,000 (including formative and media costs) per quality-adjusted life-year saved with Internet testing versus clinic-based testing. 61 …”

Could Home Sexually Transmitted Infection Specimen Collection With e-Prescription Be a Cost-Effective Strategy for Clinical Trials and Clinical Care?

“…5,10,21 However, the availability of eRx in a web-based system has not been evaluated except in our demonstration study, 6 and requires validation in a larger comparative effectiveness trial. If the overall study prevalence of STIs (CT+GC+TV) is greater than our estimate of 8%, cost per STI detected in a future trial may be lower than results of this cost analysis suggest.…”

“…We derived our participant testing rate estimates of 67% for the eSTI arm and 40% for the clinic-referral arm as well as the ranges for sensitivity analyses from our primary data 6 and the literature. 5,7,8 …”

“…In order to expand access to screening services, groups have evaluated the use of home sampling kits that individuals request via the internet and submit to a laboratory via the U.S. postal service. 4,5 However, these evaluations did not collect longitudinal data to determine the impact on early detection and treatment of infection or include a standard care comparison group.…”