Background:
The 2006 CDC treatment guidelines recommend rescreening women three months after treatment for Chlamydia trachomatis (CT) infection.

Objective:
To determine if home-based, self-collected vaginal swabs can increase rescreening for CT compared with rescreening in the clinic.

Method:
The study is a non-blinded, randomized intervention trial. Women/girls >16 years who had been treated for Chlamydia were enrolled from STD clinics in New Orleans, St. Louis and Jackson. After informed consent, women/girls were randomly assigned (1:1 ratio) to the Clinic Group (given an appointment to return to clinic), or the Home Group (collect a vaginal swab at home and mail it to the laboratory) for chlamydia testing. Rescreening was scheduled at 3 months following treatment, with a reminder call made to all women 2 weeks before scheduled retesting.

Result:
A total of 792 participants were enrolled from October 2004 through August 2007. Follow-up will continue through November 2007. This preliminary analysis includes 724 women (enrolled before June 1, 2007). The mean age was 22 years; 93% were African American; there were no demographic differences between study groups. Overall, 84 (23.4%) of 359 women assigned to the Clinic Group returned for rescreening and 111 (30.4%) of 365 women assigned to the Home Group mailed in a self-collected vaginal swab (p=0.03). Only 15.6% of women in the Clinic Group and 21.9% of women in the Home Group were retested within 4-weeks of scheduled rescreening (p=0.03).

Conclusion:
Chlamydia rescreening rates were low among STD attendees despite an innovative strategy to increase them. However, home-based, self-collected vaginal swabs clearly provide women an alternative to clinic-based rescreening for Chlamydia.

Implications:
The reasons for apparent low interest in rescreening among female STD clinic clients require further study. In the meantime, allowing women to choose self-collected vaginal swabs has the potential to increase rescreening rates.