Can Self-collected Vaginal Swabs Facilitate Testing for Repeat Chlamydia trachomatis Infections among STD Clinic Clients?

Wednesday, March 12, 2008: 10:30 AM
Northwest 1
Fujie Xu, MD, PhD , Division of STD Prevention, CDC, Atlanta, GA
David H. Martin, MD , Section of Infectious Diseases, Louisiana State University Health Sciences Center, Baton Rouge, LA
Bradley P. Stoner, Md, PhD , Assoc. Professor, Anthropology and Medicine, Washington University in St. Louis, St. Louis, MO
Leandro Mena, MD, MPH , Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS
Stephanie N. Taylor, MD , Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, LA
Kathleen Hutchins, BA , Division of STD Prevention, CDC, Atlanta, GA
John Papp, PhD , Division of STD Prevention, CDC, Atlanta, GA
Lauri E. Markowitz, MD , Division of STD Prevention, CDC, Atlanta, GA

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

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

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.

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).

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.

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.
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