Chlamydia and gonorrhea reinfections are common and associated with serious reproductive health sequelae. Routine retesting a few months after treatment can detect reinfections early, reducing the risk of complications. Although national guidelines have recommended retesting for over a decade, retesting rates remain below 50%. A major contributing factor to low rates is patients not returning to clinic for retesting. Effective strategies for increasing patient retest return rates have been elusive.
From 2010-2011, female California Family Planning, Access, Care, and Treatment Program clients treated for CT and/or GC at six geographically diverse California Title X clinics were counseled about the dangers of reinfections and importance of retesting (education phase). During 2011-2012, treated CT/GC-positive clients were additionally enrolled in the InTOUCH Study and offered options for customizing their follow-up care, including receiving retest reminders via postcard, text, and/or email, and retesting using a mailed-in home-testing kit (education-plus-options phase).
Clinic-level return rates during the 31-180 days post CT/GC treatment were calculated using laboratory and clinical encounter data. Fisher’s exact test was used to compare differences in return rates from the two intervention phases versus the historical period just prior to study initiation.
The number of eligible patients in the historical, education, and enrolled education-plus-options phases were 2696, 1454, and 575, respectively. Among enrolled patients, 90% opted to receive retest reminders while only 5% opted to use the home-test kit. The historical patient retest return rate was 54% (range 47-60%). This rate increased significantly during the education phase to 59% (range 52-66%, p=0.01), and during the education-plus-options phase to 62% (range 52-73%, p=0.001).
By providing CT/GC patients education about reinfections and retesting, and options for customizing their follow-up care, including receiving retest reminders, we were able to increase patient retest return rates by 15%. These low cost interventions can be broadly and feasibly implemented.