4B 3 Home-Based Self-Collection for the Detection of Sexually Transmitted Infections in High-Risk Women in North Carolina

Wednesday, June 11, 2014: 3:20 PM
Dogwood A
Andrea Des Marais, MPH1, Virginia Senkomago, PhD, MPH1, Craig Hill, PhD2, Lynn Barclay, BA3 and Jennifer Smith, PhD, MPH1, 1Department of Epidemiology, Gillings School of Global Public Health at the University of North Carolina, Chapel Hill, Chapel Hill, NC, 2Scientific Affairs, Hologic Gen-Probe, San Diego, CA, 3American Sexual Health Association, Research Triangle Park, NC

Background: Use of mailed, home-based self-collection kits to test for sexually transmitted infections (STIs) is a promising strategy to increase screening in medically underserved women. Recent advances in methods for collection, preservation, and processing of samples, including mailing for self-collection, allow for greater flexibility in STI testing.

Methods: Study participants were low-income women in North Carolina with histories of infrequent cervical cancer screening. Participants were asked to self-collect a cervical/vaginal sample at home and return the sample by mail, then referred to a local clinic to complete a second self-collected sample and a clinician-collected endocervical sample. Samples were tested for chlamydia trachomatis, gonorrhea, trichomonas vaginalis, mycoplasma genitalium, and oncogenic HPV infection using Aptima assays (Hologic Gen-Probe). Analysis used Kappa statistics to compare detected prevalence between the home self-collected, clinic self-collected, and clinician-collected samples.

Results: A total of 181 women received self-collection kits and 150 successfully returned samples for subsequent testing. In 137 women who completed all 3 samples to date, the most common STIs detected were HPV (13% in self-home, 16% in self-clinic, 12% in clinician), followed by trichomonas (10%, 12%, and 12%) and M. genitalium (3%, 4%, and 3%). High Kappa values were found between home self-collection and clinician collection results for trichomonas (Kappa=0.89), HPV (0.76), and M. genitalium (0.65). Similar Kappa values were observed between home self-collection and clinic self-collection for these STIs. Kappa values are not presented for chlamydia and gonorrhea, as these infections were relatively rare (<1%).

Conclusions: Mailed self-collection kits were used with a high rate of successful completion in this population of medically underserved women. Results for trichomonas, HPV, and M. genitalium from home self-collected samples were highly concordant with both clinic self-collection and clinician-collected samples. Self-collection may ultimately be a valid method of increasing STI screening coverage among women who do not regularly access medical care.