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

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.