No abstract

Objectives: To test whether more women are screened for sexually transmitted infections when offered homebased versus clinic-based testing and to evaluate the feasibility and acceptability of self-sampling and selftesting in home and clinic settings in a resource-poor community. Methods: Women aged 14-25 were randomised to receive a home kit with a pre-paid addressed envelope for mailing specimens or a clinic appointment, in Gugulethu, South Africa. Self-collected vaginal swabs were tested for gonorrhoea, chlamydia and trichomoniasis using PCR and self-tested for trichomoniasis using a rapid dipstick test. All women were interviewed at enrolment on sociodemographic and sexual history, and at the 6-week follow-up on feasibility and acceptability. Results: 626 women were enrolled in the study, with 313 in each group; 569 (91%) completed their 6-week follow-up visit. Forty-seven per cent of the women in the home group successfully mailed their packages, and 13% reported performing the rapid test and/or mailing the kit (partial responders), versus 42% of women in the clinic group who kept their appointment. Excluding partial responders, women in the home group were 1.3 (95% CI 1.1 to 1.5) times as likely to respond to the initiative as women in the clinic group. Among the 44% who were tested, 22% tested positive for chlamydia, 10% for trichomoniasis, and 8% for gonorrhoea. Conclusions: Self-sampling and self-testing are feasible and acceptable options in low-income communities such as Gugulethu. As rapid diagnostic tests become available and laboratory infrastructure improves, these methodologies should be integrated into services, especially services aimed at young women.

Although self-sampling should not replace speculum examinations in all circumstances, it should be explored further as an RTI screening strategy.

We assessed the agreement in detection of high-risk human papillomavirus (HPV), as well as specific HPV types, between self-and clinician-obtained specimens for 450 women over 18 years of age attending a community health center in Gugulethu, South Africa. Both self-collected swabs and tampons had high agreement with clinician-obtained brushes when the Roche Reverse Line Blot Assay (RLBA) was used (for swabs, 86% concordance, with a kappa statistic [] of 0.71; for tampons, 89% concordance, with of 0.75). Agreement was lower, although still fair, with the Digene Hybrid Capture 2 test (HC2), with higher for swabs than for tampons (for swabs, 81% concordance, with of 0.61; for tampons, 82% concordance, with of 0.55). Low-risk HPV types were nearly two times more common in self-collected specimens than in clinician-collected specimens tested by RLBA. All 15 women diagnosed with high-grade lesions by cytology tested positive for high-risk HPV with clinician-collected specimens tested by RLBA and HC2, while 11 out of 15 tested positive with self-collected specimens by HC2 and 5 out of 6 tested positive by RLBA. Self-collected specimens can provide valid specimens for HPV testing using nucleic acid amplification tests, although a few cytological abnormalities may be missed.An estimated 493,000 new cases of cervical cancer occur each year, with over 80% occurring in developing countries (7,17). While Papanicolaou (Pap) screening programs have led to significant declines in cervical cancer mortality rates in developed countries, they have been less successful in resource-poor settings, as they require significant clinical and laboratory infrastructure, trained cytologists or pathologists, and frequent patient visits due to the relatively low sensitivity (1, 2). Human papillomavirus (HPV) testing is being promoted increasingly as a screening test for women over 30 years old, as it is more sensitive than the Pap smear and identifies a subgroup of women positive for high-risk HPV who require further cytology (11).The "gold standard" for obtaining specimens to detect HPV is for a clinician to use an endocervical brush during a speculum examination. However, this procedure is invasive and time consuming; requires private clinic space, a gynecological table, and sterilizing equipment; and, in some instances, is not culturally acceptable (16). Therefore, alternative sampling methods, such as self-obtained swabs or tampons, are needed. Selfsampling for HPV diagnosis has been tried in a number of settings (3, 5, 6, 8-10, 12-15, 18, 20-22, 25). However, few studies have been implemented in Africa (14,22,25), and few have compared HPV type-specific identification between clinician-and self-obtained specimens (3,8,20,21).The goal of this study was to determine the agreement between clinician-obtained endocervical brush specimens during a speculum examination and self-sampling with swabs or tampons for high-risk HPV in general, as well as for individual types, in women attending a community health center in Gugulethu, South Africa. Cy...

The objective of this study was to determine acceptability and feasibility of patient-based partner referral (PBPR) and patient-delivered partner medication (PDPM) among female sexually transmitted infection (STI) patients in a community-based STI screening study. Women were randomized to STI screening at home or at a clinic. STI patients could choose between PBPR and PDPM. Six-week follow-up interviews, and in-depth interviews, were conducted. STI prevalence was high. Most of the 106 women with an STI chose PDPM, mainly because partners would not have time or would not want to attend a clinic, and to ensure that partners received treatment. Nearly all partners reportedly took medication (94; 89% took it in front of the woman) or went to a clinic for treatment (92%). No adverse events were reported. Good communication emerged as the key to successful partner notification. In conclusion, PDPM could be used as a strategy to improve STI treatment coverage.