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Pearce E, Jolly K, Harris IM, Adriano A, Moore D, Price M, Ross J. What is the effectiveness of community-based health promotion campaigns on chlamydia screening uptake in young people and what barriers and facilitators have been identified? A mixed-methods systematic review. Sex Transm Infect 2021; 98:62-69. [PMID: 34446545 PMCID: PMC8785066 DOI: 10.1136/sextrans-2021-055142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/13/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The UK National Chlamydia Screening Programme uses an opportunistic approach. Many programmes use campaigns to raise awareness of chlamydia screening in young people. This review aimed to assess the effectiveness of campaigns on uptake of chlamydia screening in young people. METHODS We conducted a mixed-methods systematic review of articles assessing the outcomes of community-based health-promotion campaigns to increase chlamydia screening in young people, their experiences of the campaigns and other facilitators and barriers to the conduct of the campaigns. We searched four databases for quantitative and qualitative studies with no language restrictions. MAIN RESULTS From 10 329 records identified, 19 studies (20 articles) were included in the review: 14 quantitative, 2 qualitative and 3 mixed methods. All studies with quantitative outcomes were before-after study designs or interrupted time series. The prediction interval for relative change (RC) in test counts ranged from 0.95 to 1.56, with a summary pooled estimate of RC 1.22 (95% CI 1.14 to 1.30, 13 studies, I2=97%). For test positivity rate, 95% prediction interval was 0.59 to 1.48, with a summary pooled estimate of RC 0.93 (95% CI 0.81 to 1.07, 8 studies, I2=91.8%). Large variation in characteristics between studies precluded exploring outcomes by type of campaign components. Seven major qualitative themes to improve screening were identified: targeting of campaigns; quality of materials and message; language; anonymity; use of technology; relevance; and variety of testing options. CONCLUSIONS Health promotion campaigns aiming to increase chlamydia testing in those aged 15-24 years may show some effectiveness in increasing overall numbers of tests, however numbers of positive tests do not follow the same trend. Qualitative findings indicate that campaigns require clear, relevant messaging that displays the full range of testing options and assures anonymity in order to be effective.
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Affiliation(s)
- Emma Pearce
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Ada Adriano
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Malcolm Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Ross
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
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Quezada-Yamamoto H, Dubois E, Mastellos N, Rawaf S. Primary care integration of sexual and reproductive health services for chlamydia testing across WHO-Europe: a systematic review. BMJ Open 2019; 9:e031644. [PMID: 31628129 PMCID: PMC6803110 DOI: 10.1136/bmjopen-2019-031644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify current uptake of chlamydia testing (UCT) as a sexual and reproductive health service (SRHS) integrated in primary care settings of the WHO European region, with the aim to shape policy and quality of care. DESIGN Systematic review for studies published from January 2001 to May 2018 in any European language. DATA SOURCES OVID Medline, EMBASE, Maternal and Infant Care and Global Health. ELIGIBILITY CRITERIA Published studies, which involved women or men, adolescents or adults, reporting a UCT indicator in a primary care within a WHO European region country. Study designs considered were: randomised control trials (RCTs), quasi-experimental, observational (eg, cohort, case-control, cross-sectional) and mixed-methods studies as well as case reports. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened the sources and validated the selection process. The BRIGGS Critical Appraisal Checklist for Analytical Cross-Sectional Studies, the Mixed Methods Appraisal Tool 2011 and Critical Appraisal Skills Programme (CASP) checklists were considered for quality and risk of bias assessment. RESULTS 24 studies were finally included, of which 15 were cross-sectional, 4 cohort, 2 RCTs, 2 case-control studies and 1 mixed-methods study. A majority of the evidence cites the UK model, followed by the Netherlands, Denmark, Norway and Belgium only. Acceptability if offered test in primary healthcare (PHC) ranged from 55% to 81.4% in women and from 9.5% to 70.6% when both genders were reported together. Men may have a lower UCT compared with women. When both genders were reported together, the lowest acceptability was 9.5% in the Netherlands. Denmark presented the highest percentage of eligible people who tested in a PHC setting (87.3%). CONCLUSIONS Different health systems may influence UCT in PHC. The regional use of a common testing rate indicator is suggested to homogenise reporting. There is very little evidence on integration of SRHS such as chlamydia testing in PHC and there are gaps between European countries.
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Affiliation(s)
- Harumi Quezada-Yamamoto
- WHO Collaborating Centre, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Elizabeth Dubois
- WHO Collaborating Centre, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Nikolaos Mastellos
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Salman Rawaf
- WHO Collaborating Centre, Department of Primary Care and Public Health, Imperial College London, London, UK
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van Loo IHM, Dukers-Muijrers NHTM, Heuts R, van der Sande MAB, Hoebe CJPA. Screening for HIV, hepatitis B and syphilis on dried blood spots: A promising method to better reach hidden high-risk populations with self-collected sampling. PLoS One 2017; 12:e0186722. [PMID: 29053737 PMCID: PMC5650165 DOI: 10.1371/journal.pone.0186722] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/08/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction Many people at high risk for sexually transmitted infections (STIs), e.g., men who have sex with men (MSM), are not optimally reached by current sexual health care systems with testing. To facilitate testing by home-based sampling or sampling in outreach setting we evaluated dried blood spots (DBS), a method for self-collected blood sampling for serological screening of HIV, hepatitis B (HBV) and syphilis. The aims of this study were to assess the acceptability and feasibility of self-collected DBS and to compare the test results for screening of HIV, HBV and syphilis from DBS with blood drawn by venous puncture. Methods DBS were collected from men who have sex with men (MSM), visiting the STI clinic of the public health service South Limburg (n = 183) and HIV positive and HBV positive patients (n = 34), visiting the outpatient clinics of the Maastricht University Medical Centre in the period January 2012–April 2015. The 93 first participating MSM visiting the STI clinic were asked to fill in a questionnaire about the feasibility and acceptability about self-collection of DBS in a setting without going to a health care facility and were asked to collect the DBS themselves. Serological screening tests for HIV (HIV combi PT, Roche), HBV (HBsAg, Roche) and syphilis (Treponema pallidum Ig, Biokit 3.0) were performed on DBS and on blood drawn by venous puncture, which was routinely taken for screening. Results In total 217 participants were included in the study with a median age of 40 years (range between 17–80). Of MSM 84% agreed that it was clear and easy to do the finger-prick, while 53% agreed that it was clear and easy to apply the blood onto the DBS card. Also, 80% of MSM would use the bloodspot test again. In 91% (198) of DBS, sufficient material was collected to perform the three tests. No difference was observed in DBS quality between self-collected DBS and health care worker collected DBS. For HIV (n = 195 DBS-serum pairs) sensitivity and specificity were 100%. For HBV the sensitivity for HBsAg (n = 202) was 90% and specificity was 99%. For syphilis (n = 191) the sensitivity of the DBS was 93% with a specificity of 99%. Analysis of the DBS of HIV positive participants (n = 38) did show similar test performance for HBV and syphilis as in HIV negatives. Conclusion DBS is an acceptable self-sampling method for MSM, as there was no difference in DBS quality in self-collected and health care worker collected DBS. Test performance, i.e., its high sensitivity (>90%) and specificity (>99%) measures show that DBS is a valid alternative for venous blood puncture. Especially when DBS is combined with home-collected sampling for Chlamydia trachomatis and Neisseria gonorrhoeae, complete STI screening can be done in outreach setting and/or home-collected sampling in MSM.
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Affiliation(s)
- Inge H. M. van Loo
- Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Nicole H. T. M. Dukers-Muijrers
- Department for Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - Rosalie Heuts
- Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marianne A. B. van der Sande
- Centre Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Christian J. P. A. Hoebe
- Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department for Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
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den Heijer CDJ, van Liere GAFS, Hoebe CJPA, van Bergen JEAM, Cals JWL, Stals FS, Dukers-Muijrers NHTM. Who tests whom? A comprehensive overview of Chlamydia trachomatis test practices in a Dutch region among different STI care providers for urogenital, anorectal and oropharyngeal sites in young people: a cross-sectional study. Sex Transm Infect 2015; 92:211-7. [PMID: 26265066 DOI: 10.1136/sextrans-2015-052065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/20/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate and compare Chlamydia trachomatis (CT) diagnostic test practices of different sexually transmitted infection (STI) care providers in 16-29 year olds from one defined geographic Dutch region (280,000 inhabitants). Both number and proportion of positive CT tests (ie, test positivity) were assessed, and factors associated with these outcomes. METHODS Data on laboratory testing and diagnosis of urogenital, anorectal and oropharyngeal CT between 2006 and 2010 were retrieved from general practitioners (GPs), gynaecologists, an STI clinic and a population-based chlamydia screening programme. Multivariable regression analyses explored associations between age, sex, test year, socio-economic status (SES) and STI care provider and the outcomes being the number of tests and test positivity. RESULTS Overall, 22,831 tests were performed (1868 positive; 8.2%). Extragenital (ie, anorectal and oropharyngeal) tests accounted for 4% of all tests (7.5% positive) and were almost exclusively (99%) performed by the STI clinic. STI clinics tested most men (37.2% of all tested men), whereas GPs tested most women (29.9% of all tested women). GPs and STI clinics accounted for 73.3% (1326/1808) of urogenital CT diagnoses. In women, the number of tests increased with age, whereas test positivity decreased for all STI care providers. Lower SES was associated with higher test positivity in GP and gynaecology patients. CONCLUSIONS STI clinics performed most CT tests in men, whereas GPs performed most CT tests in women. GPs and STI clinics accounted for the majority of positives. Extragenital CT testing is rarely performed outside the STI clinic and needs to be promoted, especially in men who have sex with men.
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Affiliation(s)
- Casper D J den Heijer
- Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - G A F S van Liere
- Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - C J P A Hoebe
- Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
| | - J E A M van Bergen
- Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands Soa Aids Nederland, Amsterdam, The Netherlands
| | - J W L Cals
- Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - F S Stals
- Department of Medical Microbiology, Atrium Medical Centre, Heerlen, The Netherlands
| | - N H T M Dukers-Muijrers
- Department of Medical Microbiology, Maastricht University Medical Centre, School of Public Health and Primary Care, Maastricht, The Netherlands Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
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Smith KS, Hocking JS, Chen MY, Fairley CK, McNulty AM, Read P, Bradshaw CS, Tabrizi SN, Wand H, Saville M, Rawlinson W, Garland SM, Donovan B, Kaldor JM, Guy RJ. Dual Intervention to Increase Chlamydia Retesting: A Randomized Controlled Trial in Three Populations. Am J Prev Med 2015; 49:1-11. [PMID: 26094224 DOI: 10.1016/j.amepre.2015.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/10/2015] [Accepted: 01/22/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Chlamydia retesting 3 months after treatment is recommended to detect reinfections, but retesting rates are typically low. The purpose of this study is to determine if the addition of a postal home collection kit to a short message service (SMS) reminder at 3 months increases the percentage of patients retested for chlamydia at 1-4 months, compared to SMS alone. DESIGN In this unblinded randomized controlled trial, participants were randomized 1:1 to intervention (home arm) or control (clinic arm) status. SETTING/PARTICIPANTS Participants included 200 each of women, heterosexual men, and men who have sex with men diagnosed and treated for chlamydia at sexual health services. INTERVENTION Three months after chlamydia diagnosis, home arm participants received an SMS reminder and postal home collection kit (women, vaginal swab; heterosexual men, Copan UriSwab; men who have sex with men, UriSwab and rectal swab). MAIN OUTCOME MEASURES The main outcome measures were the percentage of participants retested at 1-4 months after chlamydia diagnosis and the percentage in each arm with repeat positive tests, by risk group and overall, analyzed by intention to treat. Data were collected from 2011 to 2013 and analyzed in 2014. RESULTS The percentage retested within 1-4 months of chlamydia diagnosis was significantly higher in home versus clinic arm participants among women (64% [66/103] vs 39% [38/97], p<0.001); heterosexual men (56% [57/101] vs 34% [34/99], p=0.002); men who have sex with men (62% [61/98] vs 44% [45/102], p=0.010); and overall (61% [184/302] vs 39% [117/298], p<0.001). The percentage in the home versus clinic arm with repeat positive tests was significantly higher among men who have sex with men (16% [16/98] vs 5% [5/102], p=0.021) and overall (10% [31/302] vs 4% [12/298], p=0.006). CONCLUSIONS The addition of a postal home collection kit to routine SMS reminders resulted in substantial improvements in chlamydia retesting rates in all three risk groups and detection of more repeat positive tests, compared with SMS alone. Extending the intervention to other primary care settings with low retesting rates should be considered.
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Affiliation(s)
- Kirsty S Smith
- Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Marcus Y Chen
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Melbourne Sexual Health Centre, Carlton, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Carlton, Australia; Central Clinical School, Monash University, Australia
| | - Anna M McNulty
- School of Public Health and Community Medicine, University of New South Wales, Sydney; Sydney Sexual Health Centre, Sydney, Australia
| | - Phillip Read
- Kirby Institute, University of New South Wales, Sydney, Australia; Kirketon Road Centre, Kings Cross, Australia
| | - Catriona S Bradshaw
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Melbourne Sexual Health Centre, Carlton, Australia; Central Clinical School, Monash University, Australia
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Department of Microbiology, Royal Women's Hospital, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - William Rawlinson
- Virology Division, SEALS Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Department of Microbiology, Royal Women's Hospital, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, Australia; Sydney Sexual Health Centre, Sydney, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rebecca J Guy
- Kirby Institute, University of New South Wales, Sydney, Australia
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