Abstract
BackgroundRepeat infection with Chlamydia trachomatis is common and increases the risk of sequelae in women and HIV seroconversion in men who have sex with men (MSM). Despite guidelines recommending chlamydia retesting three months after treatment, retesting rates are low. We are conducting the first randomised controlled trial to assess the effectiveness of home collection combined with short message service (SMS) reminders on chlamydia retesting and reinfection rates in three risk groups.Methods/DesignThe REACT (retest after Chlamydia trachomatis) trial involves 600 patients diagnosed with chlamydia: 200 MSM, 200 women and 200 heterosexual men recruited from two Australian sexual health clinics where SMS reminders for retesting are routine practice. Participants will be randomised to the home group (3-month SMS reminder and home-collection) or the clinic group (3-month SMS reminder to return to the clinic). Participants in the home group will be given the choice of attending the clinic if they prefer. The mailed home-collection kit includes a self-collected vaginal swab (women), UriSWAB (Copan) for urine collection (heterosexual men), and UriSWAB plus rectal swab (MSM). The primary outcome is the retest rate at 1-4 months after a chlamydia diagnosis, and the secondary outcomes are: the repeat positive test rate; the reinfection rate; the acceptability of home testing with SMS reminders; and the cost effectiveness of home testing. Sexual behaviour data collected via an online survey at 4-5 months, and genotyping of repeat infections, will be used to discriminate reinfections from treatment failures. The trial will be conducted over two years. An intention to treat analysis will be conducted.DiscussionThis study will provide evidence about the effectiveness of home-collection combined with SMS reminders on chlamydia retesting, repeat infection and reinfection rates in three risk groups. The trial will determine client acceptability and cost effectiveness of this strategy.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12611000968976.
Highlights
Repeat infection with Chlamydia trachomatis is common and increases the risk of sequelae in women and HIV seroconversion in men who have sex with men (MSM)
This study will provide evidence about the effectiveness of home-collection combined with short message service (SMS) reminders on chlamydia retesting, repeat infection and reinfection rates in three risk groups
We describe here a randomised controlled trial that aims to assess the effectiveness of home-collection combined with SMS reminders on chlamydia retesting rates in MSM, women and heterosexual men
Summary
Chlamydia retesting at 3 months after infection is an important strategy to detect reinfections and to monitor the effectiveness of partner notification, but retesting rates are low. In a US study by Sparks et al [58], heterosexuals aged 14 years or older were given a choice of either mailing a specimen for testing or returning to the clinic for retesting, and 30% of participants in the intervention arm chose the mailed retesting option compared with 70% who opted to attend the clinic for rescreening Another US study of home screening by Cook et al [31] reported that most young women (179) received their home-collection kit in the mail, 18 (9%) opted to pick it up from the clinic, and a study in Australia found that young people were less likely to return home-collection kits if they lived with their parents [59]. Authors’ contributions All authors contributed to the design of the study and have read, contributed to and approved the final manuscript
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