Reducing barriers to testing for Chlamydia trachomatis by mailed self-collected samples

Abstract

Chlamydia trachomatis (chlamydia) is the most commonly notified sexually transmissible bacterial infection in Australia, where distance to health services can be a barrier. This study investigated the acceptability of a self-collection kit for chlamydia testing (sent by mail) and assessed the risk profiles of participants with respect to locality. In total, 2587 self-collection kits were distributed opportunistically or sent directly to participants upon request, as was a self-administered questionnaire. The return rate was 13.2% (n=341) for samples and questionnaires. The return rate did not differ with location (P=0.522) but with mode of distribution (opportunistic: 9.7%; by request: 27.4%; P<0.001). Although 37% of participants had previously been tested for chlamydia, 77.5% said that they would not have sought testing otherwise. The median age of participants was 22.6 years, 33.8% were male and 9.1% were of Aboriginal descent. Overall, 9.0% (95% confidence interval (CI)=6.1-12.5) of participants were chlamydia-positive. Prevalence of chlamydia and Aboriginal participation increased with remoteness (P<0.001), and self-reported condom use was significantly reduced for remote and very remote locations (P=0.008). Within remote and very remote locations, 30.8% (95% CI=9.1-61.4) of Aboriginal participants and 38.9% of non-Indigenous participants were chlamydia-positive (P=0.718; 95% CI=17.3-64.3). Testing for chlamydia using a mailed self-collection kit opened access to a predominantly test-naïve population. The proposed model was able to reach remote populations. Actively requested kits were more likely to be returned.