Comparative effectiveness and acceptability of home based and clinic-based sampling methods for sexually transmissible infection screening in females aged 14-50 years: a systematic review and meta-analysis
Background: Home-based sampling is a strategy to enhance uptake of sexually transmissible infection (STI) screening. This review aimed to compare the screening uptake levels of home-based self-sampling and clinicbased specimen collection for STIs (chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and trichomoniasis) in females aged 14–50 years. Acceptability and effect on specimen quality were determined. Methods: Sixteen electronic databases were searched from inception to September 2012. Randomised controlled trials (RCTs) comparing the uptake levels of home-based self-sampling and clinic-based sampling for chlamydia, gonorrhoea and trichomoniasis in females aged 14–50 years were eligible for inclusion. The risk of bias in the trials was assessed. Risk ratios (RRs) for dichotomous outcomes were meta-analysed. Results: Of 3065 papers, six studies with seven RCTs contributed to the final review. Compared with clinic-based methods, home-based screening increased uptake significantly (P = 0.001–0.05) in five trials and was substantiated in a meta-analysis (RR: 1.55; 95% confidence interval: 1.30–1.85; P = 0.00001) of two trials. In three trials, a significant preference for home-based testing (P = 0.001–0.05) was expressed. No significant difference was observed in specimen quality. Sampling was rated as easy by a significantly higher number of women (P = 0.01) in the clinic group in one trial. Conclusions: The review provides evidence that home-based testing results in greater uptake of STI screening in females (14–50 years) than clinic-based testing without compromising quality in the developed world. Home collection strategies should be added to clinic-based screening programs to enhance uptake.