Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis.
Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis.
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DOI：
10.1371/journal.pone.0132776
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Ogilvie G
中科院分区：
文献类型：
--
作者：
Lunny C;Taylor D;Hoang L;Wong T;Gilbert M;Lester R;Krajden M;Ogilvie G
尽管初级保健和有针对性的公共卫生方案以及全民保健的背景下，自1990年代末以来，加拿大的性传播感染比率仍在上升。需要更多创新的干预措施，以消除STI检测的障碍，例如对难以接触到的患者、拒绝接受临床医生检测或拒绝检查的患者进行基于互联网或邮寄家庭和社区服务的检测。新西兰和美国一些州等司法管辖区目前使用自我收集的样本，但没有必要的证据来确定在衣原体和淋病诊断准确性方面，自我收集的样本是否与临床医生收集的样本一样准确。本综述的目的是将自采集的阴道、尿液、咽部和直肠样本与我们的参考标准-临床医生收集的宫颈、尿路、咽部和直肠样本进行比较，以使用核酸扩增试验鉴定阳性样本。使用分级汇总接收器操作特性和固定效应模型来评估患者与临床医生收集的可比标本的准确性。敏感度和特异度以95%可信区间(CI)估计作为我们的主要结果。我们包括了21项基于6100多对样本的研究。14项研究只检查衣原体，6项研究在同一项研究中分别比较了淋病和衣原体，1项研究检查了淋病。与其他标本类型(尿液/尿路或尿液/宫颈)相比，用阴道拭子和临床医生采集的宫颈拭子采集衣原体的6项研究具有最高的敏感性(92%，95%CI 87-95)和特异性(98%，95%CI 97-99)。6项研究比较了男性尿液自身样本和临床医生采集的尿样，其敏感性为88%(95%可信区间83-93)，特异性为99%(95%可信区间0.94-0.99)。考虑到尿液标本可能不如宫颈标本敏感，8项比较尿液自身采集和临床医生采集宫颈标本的衣原体研究的敏感性为87%(95%可信区间81~91)，高度特异性为99%(95%可信区间0.98~1.00)。在淋病检测中，男性自身采集的尿样与临床医生采集的尿样相比，敏感性为92%(95%CI 83-97)，特异性为99%(95%CI 0.98-1.00)。与临床医生采集的拭子相比，阴道自采集拭子的敏感性和特异性支持将阴道拭子用作家庭衣原体和淋病筛查的推荐样本。男性采集的淋病尿样具有相对较高的敏感性和特异性，因此可以推荐，因为它们可以在室温下放置几天，从而允许在家中进行邮寄检测的可能性。在可能根本不去检测、没有临床检测选择或拒绝临床检查的人群中，自我收集筛查将是一个很好的选择。我们建议出版关于如何自我收集淋病和衣原体尿液、阴道、直肠和咽部标本的指南。
The increases in STI rates since the late 1990s in Canada have occurred despite widespread primary care and targeted public health programs and in the setting of universal health care. More innovative interventions are required that would eliminate barriers to STI testing such as internet-based or mail-in home and community service testing for patients that are hard to reach, who refuse to go for clinician-based testing, or who decline an examination. Jurisdictions such as New Zealand and some American states currently use self-collected sampling, but without the required evidence to determine whether self-collected specimens are as accurate as clinician-collected specimens in terms of chlamydia and gonorrhea diagnostic accuracy. The objective of the review is to compare self-collected vaginal, urine, pharyngeal and rectal samples to our reference standard - clinician-collected cervical, urethral, pharyngeal and rectal sampling techniques to identify a positive specimen using nucleic acid amplification test assays. The hierarchical summary receiver operating characteristic and the fixed effect models were used to assess the accuracy of comparable specimens that were collected by patients compared to clinicians. Sensitivity and specificity estimates with 95% confidence intervals (CI) were reported as our main outcome measures. We included 21 studies based on over 6100 paired samples. Fourteen included studies examined chlamydia only, 6 compared both gonorrhea and chlamydia separately in the same study, and one examined gonorrhea. The six chlamydia studies comparing self-collection by vaginal swab to a clinician-collected cervical swab had the highest sensitivity (92%, 95% CI 87-95) and specificity (98%, 95% CI 97-99), compared to other specimen-types (urine/urethra or urine/cervix). Six studies compared urine self-samples to urethra clinician-collected samples in males and produced a sensitivity of 88% (95% CI 83-93) and a specificity of 99% (95% CI 0.94-0.99). Taking into account that urine samples may be less sensitive than cervical samples, eight chlamydia studies that compared urine self-collected verses clinician-collected cervical samples had a sensitivity of 87% (95% CI 81-91) and high specificity of 99% (95% CI 0.98-1.00). For gonorrhea testing, self-collected urine samples compared to clinician-collected urethra samples in males produced a sensitivity of 92% (95% CI 83-97) and specificity of 99% (95% CI 0.98-1.00). The sensitivity and specificity of vaginal self-collected swabs compared to swabs collected by clinicians supports the use of vaginal swab as the recommended specimen of choice in home-based screening for chlamydia and gonorrhea. Urine samples for gonorrhea collected by men had comparably high sensitivity and specificity, so could be recommended as they can be left at room temperature for several days, allowing for the possibility of mail-in home-based testing. In populations that may not go for testing at all, do not have the option of clinical testing, or who refuse a clinical examination, self-collected screening would be a good alternative. We recommend that guidelines on how to self-collect gonorrhea and chlamydia urine, vaginal, rectal and pharyngeal specimens be published.