Internet-accessed sexually transmitted infection (e-STI) testing and results service: A randomised, single-blind, controlled trial.
Internet-accessed sexually transmitted infection (e-STI) testing and results service: A randomised, single-blind, controlled trial.
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DOI：
10.1371/journal.pmed.1002479
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发表时间：
2017-12
期刊：
影响因子：
15.8
通讯作者：
Baraitser P
中科院分区：
文献类型：
--
作者：
Wilson E;Free C;Morris TP;Syred J;Ahamed I;Menon-Johansson AS;Palmer MJ;Barnard S;Rezel E;Baraitser P
通过互联网进行的性传播感染检测（e-STI检测）越来越多地成为诊所检测的替代方法。通常，这种测试模式使用户能够从虚拟服务（通过网站或应用程序）订购测试套件，收集自己的样本，将测试样本返回实验室，并通过短信服务（SMS）或电话通知他们的结果。与面对面服务相比，电子性传播感染检测被认为会增加获得检测的机会，但证据尚不清楚。我们进行了一项随机对照试验，以评估e-STI检测和结果服务（衣原体，淋病，艾滋病毒和梅毒）对STI检测吸收和STI诊断病例的有效性。这项研究在伦敦的兰贝斯和萨瑟克区进行。在2014年11月24日至2015年8月31日期间，我们招募了2，072名年龄在16-30岁之间的参与者，他们居住在这些区，在过去12个月内至少有一个性伴侣，表示愿意接受STI测试，并可以访问互联网。那些无法提供同意书和无法阅读英语的人被排除在外。参与者被随机分配到接收1条带有e-STI测试和结果服务的网络链接的短信（干预组）或接收1条带有定制网站的网络链接的短信，该网站列出了7个当地性健康诊所的位置，联系方式和网站（对照组）。在研究期间，参与者可以自由使用任何其他服务或干预措施。主要结局是6周时自我报告的STI检测（通过患者记录检查验证）和6周时自我报告的STI诊断（通过患者记录检查验证）。次要结果是为STI处方治疗的参与者比例，从随机化到完成STI测试的时间，以及从随机化到STI治疗的时间。参与者在提交自我报告的数据时获得10英镑的现金奖励。我们在2016年6月17日之前完成了所有随访，包括患者记录检查。在6周时，干预组STI检测的接受率增加（50.0%对26.6%，相对危险度[RR] 1.87，95%CI 1.63至2.15，P < 0.001）。干预组中被诊断的参与者比例为2.8%，对照组为1.4%（RR 2.10，95% CI 0.94至4.70，P = 0.079）。对于任何预先指定的亚组分析，均未观察到异质性证据。干预组接受治疗的受试者比例为1.1%，对照组为0.7%（RR 1.72，95% CI 0.71 - 4.16，P = 0.231）。与对照组相比，干预组的测试时间较短（28.8天vs 36.5天，P < 0.001，限制平均生存时间[RMST]差异检验），但未观察到治疗时间差异（83.2天vs 83.5天，P = 0.51，RMST差异检验）。我们无法招募计划中的3，000名参与者，因此缺乏对性传播感染诊断和治疗的性传播感染病例进行分析的能力。电子性传播感染检测服务增加了包括高危群体在内的所有群体接受性传播感染检测的人数。干预措施要求人们去诊所接受治疗，并没有减少治疗时间。需要进行服务创新，以提高在线诊断者的治疗率，可包括电子治疗和邮政治疗服务。电子科技创新测试服务需要长期监测和评估。ISRCTN登记研究ISRCTN 13354298。在一项单盲随机试验中，Emma Wilson及其同事评估了e-STI服务对检测吸收和诊断病例的影响。通过互联网进行的性传播感染检测（e-STI检测）越来越多。然而，与面对面服务相比，电子性传播感染测试的有效性尚不清楚。我们在英国伦敦进行了一项大型随机对照试验，以评估e-STI检测和结果服务（SH：24）与常规护理一起提供时对STI检测和STI诊断和治疗病例的影响。该干预措施提供了衣原体、淋病、艾滋病毒和梅毒的邮寄自我采样检测试剂盒，通过短信或电话提供结果，以及基于网络的安全性行为健康信息。我们发现，e-STI检测几乎使所有群体的检测率翻了一番，包括STI高风险群体。需要进行更大规模的研究，以了解e-STI检测对STI诊断和STI病例治疗的影响。需要进行进一步研究，以评估被诊断者接受治疗的比例。我们的研究结果表明，可能需要额外的投入来加强与治疗的联系（例如，邮政处理）。电子性传播感染检测应被视为对现有服务的补充，也是提高性传播感染检测普及率的有效措施。需要进一步评价e-STI检测对诊断和治疗病例的影响。
Internet-accessed sexually transmitted infection testing (e-STI testing) is increasingly available as an alternative to testing in clinics. Typically this testing modality enables users to order a test kit from a virtual service (via a website or app), collect their own samples, return test samples to a laboratory, and be notified of their results by short message service (SMS) or telephone. e-STI testing is assumed to increase access to testing in comparison with face-to-face services, but the evidence is unclear. We conducted a randomised controlled trial to assess the effectiveness of an e-STI testing and results service (chlamydia, gonorrhoea, HIV, and syphilis) on STI testing uptake and STI cases diagnosed. The study took place in the London boroughs of Lambeth and Southwark. Between 24 November 2014 and 31 August 2015, we recruited 2,072 participants, aged 16–30 years, who were resident in these boroughs, had at least 1 sexual partner in the last 12 months, stated willingness to take an STI test, and had access to the internet. Those unable to provide consent and unable to read English were excluded. Participants were randomly allocated to receive 1 text message with the web link of an e-STI testing and results service (intervention group) or to receive 1 text message with the web link of a bespoke website listing the locations, contact details, and websites of 7 local sexual health clinics (control group). Participants were free to use any other services or interventions during the study period. The primary outcomes were self-reported STI testing at 6 weeks, verified by patient record checks, and self-reported STI diagnosis at 6 weeks, verified by patient record checks. Secondary outcomes were the proportion of participants prescribed treatment for an STI, time from randomisation to completion of an STI test, and time from randomisation to treatment of an STI. Participants were sent a £10 cash incentive on submission of self-reported data. We completed all follow-up, including patient record checks, by 17 June 2016. Uptake of STI testing was increased in the intervention group at 6 weeks (50.0% versus 26.6%, relative risk [RR] 1.87, 95% CI 1.63 to 2.15, P < 0.001). The proportion of participants diagnosed was 2.8% in the intervention group versus 1.4% in the control group (RR 2.10, 95% CI 0.94 to 4.70, P = 0.079). No evidence of heterogeneity was observed for any of the pre-specified subgroup analyses. The proportion of participants treated was 1.1% in the intervention group versus 0.7% in the control group (RR 1.72, 95% CI 0.71 to 4.16, P = 0.231). Time to test, was shorter in the intervention group compared to the control group (28.8 days versus 36.5 days, P < 0.001, test for difference in restricted mean survival time [RMST]), but no differences were observed for time to treatment (83.2 days versus 83.5 days, P = 0.51, test for difference in RMST). We were unable to recruit the planned 3,000 participants and therefore lacked power for the analyses of STI diagnoses and STI cases treated. The e-STI testing service increased uptake of STI testing for all groups including high-risk groups. The intervention required people to attend clinic for treatment and did not reduce time to treatment. Service innovations to improve treatment rates for those diagnosed online are required and could include e-treatment and postal treatment services. e-STI testing services require long-term monitoring and evaluation. ISRCTN Registry ISRCTN13354298. In a single-blind randomised trial, Emma Wilson and colleagues assess the impact of an e-STI service on testing uptake and cases diagnosed. Internet-accessed sexually transmitted infection testing (e-STI testing) is increasingly available. Yet the effectiveness of e-STI testing compared to face-to-face services is unclear. We conducted a large randomised controlled trial in London, United Kingdom, to assess the effects of an e-STI testing and results service (SH:24) on uptake of STI testing and STI cases diagnosed and treated, when delivered alongside usual care. The intervention offered postal self-sampling test kits for chlamydia, gonorrhoea, HIV, and syphilis, results delivered via text message or telephone, and web-based safer sex health information. We found that e-STI testing almost doubled uptake of testing among all groups, including groups at high risk for STIs. A larger study is required to understand the effects of e-STI testing on STI diagnosis and STI cases treated. Further research is required to evaluate the proportion of those diagnosed who are treated. Our findings suggest that additional inputs may be required to strengthen linkages to treatment (e.g., postal treatment). e-STI testing should be considered as a complement to existing services and as an effective measure to increase uptake of STI testing. The effect of e-STI testing on cases diagnosed and treated requires further evaluation.
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影响因子：
3.1
作者：
Blake DR;Spielberg F;Levy V;Lensing S;Wolff PA;Venkatasubramanian L;Acevedo N;Padian N;Chattopadhyay I;Gaydos CA
通讯作者：
Gaydos CA
影响因子：
7.4
作者：
Hottes TS;Farrell J;Bondyra M;Haag D;Shoveller J;Gilbert M
通讯作者：
Gilbert M
影响因子：
3.6
作者：
Ladd, Jessica;Hsieh, Yu-Hsiang;Gaydos, Charlotte A.
通讯作者：
Gaydos, Charlotte A.
影响因子：
168.9
作者：
Free, Caroline;Knight, Rosemary;Robertson, Steven;Whittaker, Robyn;Edwards, Phil;Zhou, Weiwei;Rodgers, Anthony;Cairns, John;Kenward, Michael G.;Roberts, Ian
通讯作者：
Roberts, Ian
影响因子：
2.8
作者：
Baraitser P;Syred J;Spencer-Hughes V;Howroyd C;Free C;Holdsworth G
通讯作者：
Holdsworth G