At-home specimen self-collection as an additional testing strategy for chlamydia and gonorrhoea: a systematic literature review and meta-analysis

Abstract

Introduction: Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) infections are often asymptomatic; screening increases early detection and prevents disease, sequelae and further spread. To increase Ct and Ng testing, several countries have implemented specimen self-collection outside a clinical setting. While specimen self-collection at home is highly acceptable to patients and as accurate as specimens collected by healthcare providers, this strategy is new or not being used in some countries. To understand how offering at home specimen self-collection will affect testing uptake, test results, diagnosis and linkage to care, when compared with collection in clinical settings, we conducted a systematic literature review and meta-analysis of peer-reviewed studies.

Methods: We searched Medline, Embase, Global Health, Cochrane Library, CINAHL (EBSCOHost), Scopus and Clinical Trials. Studies were included if they directly compared specimens self-collected at home or in other non-clinical settings to specimen collection at a healthcare facility (self or clinician) for Ct and/or Ng testing and evaluated the following outcomes: uptake in testing, linkage to care, and concordance (agreement) between the two settings for the same individuals. Risk of bias (RoB) was assessed using Cochrane Risk of Bias (RoB2) tool for randomised control trials (RCTs).

Results: 19 studies, from 1998 to 2024, comprising 15 RCTs with a total of 62 369 participants and four concordance studies with 906 participants were included. Uptake of Ct or Ng testing was 2.61 times higher at home compared with clinical settings. There was a high concordance between specimens collected at home and in clinical settings, and linkage to care was not significantly different between the two settings (prevalence ratio 0.96 (95% CI 0.91-1.01)).

Conclusion: Our meta-analysis and systematic literature review show that offering self-collection of specimens at home or in other non-clinical settings could be used as an additional strategy to increase sexually transmitted infection testing in countries that have not yet widely adopted this collection method.

Keywords: Diagnostics and tools; Infections, diseases, disorders, injuries; Public Health; Systematic review.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of the publication inclusion process.

Figure 2. Uptake of Ct/Ng testing in sexually active persons. Forest plot depicting the effect of specimen self-collection at home compared with specimen collection in clinical settings for Ct and Ng testing. Clinic care represents who collected the specimen, either HCP, self, no information (N.I.) or usual care was indicated. (B) Risk of bias for studies that investigated uptake of testing at home and in clinical settings. Green=low risk of bias, yellow=some concerns, red=high risk of bias. Ct, Chlamydia trachomatis; FP, family planning; Ng, Neisseria gonorrhoeae; PR, prevalence ratio; STD, sexually transmitted disease; VS, vaginal specimen.

Figure 3. Proportion of Chlamydia trachomatis/Neisseria gonorrhoeae infections treated. Forest plot depicting the effect of specimen self-collection at home compared with specimen collection in clinical settings on the proportion of infections treated. (B) Risk of bias for studies that investigated the number of infections treated for those diagnosed at home and in clinical settings. Green=low risk of bias, yellow=some concerns. PR, prevalence ratio.