Use of an Internet-Based Self-Screening Program to Screen for Chlamydia and Gonorrhea Wendy Voet On Behalf Of Charlotte A. Gaydos and Karen Dwyer, Mathilda Barnes, Billie Jo Wood, Toni Flemming, Patricia RizzoPrice, Catherine Wright, Dawn Middleton, Terry Hogan

OBJECTIVES To implement an Internet project to facilitate home screening for CT and GC To encourage women to obtain and use self-administered vaginal swabs (SAS) To measure STD prevalence and risk factors of women who used SAS

Objectives Continued… To measure opinions and perceptions of the women participants about home screening

METHODS-Use of the Kit Website at: Kits containing consent form, swab, instructions, questionnaire, contact form and mailer Clinic Network in Place for Treatment 800 Number Available for Clients to Access Results

Methods – Use of Kit Continued… Publicity: City Paper, Smart Woman Magazine, Radio, Flyers 1,254 kits in pharmacies & community (discontinued) 2,418 kits mailed to homes from /phone requests since July 2004

METHODS- Use of the Kit Each swab tested by multiple nucleic acid amplification tests (NAATs) for CT & GC PCR (Roche): Amplicore (dropped after n=500) SDA (Becton Dickinson): Probetec TMA (GenProbe): Aptima Combo2 Two different positive NAAT results required to call a sample positive

RESULTS- Use of the Kit Of 778 tested through Jan 31, (9.2%) CT positive* 12 (1.3%) GC positive *(4 co-infected w/ CT and GC) Of 115 tested for Trichomonas since September, 13 (11.3%) positive** ** (1 co-infected w/ CT and GC)

RESULTS- Use of the Kit CT: 66/69 (95.6%) confirmed treated GC: 11/11 (100%) confirmed treated Range of those participants years Median age of SAS submitters was 23 years Positives: median age 19 yr Negatives: median age 23.0 yr

CT Prevalence: Results by Race n = 752* 5.2% Infected 70.0% 22.5% 7.7% *8 did not report race; Black Race vs. All Others, p = Of 69 total positives, Black: 62 (90%), White: 4 (5.8%), Other: 3 (4.3%),

CT Prevalence: Results by Age n = 756* 8.5% Infected 8.0% Infected 16.8% Infected 31.2% *4 did not report age. There were 9 women 14 yr old, all were chlamydia negative 1.3% Infected 19.8%

Internet Prevalence vs. Baltimore and Maryland Family Planning Clinics Prevalence Age (yr)N Internet Project 2004 – 2005 Family Planning Clinics (n=567) Baltimore (n=3,166) Maryland (n=34,525) Baltimore (n=3,449) Maryland (n=33,873) %13.3%4.8%5.6%5.2% %12.0%7.3%9.7%7.3% %8.1%4.4%6.7%4.4% %2.6%2.3%3.6%1.9% > %2.8%1.1%1.5%0.8% Total564***9.0%4.9%4.0%4.4%4.0%

Univariate Analysis of Demographics & Risk Factors (N= 760) Black Race vs. White (p = 0.001) Age 25 yr. (p = ) Multiple partners (p = 0.017) Hx GC (p = 0.02) Univariate logistic regression: significant differences between infected & uninfected women

Symptoms Results All Women (N =756) (p > between infected vs. uninfected each symptom) Vaginal discharge was common: 47.2% Lower abdominal pain: 18.1% Pain during urination: 5.6% Pain during intercourse: 14.4% Abnormal vaginal bleeding: 6.9% Any symptoms: 61.4% No symptoms: 38.6%

Questionnaire Results: Preference for Sample Type (N=745) Pelvic 17.9% Urine 8.1% Vaginal or Urine 12.1% Self Vaginal 50.1% Other Combo 11.8%

Questionnaire Results: Preference for Receiving Results (N=744) Call 800 number 10.9% U.S. Mail 9.0% 25.5% Secure Internet 32.5% Other Combo 9.7% Phone 12.4%

Questionnaire Results SAS Collection 96%98.2%93.5%

CONCLUSIONS- Use of the Kit Use of the Internet and request for kits supported the concept of a chlamydia website that could offer educational information encourage use of SAS home sampling Most collection kits were requested Women will request and use SAS kits High prevalence of chlamydia was found High level of risk behavior noted

CONCLUSIONS- Use of the Kit The Internet recruitment method may help screen women who otherwise would not get tested for chlamydia Treatment of infected women was possible Women rated SAS use & Internet screening easy to very easy; would use again Prevalence higher than in family planning clinics in Baltimore and Maryland

Preliminary Male Data Men testing recently added (urine and penile swab) All men except one submitted both urine and penile swab (acceptability good for self penile swabs) GenProbe APTIMA Combo 2 used for CT and GC GenProbe ASR Trichomonas test used for Trich  Ct 36.8% (of 23 submitted)  GC 0%  Trich 0%

Programming Considerations and Budget Potential need for IRB 10-20% of staff time (IPP Coordinator?) It costs $6 per kit. In MD, they had 1,000 requests last year with a 34% return rate Laboratory costs: With a 34% return rate, one can assume about 300 additional tests, which equates (at $30 per test for CT/GC and Trich)

Programming Continued… Advertising Costs Toll Free Line Rudimentary Budget Includes: –Kits $6,000 (assuming $1000 sent) –Lab $9,000 (assuming 34% return rate) –Advertising: $1,000 (based on MD budget) –Toll Free –TOTAL: $17,000 plus staff time

Acknowledgements Bulbul Aumakhan Jeff Holden Nicole Quinn Andrew Hardick