Use of an Internet-Based Self-Screening Program to Screen for Chlamydia and Gonorrhea

1. 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

2. 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

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

4. METHODS-Use of the Kit • Website at: www.iwantthekit.org • 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

5. 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 email/phone requests since July 2004

6. 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

9. RESULTS- Use of the Kit • Of 778 tested through Jan 31, 2007 • 71 (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)

10. RESULTS- Use of the Kit • CT: 66/69 (95.6%) confirmed treated • GC: 11/11 (100%) confirmed treated • Range of those participants 14 - 63 years • Median age of SAS submitters was 23 years • Positives: median age 19 yr • Negatives: median age 23.0 yr

11. CT Prevalence: Results by Racen = 752* 5.2% Infected 7.7% 22.5% 70.0% *8 did not report race; Black Race vs. All Others, p = 0.0003 Of 69 total positives, Black: 62 (90%), White: 4 (5.8%), Other: 3 (4.3%),

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

13. Internet Prevalence vs. Baltimore and Maryland Family Planning Clinics Prevalence

14. Univariate Analysis of Demographics & Risk Factors (N= 760) Black Race vs. White (p = 0.001) Age <25 yr. vs. >25 yr. (p = 0.0006) Multiple partners (p = 0.017) Hx GC (p = 0.02) Univariate logistic regression: significant differences between infected & uninfected women

15. Symptoms Results All Women (N =756) (p > 0.05- 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%

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

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

18. Questionnaire Results SAS Collection 96% 98.2% 93.5%

19. 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 email requested • Women will request and use SAS kits • High prevalence of chlamydia was found • High level of risk behavior noted

20. CONCLUSIONS- Use of the Kit • 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 • The Internet recruitment method may help screen women who otherwise would not get tested for chlamydia

21. 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%

22. 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 to @$9,000 (at $30 per test for CT/GC and Trich)

23. Programming Continued… • Advertising Costs (@$1,000) • Toll Free Line (@$1,000) • 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 Line: @$1,000 • TOTAL: $17,000 plus staff time

26. Acknowledgements Bulbul Aumakhan Jeff Holden Nicole Quinn Andrew Hardick