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Charlotte A. Gaydos, MS, MPH, DrPH

Self-reported Risk History in Women Using an Internet-based Screening Program for Chlamydia trachomatis Using Self- collected Vaginal Swabs Returned by Mail. Charlotte A. Gaydos, MS, MPH, DrPH. Johns Hopkins University, Baltimore, MD cgaydos@jhmi.edu. 2006 National STD Prevention Conference

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Charlotte A. Gaydos, MS, MPH, DrPH

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  1. Self-reported Risk History in Women Using an Internet-based Screening Program for Chlamydia trachomatis Using Self- collected Vaginal Swabs Returned by Mail Charlotte A. Gaydos, MS, MPH, DrPH Johns Hopkins University, Baltimore, MD cgaydos@jhmi.edu 2006 National STD Prevention Conference Jacksonville, FL May 9, 2006

  2. BACKGROUND • The Internet is an effective tool to reach women at risk for C. trachomatis • Self-administered vaginal swabs (SAS) tested by NAATs facilitate screening for CT, are accurate and are acceptable • Women will request and use SAS kits • Most collection kits were requested through the Internet 86.6% requested by Internet email • 7.4% by phone, 5.5% picked up in the community Gayods et al. STD 2006 (in press)

  3. OBJECTIVE • To determine self- reported risk history for chlamydia in infected and uninfected women who provided questionnaires after using a home sampling kit for collecting vaginal specimens (N = 567) Website www.iwantthekit.org (Fingerprint Interactive-Brownstein Group)

  4. METHODS-Use of the Kit • Kits contained consent form, swab, instructions, questionnaire, contact form, mailer • Publicity: Papers, Magazines, Radio, Flyers • Questionnaires were taken either on line or by hard copy in the kit • Each swab tested by a multiple nucleic acid amplification tests (NAATs) for CT & GC • (Two different positive NAAT results required) • Data analysis: Chi Square, Stata v. 8.2

  5. RESULTS- Use of the Kit • Of 567 tested • 51 (9.0%) CT positives • 6 GC (3 co-infected w/ CT and GC) • 47.3% from Baltimore; 52.7% from Maryland • Median age first sex: • positives: 15 yr (11-26 yr) • negatives: 15 yr (8-39 yr)

  6. RESULTS- Use of the Kit • CT: 48/51 (94.1%) confirmed treated • GC: 6/6 (100%) confirmed treated • Median age of SAS submitters: 23 yr (range 14-63 yr) • Median age of positives: 20 yr • (range 15-45 yr)

  7. Prevalence: Results by Race 7.9% Infected 7.8% 25.2% 67% Seven did not report race; Black Race vs. All Others, p = 0.001

  8. Prevalence: Results by Age 1.6% Infected 14.8% Infected 20.2% 29.2% 9.8% Infected 8.6% Infected Age <25 yr vs. >25 yr, p = 0.01 5 did not report age. There were 7 women 14 yr old, all were chlamydia negative

  9. Questionnaire Results (N =567) Infected vs. Uninfected Behavioral Risk Factors 90% 78.4% 74.5% 56.8% 49% 46.2% 41.8% 35.3% 14% 12.7% Anal sex Consist Condom Oral sex New sex Mullti-sex P=0.012 P=0.135 P=0.334 P=ns P=0.015

  10. Questionnaire Results STD History Risk Factors (N= 567) All 34.4% Of yes: 69.2% CT 49.7% 37.3% 34.1% 12.5% 17.3% 1.3% Hx GC Hx syphilis P=0.652

  11. Questionnaire Results Behavioral Factors (N= 400) Drinking before Sex Pelvic Exam Using birth control Ever Pregnant P = 0.595 P = 0.887 P = 0.699 P = 0.106

  12. Questionnaire Results Risk Factors (N= 567) 29.6% 12.2% 5.8% 9.8% P = 0.007 P = 0.179

  13. Univariate Analysis of Demographics and Risk Factors Black Race vs. Other (p = 0.001) Age <25 yr. vs. >25 yr. (p = 0.010) Oral sex (p= 0.012) Non-consensual sex (p = 0.007) Multiple partners (p = 0.015) Chi Sq analysis: significant differences between infected & uninfected women

  14. CONCLUSIONS • High level of risk behavior reported • High prevalence for chlamydia observed • Infected women were treated • Women rated SAS use & Internet screening easy to very easy; would use Internet screening again • The Internet method may facilitate screening of women at high risk

  15. Collaborators Karen Dwyer Mathilda Barnes Toni Flemming Patricia Rizzo-Price Terry Hogan Acknowledgements Bulbul Aumakhan

  16. Questionnaire Results Preference for Sample Type Pelvic 14.6% SAS or Urine 29.6% Urine 9.9% SAS 45.9%

  17. Questionnaire Results Type of Sex Partners (N= 391) P = 0.528

  18. Questionnaire Results-Self Collection 92.2% 96.7%

  19. Questionnaire Results SAS Collection 95.3% 97.4% 94.9%

  20. Questionnaire Results (N =567) Infected vs. Uninfected Condom Use P = 0.082

  21. Logistic Regression Analysis of Demographics and Risk Factors N =400O.R. (95% C.I.) Black Race (ref.: White) 4.1 (1.6, 11.2) Age <25 yr. vs. >25 yr. 2.5 (1.1, 5.3) Non-consensual sex 0.3 (0.1, 0.9) Birth Control 0.5 (0.3, 0.9) Variables: Race, Age, # PN, Oral sex, Birth control, PN w/ STD, Non-consensual sex, prior CT

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