Sexual health services: a third way?

Sir: In the 6 June issue of the International Journal of STD and AIDS, Hambly and Luzzi reported that it is important to give people a choice of provider of sexual health services, namely either a genitourinary (GU) clinic or a general practitioner (GP). A third alternative might be providing postal specimens. In April 2006, we sent postal swabs to 231 female students taking part in a chlamydia screening trial. They were aged between 16 and 27 years and a third were from ethnic minorities. The response rate was 61% (141/231), of which 20 swabs came back after a reminder phone call or email. Responders and non-responders were similar demographically: 30% of responders (42/141) and 25% of non-responders (35/141) were from ethnic minorities; 11% of responders (16/141) and 14% of non-responders (20/141) were aged 20 years or younger. Six of the 141 samples (4.3%) tested positive for chlamydia. Five were new infections in women who had a negative test 12 months earlier, giving an incidence of new infection of 3.5%. This 61% response rate compares favourably with other studies. Many of the women participating in our study were black teenagers recruited from Further Education colleges in deprived areas of South London – a high-risk group notoriously difficult to reach. However, all the women had agreed to return the postal swabs and all had previous experience of the testing kit when they were recruited to our trial 12 months previously. The Department of Health is piloting a scheme in which chlamydia-testing kits are being given out at London branches of Boots Chemists. They report that around 19,000 kits have been given out, of which approximately 8000 (42%) have been returned (Department of Health, personal communication). The CLASS project reported an uptake of 25.3% for a single postal chlamydia test in women aged under 25 years. Our findings suggest that self-taken samples returned by post may be a realistic alternative to visits to a GP or GU clinic for tests for chlamydia. It may prove particularly suitable for women who do not want to be examined by a doctor or nurse, or who are unable to get to a clinic or surgery. Many of the women we have spoken to during the course of the trial have told us that they feel far more comfortable with a self-taken test than with one done for them by a healthcare practitioner. If this were to be offered as an alternative to other sexual health services, the response rate might be reasonable since women would presumably have requested a testing kit, whereas we offered kits to all our study participants, not only to those who considered themselves to be at risk of infection. In summary, we report a 61% response rate to a postal chlamydia self-testing kit in a group of young, hard–to–reach, women. We suggest that such a kit might be offered in conjunction with other service providers to increase the choices people have when accessing sexual health services, thereby hopefully increasing the number of people being tested and treated for chlamydia.