家庭比较与基于诊所的性传播感染筛查：一项随机对照试验。
Home compared with clinic-based screening for sexually transmitted infections: a randomized controlled trial.
机构信息
From the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
出版信息
Obstet Gynecol. 2010 Dec;116(6):1311-1318. doi: 10.1097/AOG.0b013e3181fae60d.
OBJECTIVE
To determine whether home-based screening for sexually transmitted infections results in a higher sexually transmitted infection screening rate compared with clinic-based screening in participants using long-acting reversible contraception.
METHODS
We performed a randomized clinical trial of women using long-acting reversible contraception methods in the Contraceptive CHOICE Project (n=558). Participants were randomly assigned to home-based testing (swabs mailed to the participant's home) or clinic-based testing. Self-collected vaginal swabs were tested for Chlamydia trachomatis and Neisseria gonorrhoeae using strand displacement analysis. We estimated the relative risk (RR) of screening by group using Poisson regression with robust error variance.
RESULTS
The randomization groups were similar at baseline, except for marital status; the clinic group had more never-married women (62.0% compared with 51.6%), and the home group had more divorced women (12.1% compared with 5.6%, P=.007). Women in the home group were more likely to self-report screening compared with women in the clinic group in the multivariable analysis (56.3% compared with 32.9%; RR 1.7; 95% confidence interval [CI] 1.4-2.0). When analyzed by tests received or documented in medical records, similar results were obtained (56.3% compared with 25.0%; RR 2.2; 95% CI 1.7-2.7). Women who completed screening had higher levels of education and were more likely to receive public assistance compared with those who did not complete screening.
CONCLUSION
Long-acting reversible contraception users randomized to sexually transmitted infection screening at home were more likely to complete screening than those randomized to traditional clinic-based screening. Home-based screening may be useful in women using long-acting reversible contraceptive methods who may not present for regular screening.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, www.clinicaltrials.gov, NCT01184157.
目的
在使用长效可逆避孕方法的参与者中，比较家庭为基础的性传播感染筛查与以诊所为基础的筛查，前者是否会导致更高的性传播感染筛查率。
方法
我们在避孕选择项目（Contraceptive CHOICE Project）中对使用长效可逆避孕方法的女性进行了一项随机临床试验（n=558）。参与者被随机分配到家庭检测（将拭子邮寄到参与者的家中）或诊所检测。使用链替代分析检测沙眼衣原体和淋病奈瑟菌。我们使用具有稳健误差方差的泊松回归估计按组筛查的相对风险（RR）。
结果
随机分组在基线时相似，除了婚姻状况；诊所组的未婚女性更多（62.0%比 51.6%），家庭组的离婚女性更多（12.1%比 5.6%，P=.007）。在多变量分析中，家庭组的女性比诊所组的女性更有可能自我报告筛查（56.3%比 32.9%；RR 1.7；95%置信区间[CI]1.4-2.0）。当按接受的测试或病历记录进行分析时，也得到了类似的结果（56.3%比 25.0%；RR 2.2；95%CI 1.7-2.7）。完成筛查的女性受教育程度更高，更有可能获得公共援助，而未完成筛查的女性则不然。
结论
与传统的以诊所为基础的筛查相比，随机分配到家庭性传播感染筛查的长效可逆避孕使用者更有可能完成筛查。家庭为基础的筛查可能对使用长效可逆避孕方法的女性有用，这些女性可能不会定期进行筛查。
临床试验注册
ClinicalTrials.gov，www.clinicaltrials.gov，NCT01184157。
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