前瞻性评估宫颈阴道自我采集和宫颈医生采集用于检测沙眼衣原体、淋病奈瑟菌、阴道毛滴虫和生殖支原体感染。
Prospective Evaluation of Cervicovaginal Self- and Cervical Physician Collection for the Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium Infections.
机构信息
From the Department of Epidemiology and.
Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
出版信息
Sex Transm Dis. 2018 Jul;45(7):488-493. doi: 10.1097/OLQ.0000000000000778.
BACKGROUND
This study aimed to examine the agreement between sexually transmitted infection (STI) screening using self-collected specimens and physician-collected specimens, and to investigate the acceptability of self-collection for screening in an 18-month study of female sex workers in a high-risk, low-resource setting.
METHODS
A total of 350 female sex workers in Nairobi, Kenya, participated in a prospective study from 2009 to 2011. Women self-collected a cervicovaginal specimen. Next, a physician conducted a pelvic examination to obtain a cervical specimen. Physician- and self-collected specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium (MG) using Aptima nucleic acid amplification assays (Hologic). Specimens were collected at 3-month intervals over 18-month follow-up. κ Statistics measured agreement of positivity between self-collection and physician collection.
RESULTS
Baseline STI prevalence was 2.9% for N. gonorrhoeae, 5.2% for C. trachomatis, 9.2% for T. vaginalis, and 20.1% for MG in self-collected samples, and 2.3%, 3.7%, 7.2%, and 12.9%, respectively, in physician-collected samples. κ Agreement was consistently strong (range, 0.66-1.00) for all STIs over the 18-month study period, except for MG, which had moderate agreement (range, 0.50-0.75). Most participants found self-collection easy (94%) and comfortable (89%) at baseline, with responses becoming modestly more favorable over time.
CONCLUSIONS
Self-collected specimen screening results showed strong agreement to clinical-collected specimens, except for MG, which was consistently detected more commonly in self-collected than in physician-collected specimens. Acceptability of the self-collection procedure was high at baseline and increased modestly over time. In high-risk, low-resource settings, STI screening with self-collected specimens provides a reliable and acceptable alternative to screening with physician-collected specimens.
背景
本研究旨在检验使用自我采集标本和医生采集标本进行性传播感染（STI）筛查的一致性，并在肯尼亚内罗毕的一项高危、资源匮乏环境下的 18 个月女性性工作者研究中调查自我采集筛查的可接受性。
方法
共有 350 名女性性工作者参加了 2009 年至 2011 年的前瞻性研究。女性自行采集宫颈阴道标本。然后，医生进行盆腔检查以获取宫颈标本。使用 Aptima 核酸扩增检测（Hologic）对医生和自我采集的标本进行沙眼衣原体、淋病奈瑟菌、阴道毛滴虫和生殖支原体（MG）检测。在 18 个月的随访中，每 3 个月采集一次标本。κ 统计量衡量了自我采集和医生采集的阳性结果之间的一致性。
结果
基线时，自我采集样本中 N. gonorrhoeae、C. trachomatis、T. vaginalis 和 MG 的 STI 患病率分别为 2.9%、5.2%、9.2%和 20.1%，而医生采集样本中分别为 2.3%、3.7%、7.2%和 12.9%。除 MG 外，在整个 18 个月的研究期间，所有 STI 的 κ 一致性均较强（范围为 0.66-1.00）。大多数参与者在基线时发现自我采集很容易（94%）和舒适（89%），随着时间的推移，反应变得更为有利。
结论
自我采集标本筛查结果与临床采集标本具有很强的一致性，除 MG 外，MG 在自我采集标本中比在医生采集标本中更常见。自我采集程序的可接受性在基线时较高，随着时间的推移略有增加。在高危、资源匮乏的环境中，自我采集标本进行 STI 筛查是一种可靠且可接受的替代方法，可替代医生采集标本进行筛查。
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