From the Department of Epidemiology and.
Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Sex Transm Dis. 2018 Jul;45(7):488-493. doi: 10.1097/OLQ.0000000000000778.
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.
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.
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.
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.
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。
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。
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。
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。
