Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
BMJ Glob Health. 2024 Aug 27;9(8):e015349. doi: 10.1136/bmjgh-2024-015349.
(Ct) and (Ng) infections are often asymptomatic; screening increases early detection and prevents disease, sequelae and further spread. To increase Ct and Ng testing, several countries have implemented specimen self-collection outside a clinical setting. While specimen self-collection at home is highly acceptable to patients and as accurate as specimens collected by healthcare providers, this strategy is new or not being used in some countries. To understand how offering at home specimen self-collection will affect testing uptake, test results, diagnosis and linkage to care, when compared with collection in clinical settings, we conducted a systematic literature review and meta-analysis of peer-reviewed studies.
We searched Medline, Embase, Global Health, Cochrane Library, CINAHL (EBSCOHost), Scopus and Clinical Trials. Studies were included if they directly compared specimens self-collected at home or in other non-clinical settings to specimen collection at a healthcare facility (self or clinician) for Ct and/or Ng testing and evaluated the following outcomes: uptake in testing, linkage to care, and concordance (agreement) between the two settings for the same individuals. Risk of bias (RoB) was assessed using Cochrane Risk of Bias (RoB2) tool for randomised control trials (RCTs).
19 studies, from 1998 to 2024, comprising 15 RCTs with a total of 62 369 participants and four concordance studies with 906 participants were included. Uptake of Ct or Ng testing was 2.61 times higher at home compared with clinical settings. There was a high concordance between specimens collected at home and in clinical settings, and linkage to care was not significantly different between the two settings (prevalence ratio 0.96 (95% CI 0.91-1.01)).
Our meta-analysis and systematic literature review show that offering self-collection of specimens at home or in other non-clinical settings could be used as an additional strategy to increase sexually transmitted infection testing in countries that have not yet widely adopted this collection method.
（Ct）和（Ng）感染通常无症状；筛查可提高早期检测率，预防疾病、后遗症和进一步传播。为了增加 Ct 和 Ng 检测量，一些国家已经在临床环境之外实施了标本自我采集。虽然患者非常接受在家中进行标本自我采集，且其结果与医护人员采集的标本一样准确，但该策略在一些国家尚属新方法或尚未使用。为了了解与在临床环境中采集标本相比，提供在家中进行标本自我采集将如何影响检测量、检测结果、诊断和与护理的联系，我们对同行评议研究进行了系统的文献回顾和荟萃分析。
我们在 Medline、Embase、Global Health、Cochrane 图书馆、CINAHL（EBSCOHost）、Scopus 和 ClinicalTrials.gov 上进行了检索。如果研究直接比较了在家中或其他非临床环境中自我采集的标本与在医疗机构（自我或临床医生）采集的 Ct 和/或 Ng 检测标本，并且评估了以下结果：检测的接受率、与护理的联系以及同一人群在两个环境中的一致性（一致性），则将其纳入研究。使用 Cochrane 偏倚风险（RoB2）工具评估随机对照试验（RCTs）的偏倚风险（RoB）。
纳入了 19 项研究，时间范围为 1998 年至 2024 年，其中包括 15 项 RCT 研究，共有 62369 名参与者，4 项一致性研究，共有 906 名参与者。与临床环境相比，在家中进行 Ct 或 Ng 检测的接受率高 2.61 倍。在家中采集的标本与在临床环境中采集的标本之间具有高度一致性，并且与护理的联系在两个环境之间没有显著差异（患病率比 0.96（95%CI 0.91-1.01））。
我们的荟萃分析和系统文献回顾表明，在尚未广泛采用这种采集方法的国家，提供在家中或其他非临床环境中进行标本自我采集可以作为增加性传播感染检测量的一种补充策略。
