Abstract
Sirs: Morris et al. 1 screened 1514 young men aged <30 years in non-clinical settings and found a 5.5% prevalence of Chlamydia trachomatis infection. One method of testing hard-to-reach groups could be with postal chlamydia testing. In December 2009, for a medical student research project, we conducted an on-site, self-administered, questionnaire survey of 250 consecutive genitourinary (GU) medicine clinic attendees to explore attitudes to chlamydia testing using a mailed test kit. Men would be asked about returning a urine sample and women a self-taken vaginal swab. The proposal was approved by Wandsworth research ethics committee (reference: 00168.09).
The response rate was 82% (204/250). i The majority of responders (67%, 131/195) were women, and the mean age was 27 years (range 14–55). Of 196 responders, nearly one-third (32%) described themselves as being of black (African, Caribbean or mixed) ethnicity, 58% as white and the remainder as other ethnic groups.
Note that the changing denominator reflects either:
The number of respondents who answered the question; or The proportion of respondents who selected a given option for questions where they were asked to select the options that applied to them.
Most responders (81%, 130/161) said they would be willing to send a postal sample every 4–6 months and with each new sexual partner. Availability of a hotline via which they could request a mailed test kit would make 76% (143/187) more likely to send postal samples. Other factors that they reported would encourage them to return mailed samples were if kits were quick and simple to use (54%; 111/204), and if it were easy to obtain a free kit (47%; 96/204). Barriers to using a mailed test kit were not liking the idea of posting a sample (28%; 57/204) or being too busy (20%; 42/204).
A surprisingly low percentage of responders (19%; 39/204) said financial incentive (£10 Boots voucher) would make them more likely to return postal samples. This mirrors the conclusions of a review by Molinar et al. 2 who noted that there was some evidence that financial incentives have no impact on chlamydia screening.
The main limitation to the study is that in spite of most respondents saying they would be willing to return postal samples for chlamydia testing, it is likely that actual response rates would be much less in practice. This is reflected in the results of studies by Macleod et al. 3 and Bloomfield et al. 4 who found that uptake of postal chlamydia screening was only around 20–30%. In addition, coverage was lower in areas that were more deprived, and had higher proportions of residents from ethic minority groups. 3
The other weaknesses of the study are the small size and that findings may not be generalizable to non-GU medicine populations. Respondents were also given a specified list of possible ‘encouragers’ and ‘barriers’ to testing that they ticked; although they were able to suggest other answers, this could have been a possible source of bias. However, a website where anyone could order postal chlamydia test kits and check their results online has been shown to be effective in expanding testing among young people. 5
Morris and colleagues demonstrated that chlamydia screening in non-clinical settings may be a cost-effective way of identifying infection in those who do not regularly access health care. Our results from an ethnically diverse inner city population suggest that a public health campaign involving postal chlamydia testing could also contribute to the control of chlamydia infection in some ethnically diverse, possibly hard-to-reach populations.