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Charlotte Gaydos
DrPH '93, MPH '89, MHS
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I Want the Kit: Internet-based STI education and testing
Johns Hopkins University, in conjunction with the Baltimore City Health Department and Region III Chlamydia Infertility Project, is conducting an outreach project entitled "Improving Community Access to STD Screening through a Web-based Intervention." This project has recruited women and men in Maryland, Washington, D.C., West Virginia and, recently, Denver, Colo., and parts of Illinois.
This educational website targets women and men who use the Internet to acquire information about STDs, and offers them the use of a home sampling kit for free mail-back testing for STDs. Our research has shown this novel approach is appealing to women, much like the ability to use a home pregnancy test. It was originally targeted to Chlamydia trachomatis screening in women, but now we are able to include men and also offer screening for gonorrhea and trichomonas.
The overall conceptual framework and design of the project is for participants to acquire basic information about STDs from our educational website www.iwantthekit.org, and to offer free STD screening to young women and men. Participants are recruited through a link on the website to request a free home collection kit, which is sent by mail. Women collect a self-administered vaginal swab and men collect a urine and penile (urethral orifice) swab. The samples are mailed to our laboratory for free testing using a pre-addressed, postage-paid mailer from the kit. We use state-of-the-art molecular nucleic acid amplification tests. We have successfully used this website in Maryland for women since 2004; male testing was added in 2006.
Thus far, 1,145 women from Maryland, West Virginia and Washington, D.C., have participated in this project, and recently 180 men have sent in samples. Of these, 8.9 percent of women were chlamydia positive; more than 95 percent were treated. For gonorrhea, 1.4 percent were infected, and all were treated. For trichomonas, 8.1 percent were infected, and all have been treated. Questionnaires indicated participants had high behavioral risk for STDs, preferred self-collection, rated collection easy/very easy, and would use the Internet program again. Of men, 14.1 percent were infected with chlamydia, 1.1 percent were infected with gonorrhea and 1.7 percent were infected with trichomonas. Preliminary findings for women have been published (Gaydos CA, Dwyer K, Barnes M, Rizzo-Price PA, Wood BJ, Flemming T, Hogan MT. Internet-based screening for Chlamydia trachomatis to reach non-clinic populations with mailed self-administered vaginal swabs. Sex. Transmit Dis. 2006:33:451-457).
Women and men who utilize the website to learn about STDs are offered free screening and treatment for chlamydia, gonorrhea and trichomonas. Those older than 14 years of age are allowed access to screening. Signature on a consent form is required, and the project is IRB-approved by Johns Hopkins University and the state of Maryland. This study includes use of a survey questionnaire and is primarily focused on chlamydia. However, since the assay can also test for gonorrhea and trichomonas, we also offer screening for Neisseria gonorrhoeae and Trichomonas vaginalis.
Participants call a toll-free number to obtain results, and women and men who are found to be infected are given an appointment for free treatment at a local clinic (such as family planning clinics, planned parenthood, STD clinics and other clinics which offer free treatment). The laboratory is a CLIA-approved, state licensed laboratory. Test results are sent by fax to the treatment clinic chosen by the participant, if they are infected.
We believe website recruitment for self-obtained urogenital samples, combined with mail-back testing, may be a unique method to reach high-risk people who otherwise may not attend a clinic for STD screening.
Charlotte Gaydos is a professor of Infectious Diseases with the Johns Hopkins University School of Medicine, and she has a joint appointment in Epidemiology and Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health.
