U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Cover of Effectiveness, acceptability and cost effectiveness of strategies to improve uptake of STI testing

Effectiveness, acceptability and cost effectiveness of strategies to improve uptake of STI testing

Reducing sexually transmitted infections (STIs)

Evidence review C

NICE Guideline, No. 221

London: National Institute for Health and Care Excellence (NICE); .
ISBN-13: 978-1-4731-4612-9

1. Effective and cost-effective strategies to improve uptake of STI testing

1.1. Review question

What strategies to improve the uptake of STI testing (excluding HIV testing) are effective and cost-effective?

1.1.1. Introduction

Sexually transmitted infections (STIs) can affect personal wellbeing, mental health and relationships and can also lead to serious health problems including pelvic inflammatory disease, ectopic pregnancy or infertility. STI testing, diagnosis and treatment are central to STI prevention strategies. The purpose of this review is to establish which strategies or interventions for increasing the uptake of STI testing are effective and cost effective.

People can use specialist sexual health services without referral or residence requirements. The number of attendances at these services has increased, and service provision varies. Some clinics have closed or reduced their opening hours. Prevention and targeted outreach services have also been cut. Some clinics have fewer consultants or health advisors, and some patients with STI symptoms report finding it more difficult to get appointments within 48 hours.

Examples of innovative services include online access to STI self-sampling kits with results sent by text message, and being able to make test appointments through the web or a phone app. The National Chlamydia Screening Programme has seen a 22% decrease in tests from 2014 to 2018, but an increase in the proportion of people testing positive over the same time period. The aim of this review is to determine the effectiveness and cost-effectiveness of such strategies.

1.1.2. Summary of the protocol

Table 1. PICO inclusion criteria.

Table 1

PICO inclusion criteria.

For the full review protocol see appendix A.

1.1.3. Methods and process

This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in appendix A and the methods document.

Declarations of interest

Declarations of interest were recorded according to NICE’s conflicts of interest policy.

1.1.4. Effectiveness evidence

1.1.4.1. Included studies

5,673 references were initially identified from the literature search. 113 quantitative papers were ordered in full-text. Of these, 19 quantitative studies met the inclusion criteria for the effectiveness review as outlined in the review protocol.

1.1.4.2. Excluded studies

Details of excluded studies can be found in appendix J along with reasons for their exclusion.

1.1.5. Summary of studies included in the effectiveness evidence

Table 2. Included effectiveness studies.

Table 2

Included effectiveness studies.

See appendix D for full evidence tables.

1.1.6. Summary of the effectiveness evidence

Note: 4 studies (Booth 2014, Kang 2012, Dolan 2014 and Niza 2014) reported some outcomes in a way that could be assessed using GRADE. Evidence statements for these findings are included in section 1.1.11.

Table 3. Remote self sampling compared to clinic tests for Increasing uptake of STI testing.

Table 3

Remote self sampling compared to clinic tests for Increasing uptake of STI testing.

Table 4. Motivation for Increasing uptake of STI testing compared to standard promotion.

Table 4

Motivation for Increasing uptake of STI testing compared to standard promotion.

Table 5. Tailored interventions compared to non-tailored intervention for increasing uptake of STI testing.

Table 5

Tailored interventions compared to non-tailored intervention for increasing uptake of STI testing.

Table 6. Computer assisted interview clinic interventions compared to standard pen and paper interviews for increase in uptake of STI testing.

Table 6

Computer assisted interview clinic interventions compared to standard pen and paper interviews for increase in uptake of STI testing.

See appendix F for full GRADE Tables.

1.1.7. Economic evidence

A search for published cost-effectiveness evidence was carried out for this review question. In total, 1,600 records were assessed against eligibility criteria. Of these, 1,506 records were assessed as being ineligible based on disease, intervention and study design and 25 records were excluded based on information in the title and abstract. Two reviewers assessed all the records. The level of agreement between the two reviewers was 100%.

The full-text papers of 69 documents were retrieved and assessed. 59 were excluded, for reasons summarised in Appendix G and further detailed in Appendix J.

1.1.7.1. Included studies

Of the 10 included studies, four were assessed as fully meeting the eligibility criteria and underwent a full data extraction. The remaining six studies partially met the inclusion criteria. Data extraction from these remaining six studies was limited to information that could be used to inform the decision problem. Two reviewers assessed all full-text papers. The level of agreement between the two reviewers was 100%.

The study selection process can be found in Appendix G and the economic evidence tables can be found in Appendix H.

1.1.7.2. Excluded studies

59 full text documents were excluded for this guideline. The documents and the reasons for their exclusion are listed in Appendix J.

1.1.8. Summary of included economic evidence

Table 8

Table 8

Bracebridge (2012) Cost-effectiveness evaluation of a chlamydia trachomatis screening service using global dispatch of testing kits, web-based data collection and test reporting, and treatment dispatch by post.

Table 9. Summary of partially extracted studies included in the economic evidence review for STI testing uptake (RQ2.1).

Table 9

Summary of partially extracted studies included in the economic evidence review for STI testing uptake (RQ2.1).

1.1.9. Economic model

An economic model was developed to assess the cost-effectiveness of offering home self-sampling as a means of STI testing for asymptomatic people. This was chosen as the comparison to model, as the intervention with the best evidence of effectiveness from the quantitative systematic review. A full write up of the economic modelling is provided in appendix I.

1.1.10. Evidence statements

Quantitative

The following evidence was identified, but could not be included in the quantitative analysis due to limitations in the reported data:

  • There is evidence from one further UK RCT on motivation interventions to increase the number of STI tests completed: Booth 2014 (n=253) reported a small but statistically non-significant effect of intervention type on test offer uptake, OR = 1.65 (95% CI 0.70, 3.88) p = .25, with 57.5% of motivational intervention participants accepting the offer of a test compared with 40.2% of standard promotion participants.
  • There is evidence from one further Australian RCT on tailored interventions to increase the number of STI tests completed. Kang 2012 (n=312) reported no statistically significant difference in condom use between the tailored intervention group and the non-tailored intervention group at follow up (p=0.30).
  • There is evidence from two UK RCT on financial incentives to increase the number of STI tests completed. Dolan 2014 (n=2988) reported no statistically significant differences between any incentive types and no statistically significant difference between incentive compared to no incentive. Those receiving a £5 voucher on sample return had the highest rates of return (73.2%) while those receiving an endowment of a £10 voucher had the lowest (67.9%). The non-incentive group had a return rate of 69.4%. Niza 2014 (n=1060) reported a statistically significant difference between incentive and no-incentive: 8.9% return rate for the incentive group, 1.5% return rate for the non-incentive group, z 3.42 (1.16 to 4.28), p<.001. Niza 2014 also reported a statistically significant difference between reward types: 22.8% return rate for vouchers, 2.8% return rate for lottery, z 3.61 (0.54 to 1.82), p<.001

Economic
  • Bracebridge (2012) assessed the cost effectiveness of chlamydia screening using the global dispatch of kits, web-based data collection and test reporting and treatment dispatch by post among 18–24-year olds in the UK. Findings from the analysis showed that the NEEPCT intervention was more costly than the NCSP comparator, with the cost per screening test 1.66 times higher and the cost per positive diagnosis 3.5 times higher. The authors highlighted that the analysis was limited to data on IMD for the predictors of test uptake, as IMD is dependent on postcode any incorrect assignment of a postcode may result in bias analysis. The reviewers highlight that sensitivity analysis was not conducted and that the simplistic costing used does not consider factors such as the cost savings from preventing STI transmission.
  • Jackson (2015) assessed the cost effectiveness of three STI screening promotion interventions for men in football clubs in England. Findings from the analysis suggested that the total costs and average cost per player tested were similar across all interventions and no intervention was judged to be dominant. Sensitivity analysis showed that adjusting the costs associated with each intervention arm subsequently led to a change in the overall cost per player screened for each intervention. The authors highlighted that the uptake of STI testing may have been underestimated as the analysis did not capture additional downstream testing that may have occurred as a result of the intervention. The authors suggested analysing further uncertainties around cost and outcome parameters if a full RCT was conducted. The reviewers highlight that, as the current study was a preliminary economic evaluation, full incremental results were not calculated.
  • Kerry-Barnard (2020) conducted a cost analysis of various uptake scenarios of the Test n Treat screening intervention for chlamydia trachomatis (CT) and neisseria gonorrhoeae (NG). Results showed that higher uptake of the Test n Treat service reduced the cost per screen. The study results suggest that incentivising testing could help increase uptake without reduce positivity rates. The authors highlighted that the study may not be widely applicable and that costs may be higher in other settings and uptake of services may be higher in other settings. The authors also stated that only a small number of students was screened per day which meant that the per student cost was sensitive to changes in the number of students screened per day. The reviewers highlight that full incremental results were not calculated.
  • Looker (2019) assessed the cost effectiveness of six of the most commonly used recall methods for chlamydia retesting for 15–24-year-old GUM clinic attendees. Findings from the analysis showed that the client led no active recall was the most cost-effective, with the cost per retest at £109. Sensitivity analysis showed that adjusting to a longer recall timeframe had a substantial impact on lowering the cost per retest. The authors highlighted that they did not assess the effects of the participant’s demographics such as sexual orientation on retest uptake and therefore cost. The authors suggested that future research may benefit from assessing online testing with automated recall as this is the most likely to be economical.

2. Acceptability of strategies to improve uptake of STI testing

2.1. Review question

What factors influence the acceptability of the strategies used to improve the uptake of STI testing?

2.1.1. Introduction

Data from Public Health England show the overall number of STI diagnoses increased by 5% between 2018 and 2019. STIs can affect personal wellbeing, mental health and relationships and can also lead to serious health problems including pelvic inflammatory disease, ectopic pregnancy or infertility. It is therefore important to address interventions to help prevent or reduce STIs.

STI testing, diagnosis and treatment are central to STI prevention strategies. The purpose of this review is to establish the acceptability of strategies for improving the uptake of STI testing.

2.1.2. Summary of the protocol

Table 2.1. PICOS.

Table 2.1

PICOS.

For the full review protocol see appendix A.

2.1.3. Methods and process

This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in appendix A and the methods document.

Declarations of interest were recorded according to NICE’s conflicts of interest policy.

2.1.4. Qualitative evidence

2.1.4.1. Included studies

5,673 references were initially identified from the literature search. 40 qualitative papers were ordered in full-text. Of these, 15 qualitative studies met the inclusion criteria for the qualitative review as outlined in the review protocol.

2.1.4.2. Excluded studies

The full list of excluded studies and reasons for exclusion are in appendix J.

2.1.5. Summary of studies included in the qualitative evidence

See table 2.1 for a summary of the study characteristics and appendix D for full evidence tables.

Table 2.2. Summary of studies included in the qualitative review.

Table 2.2

Summary of studies included in the qualitative review.

See appendix D for full evidence tables

2.1.6. Summary of themes and sub-themes

Iterative aggregation of codes generated the following key themes and sub-themes

Table 2.3. Summary of themes and sub-themes.

Table 2.3

Summary of themes and sub-themes.

2.1.7. Summary of the qualitative evidence

Table 2.4. Summary of the qualitative evidence.

Table 2.4

Summary of the qualitative evidence.

See appendix F for full GRADE-CERQual tables

3. Integration and discussion of the evidence

3.1. Mixed methods integration

The section headings in this integration are based on the mixed methods questions recommended by the Joanna Briggs Institute manual chapter for mixed methods reviewing.

Are the results/findings from individual syntheses supportive or contradictory?

The effectiveness evidence showed that home testing is effective for increasing the uptake of STI testing and that tailoring of interventions is effective in terms of increasing the number of tests taken and the intention to get tested. It did not find a meaningful difference for a computer assisted interviewing intervention in sexual health clinics.

This evidence is consistent with the finding from the qualitative synthesis. Themes from the synthesis support a preference for remote self-sampling and tailoring of interventions, though the qualitative evidence also highlights the importance of being able to access in-person testing at a sexual health clinic or other venue.

Does the qualitative evidence explain why the intervention is/is not effective?

Themes from the qualitative evidence support the findings of the effectiveness review. The qualitative evidence highlights positive aspects of screening at home such as its convenience and speed. They also highlighted concerns around confidentiality and anonymity in face-to-face services and were concerned that they would be embarrassed or feel judged, especially during face-to-face interviews with a healthcare professional. These themes support the finding that uptake of testing is higher in remote self-sampling interventions because they explain why people might prefer remote tests. They also explain why the in-clinic computer supported interview intervention was not found to be effective – it does not address peoples concerns about embarrassment or feeling judged.

The qualitative evidence provides less support for the effectiveness evidence about tailoring approaches, however the theme about the design and credibility of the intervention highlights that people trust services more if they feel familiar to them and respond to the aesthetics, language and design of interventions. This may explain the relative effectiveness of tailored interventions.

Qualitative finding showed that incentives were useful ways of encouraging people to test, but not necessarily because of the incentive, but because it gave them a reason to test that they could use to justify testing to their peers. The quantitative evidence was sparse and contradictory about the effectiveness of incentive interventions.

Does the qualitative evidence explain differences in the direction and size of effect across the included quantitative studies?

The remote self-sampling interventions vs in-clinic testing showed large amounts of heterogeneity (I2 over 70% in each case). This heterogeneity may be partly explained by qualitative findings about preferences for in-clinic vs remote testing. Qualitative findings report that even though there are many benefits to remote self-sampling, many participants recognised the benefits of being able to attend an in-person appointment, for example to have more confidence in the test results, or, in the case of people with mild learning disabilities, to help them to conduct the test properly. Some participants simply valued the support of a healthcare professional.

Which aspects of the quantitative evidence were/were not explored in the qualitative studies?

The qualitative evidence did not explore the differences found between the secondary outcomes in the quantitative results. Motivational interventions found differences in attitude towards testing but not in intention to test, condom use or contact with a clinician. Tailored interventions found differences in intention to test and contact with a clinician, but not in attitude towards testing or condom use.

Which aspects of the qualitative evidence were/were not tested in the quantitative studies?

The quantitative evidence did not test findings about many of the perceived social norms around STI testing such as the sense of judgment, stigma, or embarrassment, nor did they investigate their participants’ testing preferences or awareness of their STI risk in a quantifiable way. They also did not address the influence of the healthcare workers delivering the interventions or the design and presentation of the interventions, which the qualitative evidence suggested was important. The qualitative data also suggests that there may be gender differences in how people respond to the interventions, but no gender comparisons were explored in the quantitative studies. One of the qualitative papers reported on data from people with mild learning disabilities and their experiences of using remote self-sampling. The quantitative data did not allow sub-grouping of people with learning disabilities to test whether these findings were generalisable. The qualitative evidence also contained a theme about where tests were available and how they could be accessed that was not reflected in the quantitative evidence

3.2. The committee’s discussion and interpretation of the evidence

The qualitative and quantitative reviews are presented as a combined discussion.

3.2.1. The outcomes that matter most

Quantitative evidence

The primary outcome as agreed with the committee in the review protocol was testing uptake. Secondary outcomes discussed were:

  • Changing STI diagnosis rate
  • The number of people at risk who intend to have an STI test
  • Condom use
  • Contact with a clinician regarding sexual health
  • Attitude towards STI testing

The consensus was that the direct measure of testing uptake – the number of tests taken – was the most important outcome, and the discussion about which interventions to use was directed by the findings of it. The committee used the evidence from secondary outcomes to support the main finding but didn’t use the information from them directly as they were derived from fewer studies and were less consistent in the conclusions that could be drawn.

Qualitative evidence

Qualitative outcomes were individual perspectives, experiences, values, beliefs, preferences, views and considerations that influence the acceptability of strategies to increase STI testing uptake. These outcomes covered 8 broad themes:

  • Reasons for testing
  • Accessibility (for people with learning disabilities)
  • Intervention quality and practicalities
  • Design and credibility of the intervention
  • The experience of using the test
  • Confidentiality and stigma
  • Involvement of healthcare professionals
  • Where the tests are available

The qualitative evidence was collected predominantly from younger people, aged 18–35, which may have limited the generalisability to other populations.

3.2.2. The quality of the evidence

The quantitative evidence was rated from moderate to very low confidence using the GRADE criteria: 4 meta-analyses were rated very low and 1 rated low; 2 single study comparisons were rated very low, 4 were rated low and 6 were rated moderate. The evidence for the primary outcome of testing uptake was all rated very low. The committee expressed some concerns about this and there was discussion about why the confidence ratings were not higher: the interventions were grouped into similar approaches but were not identical, therefore there was a lot of heterogeneity; the studies often had issues relating to their risk of bias since it is difficult to blind participants and researchers in these kinds of trial; and many results had large confidence intervals which indicated problems with imprecision. The committee appreciated that the GRADE assessment will give lower scores for this type of evidence as it cannot meet the standards of a classic placebo controlled double blind trial. They felt that the quality should be considered in relative rather than absolute terms for the purposes of interpretation, so did not view very low quality evidence as a barrier to making a recommendation on the interventions which found a statistically significant effect.

The committee were content with the confidence ratings given to the qualitative evidence using the GRADE-CERQUAL criteria. The majority of the 29 sub-themes were rated as high confidence (13 themes) or moderate confidence (11 themes). There were 5 themes rated as low confidence. Themes were downgraded for various reasons in each of the four GRADE-CERQUAL quality domains with either minor or moderate concerns, but with no serious concerns. See appendix F for full details.

The committee noted that the quantitative narrative findings for the use of incentives were contradictory and inconclusive. Niza 2014 supported the use of incentives, but Dolan 2014 found no significant effect of incentives, nor any differences between incentive types (e.g. vouchers, lotteries, donations). The committee did not feel able to base any recommendations on this evidence due to the low quality, but were still interested in exploring the possibility of using incentives as the qualitative evidence supported their use in some contexts.

The quantitative evidence for interventions within clinics showed no effect in a single study. The committee agreed that this was due to the particular intervention, as it was not appropriate to address the issues they were concerned about in this setting.

3.2.3. Benefits and harms

Home testing using self-sampling kits

The committee were satisfied that the evidence supports the use of remote self-sampling kits (where a person collects their own sample for laboratory analysis). The quantitative evidence found significantly higher uptake of STI testing in home self-sampling interventions compared to clinic-based testing. The qualitative evidence also found that self-sampling was well received, provided that the sampling kit is practical, well-designed and accessible. It also indicated that this intervention was beneficial in avoiding issues around stigma and embarrassment that are common in clinic testing. The committee felt that this combination of findings provided a strong justification for recommending this intervention as an alternative to clinic attendance.

The committee agreed that the main benefit would be that it could encourage people who have previously never engaged in services to come forward for testing. However, the demand for these tests is often greater than the supply available and there is a lot of wastage as many kits are not returned. There are also unintended consequences as a result of not having direct clinic contact; the opportunity to diagnose and treat an STI and to initiate partner notification are impaired and rely on the person having the test to take the initiative. They concluded that the benefit of increased uptake would outweigh these downsides, so did not consider them an impediment to recommending this intervention.

There is regional variation in whether home tests are offered and how many are available. In locations that do offer home testing, it still cannot reach everyone who is eligible. In particular, committee members highlighted the self-efficacy needed to access, complete, and return tests and to interpret the results. They also described the specific barriers faced by gender diverse people when answering questions about sex, gender and anatomy to access an appropriate kit. To address this, they recommended ensuring services keep their websites up to date with information on local testing options and to monitor the return rates of kits to check which groups are and are not accessing them. The committee further noted the lack of specific qualitative evidence relating to the experiences and preferences of LGBT+ people in accessing STI testing services, both in clinic and remote, and made a research recommendation about it (see appendix K).

In committee members’ experiences, self-sampling is suitable for chlamydia and gonorrhoea, but less so for other STIs. Tests which require a blood sample, such as syphilis tests, are more challenging to complete so are more likely to be returned in an unsuitable state for analysis. Antibodies from previous infections can also result in false positives that a clinic test would be better able to address. They concluded that self-sampling at home should be part of a suite of testing options and recommended offering it along with in-person attendance at specialist clinics or in primary care, and outreach services based on local needs. In current practice, remote self-sampling is offered only to people who are asymptomatic, so the committee also discussed the potential use of remote self-sampling for appropriate people who have symptoms. It was noted that during the COVID pandemic, some areas had offered remote self-sampling to symptomatic people following telephone triage. The committee were interested in whether this was effective and what the unintended consequences might be, so they made a research recommendation about it (see appendix K).

Tailored interventions

The quantitative evidence showed that individually tailored interventions were effective in increasing testing uptake, whereas motivational interventions without tailoring were not. The committee agreed that this was consistent with previous discussions about cultural competence in targeting interventions to specific groups, so felt confident in recommending this approach. They decided that detailed and specific tailoring used in most of the tailored intervention studies would probably be too resource intensive in practice, so recommended low-level personalisation based on elements of Kang’s (2012) intervention, such as adding names (of patients or healthcare professionals) and demographic-specific information to communications (for example the local rates of STIs in their group). The qualitative evidence did not address tailored interventions, so there was no further information to support the discussion of how to tailor outreach services to specific groups or communities. As a result of this gap in the evidence, the committee made a research recommendation to explore this further. (see appendix K).

Incentives

The committee were interested in the potential of incentives, despite the weakness of the existing quantitative evidence (narrative findings from Niza 2014 and Dolan 2014 which produced conflicting results on whether incentives increased uptake; and were undertaken in specific subpopulations, for example students living in university accommodation in Niaz). They recounted anecdotal evidence of success with voucher schemes in homeless shelters and evidence from other topic areas. Some committee members expressed that vouchers intuitively felt like a better incentive than a lottery, regardless of Dolan 2014 finding no differences in incentive types. They suggested that incentives should not necessarily be disregarded when they seem to work in reality while weaknesses in the design and analysis of the studies may have accounted for the ambiguity of the results.

There were, however, concerns about ethical issues, particularly for those who are financially vulnerable; incentive schemes could constitute a perverse incentive, encouraging people to expose themselves to STI risks in order to be eligible to claim the incentive. The committee agreed that the type of incentive offered is an important consideration. Some committee members suggested non-financial incentives such as virtual badges to indicate STI testing status on dating apps as a way to avoid the potential problems of financial perverse incentives. There are also unintended consequences to STI testing: the procedure itself, taking blood, the risk of false positives, and anxiety while waiting for results. While increased testing is a good thing, excessive or unnecessary testing to gain incentives is not desirable. As there is currently a lack of high quality quantitative evidence to support the use of incentives and little consideration of the possible unintended consequences, the committee made a research recommendation to explore these further (see appendix K)

3.2.4. Cost effectiveness and resource use

The committee noted there were a number of published cost-effectiveness analyses for this review question, which were of reasonable quality and applicability to the UK. However, there were two key limitations that meant they did not feel confident making recommendations directly based off those studies. First, many of the studies looked at issues that would fall within the remit of the National Chlamydia Screening Programme. The committee considered whether those findings could be extrapolated to other STIs or settings, but considered that the existence of the screening programme means services (for those eligible under it) are set up in a somewhat different way to other services, and therefore are not particular generalisable. Other studies looked at very specifically targeted interventions (for example, testing in football clubs) and the committee agreed this was better covered in more general recommendations elsewhere in the guidance about providing a range of services, and targeting to the needs of specific populations, rather than by listing any of these specific individual cases within the recommendations.

The committee made two sets of recommendations from this evidence review. The first set, on tailoring interventions, the committee were confident would not have a significant resource impact, due to the low complexity of the things being recommended. For the second area, on remote self-sampling as a method of STI testing for asymptomatic people, the committee noted that widespread adoption of this would come with significant implications for the restructuring of services, and therefore agreed cost-effectiveness modelling in this area would provide value.

The model built compared a system of solely in clinic STI testing to a system where remote (in particular at home) self-sampling is available. It looked at the benefits of additional identified cases, both for reducing long-term complications in the index-cases identified, and in reducing onward transmission and secondary cases. The analysis covered a range of bacterial STIs (chlamydia, gonorrhoea and syphilis) and looked both at the general population accessing STI testing, and at specific high-risk subgroups (defined by a higher baseline prevalence of STIs).

The modelling found that, assuming self-sampling interventions were as effective in real world settings as in the identified RCTs, offering this as an intervention would be highly cost-effective, with the additional costs generated by the higher volume of tests requested generating considerable additional QALYs, as well as some downstream savings from prevented complications and secondary infections. Data to populate the analysis for the high-risk subgroups was extremely limited, but what was available suggested the intervention would be either approximately equally or most cost-effective in these populations compared to the general population, and therefore the committee were confident in making recommendations covering the whole population, and that these would also be appropriate for these subpopulations.

The committee did note, however, that there were a number of potential risks in widescale implementation of self-sampling that might make it less cost-effective than in trial settings. These would include people requesting and not returning tests, people providing unusable test samples and therefore requiring retesting, and the potential need for confirmatory clinical tests in people with a positive self-sampling test (particular for syphilis testing). Additionally, there is possibility that the availability of self-sampling means lower risk individuals decide to get tested, resulting in a lower test positive rate, reducing the cost-effectiveness of the intervention. The committee noted the impact of these issues will have been captured in the RCT results as far as they happened in those trials, but agreed that in principle there was a risk that the additional information provided and monitoring undertaken during a trial would mean they may not exist to the same extent as when rolled out more widely. A series of sensitivity analyses were conducted (using data from UK routine practice on these factors where available), which showed that when multiple of these more negative assumptions were made simultaneously, there were scenarios in which offering home self-sampling was no longer cost-effective. The committee noted these analyses were likely to be somewhat biased against self-sampling, due to the risk of double counting issues (for example, applying the general UK rate of non-returned tests on top of the unreturned tests already accounted for in the trial), but felt they were still useful as a way of testing the robustness of the conclusions.

The committee considered these findings and decided they were still confident in recommending self-sampling should be available as a testing method. They noted that it was still relatively recently widespread use of these interventions had been made in the UK, and therefore the data at the moment likely reflected teething issues in the setup of services, and improvements were likely as services became more established. Second, they noted that many of these factors were not inevitable results of having a self-sampling service, but rather modifiable parameters that services could look to improve. Therefore, alongside their recommendations that self-sampling be available as a testing methods, they also made implementation recommendations, such as for services to monitor return rates of kits, and to improve the accessibility and usability of those kits, all of which would be expected to improve rates of correct test returns, and therefore improve the cost-effectiveness of the intervention.

The committee noted there had been a considerable increase in remote self-sampling services as a result of the COVID-19 pandemic, but noted in many cases these had been offered instead of in clinic services (with those not being available), rather than as a choice alongside in clinic testing as this guideline recommends as a long-term model. However, this does mean that many services now have increased familiarity with and systems for remote self-sampling, and therefore the implementation barriers to this change should be considerably lower than they would have been if implemented before the onset of the pandemic.

3.2.5. Other factors the committee took into account

The impact of Covid 19 self-sampling

All studies included in the review were conducted prior to the Covid 19 pandemic, so the committee were interested in how people’s behaviour and attitudes may have changed as a result of it. Familiarity and experience with self-swab testing at home will have increased considerably as a result of widespread covid testing, thereby normalising the procedure. In addition, some areas introduced or expanded self-testing for STIs during the pandemic due to service restrictions whereby asymptomatic screening was not available in clinics. Committee members observed that the acceptance of home-testing and self-testing had increased considerably, and that online testing services had been well received during this period. They cautioned, however, that this increase was mainly people who were seeking testing services, rather than reaching people who would not have otherwise come forward for testing. It is also likely that there were some people who declined to use this service if they had wanted an in-clinic test. The committee considered the possibility that a change in acceptance of self-sampling may be short lived if covid becomes less prevalent and noted that frequent covid testing is not directly comparable to frequent STI testing. They made a research recommendation to explore this further (see appendix K).

Informed consent and profiling

Some self-sampling interventions in the quantitative evidence used ‘pop-up’ outreach campaigns to distribute kits to people who may not have sought out testing, particularly targeting hard to reach groups. The committee discussed the ethics and impact of targeting specific demographics for testing and of offering testing to these people in non-clinical settings without fully explaining why it was offered. It was suggested that there may be a lack of informed consent if people are not aware of the implications for themselves and their sexual partners. The qualitative evidence provided a mixture of views on this issue; some found it invasive and inappropriate to be offered testing in this way, while others appreciated the convenience and ease of testing being brought to them. The committee concluded that the opportunity to widen access to testing justified recommending offering self-sampling kits through outreach services.

There were also concerns raised by the qualitative finding that some young people may object to being profiled as high risk, particularly in GP settings where being approached for STI testing could distract from the purpose of their appointment. Similarly, there are also potential issues around pathologising gay, bisexual and other men who have sex with men by profiling them as high risk. Committee members pointed out that it is commonplace in public health to target groups and to profile people who are at higher risk of poor health. For this reason, the focus should be how to offer testing appropriately so that people understand why they have been offered it; they recommended recognising concerns about profiling and addressing the issue with cultural sensitivity and competency The committee further noted that targeting interventions to at-risk groups can also be achieved by making services more accessible, by addressing the needs of trans and gender diverse people, being available in different languages or being available in different formats such as videos targeted at people with learning difficulties.

Types of tests and terminology

Members of the committee explained the distinction between self-sampling (which can either be in clinic or out of clinic), remote self-sampling (where a self-sample is taken at home or in another non-clinical setting and sent for analysis), and home testing (where the sample and test are conducted by the person outside of the clinic). These terms had been used somewhat interchangeably in the evidence so they felt it was important to be clear that the intervention supported by the quantitative evidence was self-sampling at home and the interventions described in the qualitative evidence were self-sampling at home or other non-clinic locations.

There was discussion around what tests are available and appropriate. Although the qualitative evidence indicated that people would prefer a choice about what type of test they are offered and would often prefer a rapid test, this may not be possible in practice. It was pointed out that rapid point of care tests are not yet available for most STIs (they are currently used for HIV). The committee recounted that swabs and urine samples were rarely refused, whereas it can be difficult to persuade people to accept a blood test. This aspect of testing uptake was missing from most of the interventions in the review, so was considered for a research recommendation but not prioritised as the committee preferred to focus on increasing uptake overall. Lastly, it was commented that testing options are not equally effective, for example urine sampling is less sensitive than vulvo-vaginal swab tests for women, therefore offering more choice of testing options may be counter-productive to increasing detection of STIs and should not be recommended.

3.3. Recommendations supported by this, review

This evidence review supports recommendations 1.2.1 to 1.2.9 and the research recommendations on the value of incentives in increasing STI testing, attitudes to remote self-sampling and regular STI testing, the effectiveness and adverse outcomes of self-sampling for people with symptoms, and the experiences of LGBT+ people in accessing STI testing services.

3.4. References – included studies

    3.4.1. Effectiveness

    • Bauermeister, Jose A, Pingel, Emily S, Jadwin-Cakmak, Laura et al (2015) Acceptability and preliminary efficacy of a tailored online HIV/STI testing intervention for young men who have sex with men: the Get Connected! program. AIDS and behavior 19(10): 1860–74 [PMC free article: PMC4522230] [PubMed: 25638038]
    • Booth, Amy R, Norman, Paul, Goyder, Elizabeth et al (2014) Pilot study of a brief intervention based on the theory of planned behaviour and self-identity to increase chlamydia testing among young people living in deprived areas. British journal of health psychology 19(3): 636–51 [PubMed: 24103040]
    • Dolan, Paul and Rudisill, Caroline (2014) The effect of financial incentives on chlamydia testing rates: evidence from a randomized experiment. Social science & medicine (1982) 105: 140–8 [PMC free article: PMC3969100] [PubMed: 24373390]
    • Fuller, Sebastian S, Mercer, Catherine H, Copas, Andrew J et al (2015) The SPORTSMART study: a pilot randomised controlled trial of sexually transmitted infection screening interventions targeting men in football club settings. Sexually transmitted infections 91(2): 106–10 [PMC free article: PMC4345976] [PubMed: 25512674]
    • Kang, Melissa, Rochford, Arlie, Skinner, Rachel et al (2012) Facilitating chlamydia testing among young people: a randomised controlled trial in cyberspace. Sexually transmitted infections 88(8): 568–73 [PubMed: 22764218]
    • Klovstad, Hilde, Natas, Olav, Tverdal, Aage et al (2013) Systematic screening with information and home sampling for genital Chlamydia trachomatis infections in young men and women in Norway: a randomized controlled trial. BMC infectious diseases 13: 30 [PMC free article: PMC3558461] [PubMed: 23343391]
    • Lim, MS, Hocking, JS, Aitken, CK et al (2012) Impact of text and email messaging on the sexual health of young people: a randomised controlled trial. Journal of epidemiology and community health 66(1): 69–74 [PubMed: 21415232]
    • Lustria, Mia Liza A, Cortese, Juliann, Gerend, Mary A et al (2016) A model of tailoring effects: A randomized controlled trial examining the mechanisms of tailoring in a web-based STD screening intervention. Health psychology : official journal of the Division of Health Psychology, American Psychological Association 35(11): 1214–1224 [PubMed: 27441869]
    • Mevissen, Fraukje E F, Ruiter, Robert A C, Meertens, Ree M et al (2011) Justify your love: testing an online STI-risk communication intervention designed to promote condom use and STI-testing. Psychology & health 26(2): 205–21 [PubMed: 21318930]
    • Mortimer, Nathan J, Rhee, Joel, Guy, Rebecca et al (2015) A web-based personally controlled health management system increases sexually transmitted infection screening rates in young people: a randomized controlled trial. Journal of the American Medical Informatics Association : JAMIA 22(4): 805–14 [PubMed: 25773130]
    • Niza, Claudia; Rudisill, Caroline; Dolan, Paul (2014) Vouchers versus Lotteries: What works best in promoting Chlamydia screening? A cluster randomised controlled trial. Applied economic perspectives and policy 36(1): 109–124 [PMC free article: PMC4105573] [PubMed: 25061507]
    • Reagan, Mary M, Xu, Hanna, Shih, Shirley L et al (2012) A randomized trial of home versus clinic-based sexually transmitted disease screening among men. Sexually transmitted diseases 39(11): 842–7 [PMC free article: PMC3476063] [PubMed: 23064532]
    • Richens, J, Copas, A, Sadiq, ST et al (2010) A randomised controlled trial of computer-assisted interviewing in sexual health clinics. Sexually transmitted infections 86(4): 310–314 [PubMed: 20551234]
    • Roth, Alexis M, Van Der Pol, Barbara, Fortenberry, J Dennis et al (2015) The impact of brief messages on HSV-2 screening uptake among female defendants in a court setting: a randomized controlled trial utilizing prospect theory. Journal of health communication 20(2): 230–6 [PMC free article: PMC4356496] [PubMed: 25494832]
    • Smith, Kirsty S, Hocking, Jane S, Chen, Marcus Y et al (2015) Dual Intervention to Increase Chlamydia Retesting: A Randomized Controlled Trial in Three Populations. American journal of preventive medicine 49(1): 1–11 [PubMed: 26094224]
    • van den Broek, Ingrid V F, van Bergen, Jan E A M, Brouwers, Elfi E H G et al (2012) Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation. BMJ (Clinical research ed.) 345: e4316 [PMC free article: PMC3390168] [PubMed: 22767614]
    • Wilson, Emma, Free, Caroline, Morris, Tim P et al (2017) Internet-accessed sexually transmitted infection (e-STI) testing and results service: A randomised, single-blind, controlled trial. PLoS medicine 14(12): e1002479 [PMC free article: PMC5744909] [PubMed: 29281628]
    • Wilson, Emma, Leyrat, Clemence, Baraitser, Paula et al (2019) Does internet-accessed STI (e-STI) testing increase testing uptake for chlamydia and other STIs among a young population who have never tested? Secondary analyses of data from a randomised controlled trial. Sexually transmitted infections 95(8): 569–574 [PMC free article: PMC6902059] [PubMed: 31175210]
    • Xu F, Stoner BP, Taylor SN et al (2011) Use of home-obtained vaginal swabs to facilitate rescreening for Chlamydia trachomatis infections: two randomized controlled trials. Obstetrics and gynecology 118(2 Pt 1): 231–239 [PubMed: 21775837]

    3.4.2. Acceptability

    • Aicken, Catherine R H, Fuller, Sebastian S, Sutcliffe, Lorna J et al (2016) Young people’s perceptions of smartphone-enabled self-testing and online care for sexually transmitted infections: qualitative interview study. BMC public health 16: 974 [PMC free article: PMC5022229] [PubMed: 27624633]
    • Estcourt, Claudia, Sutcliffe, Lorna, Mercer, Catherine H et al (2016) No title provided.
    • Fleming, C., Drennan, V.M., Kerry-Barnard, S. et al (2020) Understanding the acceptability, barriers and facilitators for chlamydia and gonorrhoea screening in technical colleges: qualitative process evaluation of the “Test n Treat” trial. BMC public health 20(1): 1212 [PMC free article: PMC7414554] [PubMed: 32770977]
    • Fuller, Sebastian S, Pacho, Agata, Broad, Claire E et al (2019) “It’s not a time spent issue, it’s a ‘what have you spent your time doing?’ issue…” A qualitative study of UK patient opinions and expectations for implementation of Point of Care Tests for sexually transmitted infections and antimicrobial resistance. PloS one 14(4): e0215380 [PMC free article: PMC6467401] [PubMed: 30990864]
    • Gkatzidou, Voula, Hone, Kate, Sutcliffe, Lorna et al (2015) User interface design for mobile-based sexual health interventions for young people: design recommendations from a qualitative study on an online Chlamydia clinical care pathway. BMC medical informatics and decision making 15: 72 [PMC free article: PMC4549868] [PubMed: 26307056]
    • Hogan, Angela H, Howell-Jones, Rebecca S, Pottinger, Elizabeth et al (2010) “…they should be offering it”: a qualitative study to investigate young peoples’ attitudes towards chlamydia screening in GP surgeries. BMC public health 10: 616 [PMC free article: PMC2965724] [PubMed: 20955570]
    • Jackson, Louise, Al-Janabi, Hareth, Roberts, Tracy et al (2021) Exploring young people’s preferences for STI screening in the UK: A qualitative study and discrete choice experiment. Social science & medicine (1982) 279: 113945 [PubMed: 34010779]
    • Jones, Leah Ffion, Ricketts, Ellie, Town, Katy et al (2017) Chlamydia and HIV testing, contraception advice, and free condoms offered in general practice: a qualitative interview study of young adults’ perceptions of this initiative. The British journal of general practice : the journal of the Royal College of General Practitioners 67(660): e490–e500 [PMC free article: PMC5565869] [PubMed: 28533198]
    • Loaring, Jessica, Hickman, Matthew, Oliver, Isabel et al (2013) Could a peer-led intervention increase uptake of chlamydia screening? A proof of principle pilot study. The journal of family planning and reproductive health care 39(1): 21–8 [PubMed: 22855521]
    • Lorimer, Karen and McDaid, Lisa (2013) Young men’s views toward the barriers and facilitators of Internet-based Chlamydia trachomatis screening: qualitative study. Journal of medical Internet research 15(12): e265 [PMC free article: PMC3868974] [PubMed: 24300158]
    • Middleton, Alan, Laidlaw, Rebecca, Pothoulaki, Maria et al (2021) How can we make self-sampling packs for sexually transmitted infections and bloodborne viruses more inclusive? A qualitative study with people with mild learning disabilities and low health literacy. Sexually Transmitted Infections 97(4): 276–281 [PMC free article: PMC8165145] [PubMed: 33906976]
    • Normansell, Rebecca; Drennan, Vari M; Oakeshott, Pippa (2016) Exploring access and attitudes to regular sexually transmitted infection screening: the views of young, multi-ethnic, inner-city, female students. Health expectations : an international journal of public participation in health care and health policy 19(2): 322–30 [PMC free article: PMC5055273] [PubMed: 25703741]
    • Powell, Rachael; Pattison, Helen M; Marriott, John F (2016) Perceptions of Self-Testing for Chlamydia: Understanding and Predicting Self-Test Use. Healthcare (Basel, Switzerland) 4(2) [PMC free article: PMC4934578] [PubMed: 27417613]
    • Richardson, D, Maple, K, Perry, N et al (2010) A pilot qualitative analysis of the psychosocial factors which drive young people to decline chlamydia testing in the UK: implications for health promotion and screening. International journal of STD & AIDS 21(3): 187–90 [PubMed: 20215623]
    • Wayal, Sonali, Llewellyn, Carrie, Smith, Helen et al (2011) Home sampling kits for sexually transmitted infections: preferences and concerns of men who have sex with men. Culture, health & sexuality 13(3): 343–53 [PubMed: 21154069]

    3.4.3. Economic

    • Bracebridge S, Bachmann MO, Ramkhelawon K, Woolnough A. Evaluation of a systematic postal screening and treatment service for genital Chlamydia trachomatis, with remote clinic access via the internet: a cross-sectional study, East of England. Sexually transmitted infections. 2012;88(5):375–81. [PubMed: 22375045]
    • de Wit GA, Over EAB, Schmid BV, van Bergen JEAM, van den Broek IVF, van der Sande MAB, et al Chlamydia screening is not cost-effective at low participation rates: evidence from a repeated register-based implementation study in The Netherlands. Sexually transmitted infections. 2015;91(6):423–9. [PubMed: 25759475]
    • Gillespie P ONCAETKODDBRVDOCECMBMCCF. The cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland. Sexually Transmitted Infections. 2012;88(3):222–8. [PubMed: 22213681]
    • Jackson LJ, Roberts TE, Fuller SS, Sutcliffe LJ, Saunders JM, Copas AJ, et al Exploring the costs and outcomes of sexually transmitted infection (STI) screening interventions targeting men in football club settings: preliminary cost-consequence analysis of the SPORTSMART pilot randomised controlled trial. Sexually transmitted infections. 2015;91(2):100–5. [PMC free article: PMC4345770] [PubMed: 25512670]
    • Kerry-Barnard S, Huntington S, Fleming C, Reid F, Sadiq ST, Drennan VM, et al Near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges: a cost analysis of the ‘Test n Treat’ feasibility trial. BMC health services research. 2020;20(1):316. [PMC free article: PMC7160983] [PubMed: 32299437]
    • Looker KJ, Buitendam E, Woodhall SC, Hollis E, Ong K-J, Saunders JM, et al Economic evaluation of the cost of different methods of retesting chlamydia positive individuals in England. BMJ open. 2019;9(3):e024828. [PMC free article: PMC6475158] [PubMed: 30904855]
    • Ritchie S, Henley R, Hilton J, Handy R, Ingram J, Mundt S, et al Uptake, yield and resource requirements of screening for asymptomatic sexually transmissible infections among HIV-positive people attending a hospital outpatient clinic. Sexual Health. 2014;11(1):67–72. [PubMed: 24618022]
    • Ross C, Shaw S, Marshall S, Stephen S, Bailey K, Cole R, et al Impact of a social media campaign targeting men who have sex with men during an outbreak of syphilis in Winnipeg, Canada. Canada communicable disease report = Releve des maladies transmissibles au Canada. 2016;42(2):45–9. [PMC free article: PMC5864268] [PubMed: 29770003]
    • Smith KS, Kaldor JM, Hocking JS, Jamil MS, McNulty AM, Read P, et al The acceptability and cost of a home-based chlamydia retesting strategy: findings from the REACT randomised controlled trial. BMC public health. 2016;16:83. [PMC free article: PMC4730759] [PubMed: 26822715]

Appendices

Appendix B. Literature search strategies

Download PDF (111K)

Appendix C. Evidence study selection

Quantitative evidence (PDF, 108K)

Qualitative evidence (PDF, 108K)

Appendix D. Evidence tables

D.1. Effectiveness evidence (PDF, 1022K)

D.2. Qualitative evidence (PDF, 612K)

Appendix E. Forest plotsa

Remote self-sampling kit interventions vs. standard care testing in sexual health clinics (PDF, 261K)

Motivational interventions to increase STI testing (PDF, 120K)

Tailored interventions to increase STI testing (PDF, 123K)

Clinic interventions to increase STI testing (PDF, 109K)

Footnotes

a

Forest plots are only included for outcomes where meta-analysis was undertaken. Outcomes included in single studies do not have forest plots.

Appendix F. GRADE and GRADE-CERQual tables

GRADE tables (PDF, 209K)

GRADE CERQual tables (PDF, 179K)

Appendix G. Economic evidence study selection

Download PDF (149K)

Appendix H. Economic evidence tables

Download PDF (212K)

Appendix I.

Health economic model (PDF, 423K)

References

1.
Public Health England. Antimicrobial resistance in Neisseria gonorrhoeae in England and Wales. Public Health England,: 2019. Available from: https://assets​.publishing​.service.gov.uk​/government/uploads/system​/uploads/attachment_data​/file/834924​/GRASP__2018_report.pdf.
2.
National Health Service. Syphilis Symptoms. National Health Service,: 2019. Available from: https://www​.nhs.uk/conditions​/syphilis/symptoms/.
3.
4.
Public Health England. Sexually transmitted infections and screening for chlamydia in England, 2020. 2020. Available from: https://assets​.publishing​.service.gov.uk​/government/uploads/system​/uploads/attachment_data​/file/914184​/STI_NCSP_report_2019.pdf
5.
6.
Blomquist PB, Mohammed H, Mikhail A, Weatherburn P, Reid D, Wayal S, et al Characteristics and sexual health service use of MSM engaging in chemsex: results from a large online survey in England. Sex Transm Infect. 2020;96(8):590–95. [PMC free article: PMC7677472] [PubMed: 32139497]
7.
8.
9.
Price MJ, Ades AE, Soldan K, Welton NJ, Macleod J, Simms I, et al The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis. Health Technol Assess. 2016;20(22):1–250. [PMC free article: PMC4819202] [PubMed: 27007215]
10.
Price MJ, Ades AE, De Angelis D, Welton NJ, Macleod J, Soldan K, et al Risk of pelvic inflammatory disease following Chlamydia trachomatis infection: analysis of prospective studies with a multistate model. Am J Epidemiol. 2013;178(3):484–92. [PMC free article: PMC3727337] [PubMed: 23813703]
11.
National Health Service. Gonorrhoea - complications. Available from: https://www​.nhs.uk/conditions​/gonorrhoea/complications/
12.
Public Health England. Sexual and Reproductive Health Return on Investment Tool. 2020
13.
Marcus JL, Glidden DV, Mayer KH, Liu AY, Buchbinder SP, Amico KR, et al No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis. PLoS One. 2013;8(12):e81997. [PMC free article: PMC3867330] [PubMed: 24367497]
14.
Mercer CH, Tanton C, Prah P, Erens B, Sonnenberg P, Clifton S, et al Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet. 2013;382(9907):1781–94. [PMC free article: PMC3899021] [PubMed: 24286784]
15.
Glick SN, Morris M, Foxman B, Aral SO, Manhart LE, Holmes KK, et al A comparison of sexual behavior patterns among men who have sex with men and heterosexual men and women. J Acquir Immune Defic Syndr. 2012;60(1):83–90. [PMC free article: PMC3334840] [PubMed: 22522237]
16.
McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53–60. [PMC free article: PMC4700047] [PubMed: 26364263]
17.
Sadler S, Tosh J, Rawdin A, Squires H, Sutton A, Chilcott J. A model to evaluate the cost effectiveness of condom distribution (CD) schemes, developed for NICE public health guidance on condom distribution schemes and sexually transmitted infections (STIs). 2016. Available from: https://www​.nice.org​.uk/guidance/ng68/documents​/economic-report#page​=20&zoom=100,92,97
18.
19.
20.
Personal Social Services Research Unit. Unit Costs of Health and Social Care 2020. 2020. Available from: https://www​.pssru.ac​.uk/project-pages/unit-costs​/unit-costs-2020/.
21.
Huntington SE, Burns RM, Harding-Esch E, Harvey MJ, Hill-Tout R, Fuller SS, et al Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees. BMJ Open. 2018;8(9):e020394. [PMC free article: PMC6144481] [PubMed: 30201794]

Appendix J. Excluded studies

J.1.1. Excluded quantitative studies

StudyCode [Reason]
Ahmad, Fahd A, Jeffe, Donna B, Plax, Katie et al (2014) Computerized self-interviews improve Chlamydia and gonorrhea testing among youth in the emergency department. Annals of emergency medicine 64(4): 376–84 [PMC free article: PMC4156563] [PubMed: 24612901] - Not a relevant study design
Alarcon Gutierrez, Miguel, Fernandez Quevedo, Manuel, Martin Valle, Silvia et al (2018) Acceptability and effectiveness of using mobile applications to promote HIV and other STI testing among men who have sex with men in Barcelona, Spain. Sexually transmitted infections 94(6): 443–448 [PubMed: 29626174] - Not a relevant study design
Baird, Janette and Merchant, Roland C (2014) A randomized controlled trial of the effects of a brief intervention to increase chlamydia and gonorrhea testing uptake among young adult female emergency department patients. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 21(12): 1512–20 [PubMed: 25491714] - Non-UK healthcare setting
Bilardi, Jade E, Fairley, Christopher K, Temple-Smith, Meredith J et al (2010) Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial. BMC public health 10: 70 [PMC free article: PMC2841675] [PubMed: 20158918] - Population are not the target group
Bissessor, Melanie, Fairley, Christopher K, Leslie, David et al (2011) Use of a computer alert increases detection of early, asymptomatic syphilis among higher-risk men who have sex with men. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 53(1): 57–8 [PubMed: 21653303] - Not a relevant study design
Buhrer-Skinner, Monika, Muller, Reinhold, Buettner, Petra G et al (2013) Reducing barriers to testing for Chlamydia trachomatis by mailed self-collected samples. Sexual health 10(1): 32–8 [PubMed: 23158104] - Not a relevant study design
Buhrer-Skinner, Monika, Muller, Reinhold, Buettner, Petra G et al (2011) Improving Chlamydia trachomatis retesting rates by mailed self-collection kit. Sexual health 8(2): 248–50 [PubMed: 21592441] - Not a relevant study design
Bungay, Vicky, Kolar, Kat, Thindal, Soni et al (2013) Community-based HIV and STI prevention in women working in indoor sex markets. Health promotion practice 14(2): 247–55 [PubMed: 22885289] - Not a relevant study design
Cassidy, Christine, Steenbeek, Audrey, Langille, Donald et al (2019) Designing an intervention to improve sexual health service use among university undergraduate students: a mixed methods study guided by the behaviour change wheel. BMC public health 19(1): 1734 [PMC free article: PMC6933635] [PubMed: 31878901] - Not a relevant study design
Chacko, Mariam R, Wiemann, Constance M, Kozinetz, Claudia A et al (2010) Efficacy of a motivational behavioral intervention to promote chlamydia and gonorrhea screening in young women: a randomized controlled trial. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 46(2): 152–61 [PMC free article: PMC2818061] [PubMed: 20113921] - Non-UK healthcare setting
Cheeks, Miyesha A, Fransua, Mesfin, Stringer, Harold G Jr et al (2016) A Quality Improvement Project to Increase Early Detection of Syphilis Infection or Re-infection in HIV-infected Men Who Have Sex With Men. The Journal of the Association of Nurses in AIDS Care : JANAC 27(2): 143–52 [PubMed: 26646978] - Not a relevant study design
Currie, Marian J, Schmidt, Matthias, Davis, Belinda K et al (2010) ‘Show me the money’: financial incentives increase chlamydia screening rates among tertiary students: a pilot study. Sexual health 7(1): 60–5 [PubMed: 20152098] - Not a relevant study design
Dean, Lorraine T, Montgomery, Madeline C, Raifman, Julia et al (2018) The Affordability of Providing Sexually Transmitted Disease Services at a Safety-net Clinic. American journal of preventive medicine 54(4): 552–558 [PMC free article: PMC5860994] [PubMed: 29397280] - Not applicable to a UK context
DiVasta, Amy D, Trudell, Emily K, Francis, Mary et al (2016) Practice-Based Quality Improvement Collaborative to Increase Chlamydia Screening in Young Women. Pediatrics 137(5) [PubMed: 27244777] - Population are not the target group
Dolcini, M Margaret, Harper, Gary W, Boyer, Cherrie B et al (2010) Project ORE: A friendship-based intervention to prevent HIV/STI in urban African American adolescent females. Health education & behavior : the official publication of the Society for Public Health Education 37(1): 115–32 [PMC free article: PMC2922952] [PubMed: 19535612] - Study does not contain a relevant intervention
Downing, Sandra Gaye, Cashman, Colette, McNamee, Heather et al (2013) Increasing chlamydia test of re-infection rates using SMS reminders and incentives. Sexually transmitted infections 89(1): 16–9 [PubMed: 22728911] - Non-UK healthcare setting
Eckman, M.H., Reed, J.L., Trent, M. et al (2020) Cost-effectiveness of Sexually Transmitted Infection Screening for Adolescents and Young Adults in the Pediatric Emergency Department. JAMA Pediatrics [PMC free article: PMC7607492] [PubMed: 33136149] - Population are not the target group
Edelman, Natalie, Cassell, Jackie A, de Visser, Richard et al (2017) Can psychosocial and socio-demographic questions help identify sexual risk among heterosexually-active women of reproductive age? Evidence from Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMC public health 17(1): 5 [PMC free article: PMC5209946] [PubMed: 28049459] - Not a relevant study design
Ewing, M., Read, P., Knight, V. et al (2013) Do callers to the NSW Sexual Health Infoline attend the services they are referred to?. Sexual Health 10(6): 530–532 [PubMed: 24119390] - Not a relevant study design
Fine, David, Warner, Lee, Salomon, Sarah et al (2017) Interventions to Increase Male Attendance and Testing for Sexually Transmitted Infections at Publicly-Funded Family Planning Clinics. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 61(1): 32–39 [PMC free article: PMC7021216] [PubMed: 28528207] - Not a relevant study design
Forrest, Garry, Boonwaat, Leng, Douglas, Jenny et al (2009) Enhanced chlamydia surveillance in New South Wales (Australia) prisons, 2005–2007. International journal of prisoner health 5(4): 233–40 [PubMed: 25757524] - Not a relevant study design
Friedman, Allison L, Kachur, Rachel E, Noar, Seth M et al (2016) Health Communication and Social Marketing Campaigns for Sexually Transmitted Disease Prevention and Control: What Is the Evidence of their Effectiveness?. Sexually transmitted diseases 43(2suppl1): 83–101 [PubMed: 26779691] - Review article but not a systematic review
Goller, Jane L, Guy, Rebecca J, Gold, Judy et al (2010) Establishing a linked sentinel surveillance system for blood-borne viruses and sexually transmissible infections: methods, system attributes and early findings. Sexual health 7(4): 425–33 [PubMed: 21062582] - Not a relevant study design
Gotz, Hannelore M, Wolfers, Mireille E G, Luijendijk, Ad et al (2013) Retesting for genital Chlamydia trachomatis among visitors of a sexually transmitted infections clinic: randomized intervention trial of home- versus clinic-based recall. BMC infectious diseases 13: 239 [PMC free article: PMC3666896] [PubMed: 23705624] - Comparator in study does not match that specified in protocol
Goyal, Monika K, Fein, Joel A, Badolato, Gia M et al (2017) A Computerized Sexual Health Survey Improves Testing for Sexually Transmitted Infection in a Pediatric Emergency Department. The Journal of pediatrics 183: 147–152e1 [PMC free article: PMC5440080] [PubMed: 28081888] - Non-UK healthcare setting
Graham, Simon, Guy, Rebecca J, Wand, Handan C et al (2015) A sexual health quality improvement program (SHIMMER) triples chlamydia and gonorrhoea testing rates among young people attending Aboriginal primary health care services in Australia. BMC infectious diseases 15: 370 [PMC free article: PMC4557217] [PubMed: 26329123] - Not applicable to a UK context
Graseck, Anna S, Secura, Gina M, Allsworth, Jenifer E et al (2010) Home compared with clinic-based screening for sexually transmitted infections: a randomized controlled trial. Obstetrics and gynecology 116(6): 1311–8 [PMC free article: PMC3120128] [PubMed: 21099596] - Population are not the target group
Graseck, Anna S; Shih, Shirley L; Peipert, Jeffrey F (2011) Home versus clinic-based specimen collection for Chlamydia trachomatis and Neisseria gonorrhoeae. Expert review of anti-infective therapy 9(2): 183–94 [PMC free article: PMC3097250] [PubMed: 21342066] - Review article but not a systematic review
Guy, Rebecca J, Kong, Fabian, Goller, Jane et al (2010) A new national Chlamydia Sentinel Surveillance System in Australia: evaluation of the first stage of implementation. Communicable diseases intelligence quarterly report 34(3): 319–28 [PubMed: 21090187] - Not a relevant study design
Heiligenberg, M., Rijnders, B., Van Der Loeff, M.F.S. et al (2012) High prevalence of sexually transmitted infections in HIV-infected men during routine outpatient visits in the Netherlands. Sexually Transmitted Diseases 39(1): 8–15 [PubMed: 22183837] - Study does not contain a relevant intervention
Hengel, Belinda, Jamil, Muhammad S, Mein, Jacqueline K et al (2013) Outreach for chlamydia and gonorrhoea screening: a systematic review of strategies and outcomes. BMC public health 13: 1040 [PMC free article: PMC3819260] [PubMed: 24188541] - Systematic review contains no relevant studies
Johnson, David; Harrison, Patricia; Sidebottom, Abbey (2010) Providing sexually transmitted disease education and risk assessment to disengaged young men through community outreach. American journal of men’s health 4(4): 305–12 [PubMed: 19706672] - Not a relevant study design
Kettinger, Lindsey Diane (2013) A practice improvement intervention increases chlamydia screening among young women at a women’s health practice. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN 42(1): 81–90 [PubMed: 23181977] - Not a relevant study design
Kmietowicz, Z. (2013) Educating practice staff about chlamydia boosts detection in young adults. BMJ (Online) 347(7925): f5613 [PubMed: 24041706] - Not a peerreviewed publication
Lawton, Beverley A, Rose, Sally B, Elley, C Raina et al (2010) Increasing the uptake of opportunistic chlamydia screening: a pilot study in general practice. Journal of primary health care 2(3): 199–207 [PubMed: 21069115] - Non-UK healthcare setting
Martin, L., Crawford, S., Knight, V. et al (2013) Poor uptake of community based sexually transmissible infection testing at an inner city needle and syringe program. Sexual Health 10(2): 183–184 [PubMed: 23158773] - Not a relevant study design
McNulty, Cliodna A M, Hogan, Angela H, Ricketts, Ellie J et al (2014) Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour. Sexually transmitted infections 90(3): 188–94 [PMC free article: PMC3995257] [PubMed: 24005256] - Population are not the target group
Mossenson, A., Algie, K., Olding, M. et al (2012) ‘Yes wee can’ a nurse-driven asymptomatic screening program for chlamydia and gonorrhoea in a remote emergency department. Sexual Health 9(2): 194–195 [PubMed: 22498167] - Not a relevant study design
Nguyen, M.P., Sembajwe, S., Rompalo, A.M. et al (2020) Impacts of STD/HIV Outreach Sites on the Effectiveness of Detecting New Infections in Baltimore City, 2015–2018. Sexually transmitted diseases [PubMed: 32826481] - Not a relevant study design
Nyatsanza, Farai, McSorley, John, Murphy, Siobhan et al (2016) ‘It’s all in the message’: the utility of personalised short message service (SMS) texts to remind patients at higher risk of STIs and HIV to reattend for testing-a repeat before and after study. Sexually transmitted infections 92(5): 393–5 [PubMed: 26670912] - Not a relevant study design
Obafemi, Oluyomi A, Wendel, Karen A, Anderson, Teri S et al (2019) Rapid Syphilis Testing for Men Who Have Sex With Men in Outreach Settings: Evaluation of Test Performance and Impact on Time to Treatment. Sexually transmitted diseases 46(3): 191–195 [PubMed: 30363029] - Study does not contain a relevant intervention
Orozco-Olvera, Victor; Shen, Fuyuan; Cluver, Lucie (2019) The effectiveness of using entertainment education narratives to promote safer sexual behaviors of youth: A meta-analysis, 1985–2017. PloS one 14(2): e0209969 [PMC free article: PMC6372167] [PubMed: 30753185] - No relevant outcomes
Plant, Aaron, Montoya, Jorge A, Rotblatt, Harlan et al (2010) Stop the sores: the making and evaluation of a successful social marketing campaign. Health promotion practice 11(1): 23–33 [PubMed: 18403747] - Not a relevant study design
Ronen, Keshet, Golden, Matthew R, Dombrowski, Julia C et al (2019) Uptake and Impact of Short Message Service Reminders via Sexually Transmitted Infection Partner Services on Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Frequency Among Men Who Have Sex With Men. Sexually transmitted diseases 46(10): 641–647 [PMC free article: PMC6919648] [PubMed: 31517803] - Study does not contain a relevant intervention
Ronen, Keshet, Golden, Matthew R, Dombrowski, Julia C et al (2019) Uptake and Impact of Short Message Service Reminders via STI Partner Services on HIV/STI Testing Frequency among Men Who Have Sex with Men. Sexually transmitted diseases [PMC free article: PMC6919648] [PubMed: 31517803] - Duplicate reference
Rose, Sally B, Lawton, Beverley A, Bromhead, Collette et al (2010) Poor uptake of self-sample collection kits for Chlamydia testing outside primary care. Australian and New Zealand journal of public health 34(5): 517–20 [PubMed: 21040182] - Not a relevant study design
Ross, C, Shaw, S, Marshall, S et al (2016) Impact of a social media campaign targeting men who have sex with men during an outbreak of syphilis in Winnipeg, Canada. Canada communicable disease report = Releve des maladies transmissibles au Canada 42(2): 45–49 [PMC free article: PMC5864268] [PubMed: 29770003] - Not a relevant study design
Roth, Alexis M, Goldshear, Jesse L, Martinez-Donate, Ana P et al (2016) Reducing Missed Opportunities: Pairing Sexually Transmitted Infection Screening With Syringe Exchange Services. Sexually transmitted diseases 43(11): 706–708 [PubMed: 27893601] - Study does not contain a relevant intervention
Sagor, Rachel S, Golding, Jeremy, Giorgio, Margaret M et al (2016) Power of Knowledge: Effect of Two Educational Interventions on Readiness for Chlamydia Screening. Clinical pediatrics 55(8): 717–23 [PubMed: 26350429] - Population are not the target group
Ten Hoor, Gill, Hoebe, Christian Jpa, van Bergen, Jan Eam et al (2014) The influence of two different invitation letters on Chlamydia testing participation: randomized controlled trial. Journal of medical Internet research 16(1): e24 [PMC free article: PMC3936267] [PubMed: 24480721] - Non-UK healthcare setting
Tuite, Ashleigh R, McCabe, Caitlin J, Ku, Jennifer et al (2011) Projected cost-savings with herpes simplex virus screening in pregnancy: towards a new screening paradigm. Sexually transmitted infections 87(2): 141–8 [PubMed: 21097810] - Population are not the target group
van Bergen, Jan E A M, Fennema, Johannes S A, van den Broek, Ingrid V F et al (2010) Rationale, design, and results of the first screening round of a comprehensive, register-based, Chlamydia screening implementation programme in the Netherlands. BMC infectious diseases 10: 293 [PMC free article: PMC2959064] [PubMed: 20925966] - Comparator in study does not match that specified in protocol
van den Broek, Ingrid V F, Hoebe, Christian J P A, van Bergen, Jan E A M et al (2010) Evaluation design of a systematic, selective, internet-based, Chlamydia screening implementation in the Netherlands, 2008–2010: implications of first results for the analysis. BMC infectious diseases 10: 89 [PMC free article: PMC2858140] [PubMed: 20374635] - Duplicate reference
Walker, Jennifer, Fairley, Christopher K, Walker, Sandra M et al (2010) Computer reminders for Chlamydia screening in general practice: a randomized controlled trial. Sexually transmitted diseases 37(7): 445–50 [PubMed: 20375930] - Non-UK healthcare setting
Ward, James, Guy, Rebecca J, Rumbold, Alice R et al (2019) Strategies to improve control of sexually transmissible infections in remote Australian Aboriginal communities: a stepped-wedge, cluster-randomised trial. The Lancet. Global health 7(11): e1553–e1563 [PubMed: 31607467] - Not applicable to a UK context
Wilson, David P, Heymer, Kelly-Jean, Anderson, Jonathan et al (2010) Sex workers can be screened too often: a cost-effectiveness analysis in Victoria, Australia. Sexually transmitted infections 86(2): 117–25 [PubMed: 19843534] - Not applicable to a UK context
Wong, William Chi Wai, Lau, Stephanie Tsz Hei, Choi, Edmond Pui Hang et al (2019) A Systematic Literature Review of Reviews on the Effectiveness of Chlamydia Testing. Epidemiologic reviews 41(1): 168–175 [PubMed: 31565737] - Review article but not a systematic review
Yao, Patricia, Fu, Rongwei, Craig Rushing, Stephanie et al (2018) Texting 4 Sexual Health: Improving Attitudes, Intention, and Behavior Among American Indian and Alaska Native Youth. Health promotion practice 19(6): 833–843 [PubMed: 29557176] - Not applicable to a UK context
Zenner, Dominik, Molinar, Darko, Nichols, Tom et al (2012) Should young people be paid for getting tested? A national comparative study to evaluate patient financial incentives for chlamydia screening. BMC public health 12: 261 [PMC free article: PMC3350390] [PubMed: 22471791] - Not a relevant study design
Zhang, Qinya, Huhn, Kim J, Tan, Andy et al (2017) “Testing is Healthy” TimePlay campaign: Evaluation of sexual health promotion gamification intervention targeting young adults. Canadian journal of public health = Revue canadienne de sante publique 108(1): e85–e90 [PMC free article: PMC6972345] [PubMed: 28425904] - Not a relevant study design
Zou, Huachun, Fairley, Christopher K, Guy, Rebecca et al (2013) Automated, computer generated reminders and increased detection of gonorrhoea, chlamydia and syphilis in men who have sex with men. PloS one 8(4): e61972 [PMC free article: PMC3629129] [PubMed: 23613989] - Not a relevant study design
Zou, Huachun, Fairley, Christopher K, Guy, Rebecca et al (2012) The efficacy of clinic-based interventions aimed at increasing screening for bacterial sexually transmitted infections among men who have sex with men: a systematic review. Sexually transmitted diseases 39(5): 382–7 [PubMed: 22504605] - Systematic review contains no relevant studies

J.1.2. Excluded qualitative studies

StudyCode [Reason]
Buston, Katie and Wight, Daniel (2010) Self-reported sexually transmitted infection testing behaviour amongst incarcerated young male offenders: findings from a qualitative study. The journal of family planning and reproductive health care 36(1): 7–11 [PubMed: 20067666] - Does not refer to an intervention
Cassidy, Christine, Steenbeek, Audrey, Langille, Donald et al (2019) Designing an intervention to improve sexual health service use among university undergraduate students: a mixed methods study guided by the behaviour change wheel. BMC public health 19(1): 1734 [PMC free article: PMC6933635] [PubMed: 31878901] - Does not contain qualitative data
Cook, Catherine (2011) ‘About as comfortable as a stranger putting their finger up your nose’: speculation about the (extra)ordinary in gynaecological examinations. Culture, health & sexuality 13(7): 767–80 [PubMed: 21656407] - Study was not conducted in the UK
Dang, Michelle T, Amos, Aaron, Dangerfield, Monique et al (2019) A Youth Participatory Project to Address STIs and HIV among Homeless Youth. Comprehensive child and adolescent nursing 42(3): 222–240 [PubMed: 29902090] - Study was not conducted in the UK
Freeman, Elaine, Howell-Jones, Rebecca, Oliver, Isabel et al (2009) Promoting chlamydia screening with posters and leaflets in general practice–a qualitative study. BMC public health 9: 383 [PMC free article: PMC2766388] [PubMed: 19821964] - Population are not service users
Hsieh, Y.-H., Lewis, M.K., Viertel, V.G. et al (2020) Performance evaluation and acceptability of point-of-care Trichomonas vaginalis testing in adult female emergency department patients. International Journal of STD and AIDS [PMC free article: PMC7785123] [PubMed: 32998638] - Does not contain qualitative data
Jafari, Yalda, Johri, Mira, Joseph, Lawrence et al (2014) Poor Reporting of Outcomes Beyond Accuracy in Point-of-Care Tests for Syphilis: A Call for a Framework. AIDS research and treatment 2014: 465932 [PMC free article: PMC3985157] [PubMed: 24795821] - Does not contain qualitative data
Kricka, L.J. and Price, C.P. (2009) Public opinion and experience of point-of-care testing: Results of a small pilot survey. Point of Care 8(4): 160–163 - Does not contain qualitative data
Llewellyn, Carrie, Pollard, Alex, Smith, Helen et al (2009) Are home sampling kits for sexually transmitted infections acceptable among men who have sex with men?. Journal of health services research & policy 14(1): 35–43 [PubMed: 19103915] - Published before 2010
Lorimer, K; Reid, M E; Hart, G J (2009) “It has to speak to people’s everyday life…”: qualitative study of men and women’s willingness to participate in a non-medical approach to Chlamydia trachomatis screening. Sexually transmitted infections 85(3): 201–5 [PubMed: 19106148] - Published before 2010
McDonagh, L.K., Harwood, H., Saunders, J.M. et al (2020) How to increase chlamydia testing in primary care: a qualitative exploration with young people and application of a meta-theoretical model. Sexually transmitted infections [PMC free article: PMC7677464] [PubMed: 32471931] - Does not refer to an int ervention
Pittman, Ellen, Purcell, Hillary, Dize, Laura et al (2018) Acceptability and feasibility of self-sampling for the screening of sexually transmitted infections in cabana privacy shelters. International journal of STD & AIDS 29(5): 461–465 [PMC free article: PMC6055996] [PubMed: 28959922] - Study was not conducted in the UK
Reed, Jennifer L, Punches, Brittany E, Taylor, Regina G et al (2017) A Qualitative Analysis of Adolescent and Caregiver Acceptability of Universally Offered Gonorrhea and Chlamydia Screening in the Pediatric Emergency Department. Annals of emergency medicine 70(6): 787–796e2 [PMC free article: PMC6894612] [PubMed: 28559031] - Study was not conducted in the UK
Roth, A M, Rosenberger, J G, Reece, M et al (2013) Expanding sexually transmitted infection screening among women and men engaging in transactional sex: the feasibility of field-based self-collection. International journal of STD & AIDS 24(4): 323–8 [PMC free article: PMC3970701] [PubMed: 23970665] - Study was not conducted in the UK
Roth, Alexis M, Rosenberger, Joshua G, Reece, Michael et al (2012) A methodological approach to improve the sexual health of vulnerable female populations: incentivized peer-recruitment and field-based STD testing. Journal of health care for the poor and underserved 23(1): 367–75 [PubMed: 22643484] - Study was not conducted in the UK
Roth, Alexis, Van Der Pol, Barbara, Dodge, Brian et al (2011) Future chlamydia screening preferences of men attending a sexually transmissible infection clinic. Sexual health 8(3): 419–26 [PubMed: 21851785] - Study was not conducted in the UK
Shoveller, Jean A, Knight, Rod, Johnson, Joy et al (2010) ‘Not the swab!’ Young men’s experiences with STI testing. Sociology of health & illness 32(1): 57–73 [PubMed: 20415807] - Study was not conducted in the UK
Sun, Christina J, Stowers, Jason, Miller, Cindy et al (2015) Acceptability and feasibility of using established geosocial and sexual networking mobile applications to promote HIV and STD testing among men who have sex with men. AIDS and behavior 19(3): 543–52 [PMC free article: PMC4359067] [PubMed: 25381563] - Study was not conducted in the UK
Tobin, Karin, Edwards, Catie, Flath, Natalie et al (2018) Acceptability and feasibility of a Peer Mentor program to train young Black men who have sex with men to promote HIV and STI home-testing to their social network members. AIDS care 30(7): 896–902 [PMC free article: PMC6338070] [PubMed: 29482342] - Study was not conducted in the UK
Widdice, Lea E, Hsieh, Yu-Hsiang, Silver, Barbara et al (2018) Performance of the Atlas Genetics Rapid Test for Chlamydia trachomatis and Women’s Attitudes Toward Point-Of-Care Testing. Sexually transmitted diseases 45(11): 723–727 [PMC free article: PMC6179923] [PubMed: 29771869] - Study was not conducted in the UK

J.1.3. Excluded economic studies

ReferenceReason for exclusion
Adams EJ, Ehrlich A, Turner KME, Shah K, Macleod J, Goldenberg S, et al Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK. BMJ open. 2014;4(7):e005322. [PMC free article: PMC4120370] [PubMed: 25056977] Wrong study design
Anonymous. Corrigendum to “Syphilis Screening: A Review of the Syphilis Health Check Rapid Immunochromatographic Test” (Journal of Pharmacy Technology, 33, 2, (53–59), 10.177/8755122517691308). Journal of Pharmacy Technology. 2020;36(2):91. [PMC free article: PMC7047244] [PubMed: 34752533] Systematic review
Atherly A, Blake SC. Efforts by commercial health plans to increase Chlamydia trachomatis screening among their members. Sexually transmitted diseases. 2013;40(1):55–60. [PubMed: 23254117] Wrong study design
Bennett C, Knight V, Knox D, Gray J, Hartmann G, McNulty A. An alternative model of sexually transmissible infection testing in men attending a sex-on-premises venue in Sydney: A cross-sectional descriptive study. Sexual Health. 2016;13(4):353–8. [PubMed: 27208975] Wrong outcomes
Bernstein KT, Chow JM, Pathela P, Gift TL. Bacterial Sexually Transmitted Disease Screening Outside the Clinic–Implications for the Modern Sexually Transmitted Disease Program. Sexually transmitted diseases. 2016;43(2suppl1):42–52. [PMC free article: PMC5583631] [PubMed: 26779687] Systematic review
Bissessor L, Wilson J, McAuliffe G, Upton A. Audit of Trichomonas vaginalis test requesting by community referrers after a change from culture to molecular testing, including a cost analysis. The New Zealand medical journal. 2017;130(1457):34–7. [PubMed: 28617786] Wrong intervention
Blake DR, Spielberg F, Levy V, Lensing S, Wolff PA, Venkatasubramanian L, et al Could home sexually transmitted infection specimen collection with e-prescription be a cost-effective strategy for clinical trials and clinical care? Sexually Transmitted Diseases. 2015;42(1):13–9. [PMC free article: PMC4276035] [PubMed: 25504295] Wrong setting
Borkent-Raven BA, Janssen MP, van der Poel CL, Bonsel GJ, van Hout BA. Cost-effectiveness of additional blood screening tests in the Netherlands. Transfusion. 2012;52(3):478–88. [PubMed: 21880046] Wrong intervention
Bristow CC, Larson E, Javanbakht M, Huang E, Causer L, Klausner JD. A review of recent advances in rapid point-of-care tests for syphilis. Sexual Health. 2015;12(2):119–25. [PubMed: 25622292] Systematic review
Chadwick RC, McGregor K, Sneath P, Rempel J, He BLQ, Brown A, et al STI initiative: Improving testing for sexually transmitted infections in women. BMJ open quality. 2018;7(4):e000461. [PMC free article: PMC6203025] [PubMed: 30397665] Wrong study design
Chesson HW, Bernstein KT, Gift TL, Marcus JL, Pipkin S, Kent CK. The cost-effectiveness of screening men who have sex with men for rectal chlamydial and gonococcal infection to prevent HIV Infection. Sexually transmitted diseases. 2013;40(5):366–71. [PMC free article: PMC6745689] [PubMed: 23588125] Wrong outcomes
Currie MJ, Schmidt M, Davis BK, Baynes AM, O’Keefe EJ, Bavinton TP, et al ‘Show me the money’: financial incentives increase chlamydia screening rates among tertiary students: a pilot study. Sexual health. 2010;7(1):60–5. [PubMed: 20152098] Wrong outcomes
Currie MJ, Deeks LS, Cooper GM, Martin SJ, Parker RM, Del Rosario R, et al Community pharmacy and cash reward: A winning combination for chlamydia screening? Sexually Transmitted Infections. 2013;89(3):212–6. [PubMed: 23093739] Wrong outcomes
Das BB, Ronda J, Trent M. Pelvic inflammatory disease: Improving awareness, prevention, and treatment. Infection and Drug Resistance. 2016;9:191–7. [PMC free article: PMC4998032] [PubMed: 27578991] Systematic review
Desai M, Woodhall SC, Nardone A, Burns F, Mercey D, Gilson R. Active recall to increase HIV and STI testing: a systematic review. Sexually transmitted infections. 2015;91(5):314–23. [PubMed: 25759476] Systematic review
Eaton EF, Hudak K, Muzny CA. Budgetary Impact of Compliance With STI Screening Guidelines in Persons Living With HIV. Journal of acquired immune deficiency syndromes (1999). 2017;74(3):303–8. [PMC free article: PMC5303178] [PubMed: 27787348] Wrong study design
Eaton EF, Joe W, Kilgore ML, Muzny CA. Reverse syphilis screening algorithm fails to demonstrate cost effectiveness in persons living with HIV. International journal of STD & AIDS. 2018;29(6):563–7. [PMC free article: PMC6025800] [PubMed: 29173098] Wrong outcomes
Estcourt C, Sutcliffe L, Mercer CH, Copas A, Saunders J, Roberts TE, et al No title provided. 2016. [PubMed: 27997089] Systematic review
Friedman AL, Bozniak A, Ford J, Hill A, Olson K, Ledsky R, et al Reaching Youth With Sexually Transmitted Disease Testing: Building on Successes, Challenges, and Lessons Learned From Local Get Yourself Tested Campaigns. Social marketing quarterly. 2014;20(2):116–38. [PMC free article: PMC6866650] [PubMed: 31749662] Wrong outcomes
Frost JJ, Sonfield A, Zolna MR, Finer LB. Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program. The Milbank quarterly. 2014;92(4):696–749. [PMC free article: PMC4266172] [PubMed: 25314928] Wrong intervention
Gamage DG, Fuller CA, Cummings R, Tomnay JE, Chung M, Chen M, et al Advertising sexual health services that provide sexually transmissible infection screening for rural young people - what works and what doesn’t. Sexual health. 2011;8(3):407–11. [PubMed: 21851783] Wrong outcomes
Gliddon HD, Peeling RW, Kamb ML, Toskin I, Wi TE, Taylor MM. A systematic review and meta-analysis of studies evaluating the performance and operational characteristics of dual point-of-care tests for HIV and syphilis. Sexually transmitted infections. 2017;93(s4):3–s15. [PMC free article: PMC6754342] [PubMed: 28747410] Systematic review
Guerrero EG, Cederbaum JA. Adoption and utilization of sexually transmitted infections testing in outpatient substance abuse treatment facilities serving high risk populations in the U.S. The International journal on drug policy. 2011;22(1):41–8. [PMC free article: PMC3031721] [PubMed: 20970314] Wrong outcomes
Habel MA, Haderxhanaj L, Hogben M, Eastman-Mueller H, Chesson H, Roberts CM. Does your College Campus GYT? Evaluating the Effect of a Social Marketing Campaign Designed to Raise STI Awareness and Encourage Testing. Cases in public health communication and marketing. 2015;8:51–70. [PMC free article: PMC6866652] [PubMed: 31749899] Wrong setting
Herbst de Cortina S, Bristow CC, Joseph Davey D, Klausner JD. A Systematic Review of Point of Care Testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Infectious diseases in obstetrics and gynecology. 2016;2016:4386127. [PMC free article: PMC4899593] [PubMed: 27313440] Systematic review
Hislop J, Quayyum Z, Flett G, Boachie C, Fraser C, Mowatt G. Systematic review of the clinical effectiveness and cost-effectiveness of rapid point-of-care tests for the detection of genital chlamydia infection in women and men. Health technology assessment (Winchester, England). 2010;14(29):1–iv. [PubMed: 20557810] Systematic review
Hocking JS, Donovan B, Guy R. Matters Arising: Over 150 potentially low-value health care practices: an Australian study. Med J Aust. 2013;198(2):83–4. [PubMed: 23373488] Wrong study design
Huang W, Gaydos CA, Barnes MR, Jett-Goheen M, Blake DR. Cost-effectiveness analysis of Chlamydia trachomatis screening via internet-based self-collected swabs compared with clinic-based sample collection. Sexually transmitted diseases. 2011;38(9):815–20. [PMC free article: PMC3156983] [PubMed: 21844736] Wrong outcomes
Huang W, Gaydos CA, Barnes MR, Jett-Goheen M, Blake DR. Comparative effectiveness of a rapid point-of-care test for detection of Chlamydia trachomatis among women in a clinical setting. Sexually transmitted infections. 2013;89(2):108–14. [PMC free article: PMC3671871] [PubMed: 22984085] Wrong intervention
Hull S, Kelley S, Clarke JL. Sexually Transmitted Infections: Compelling Case for an Improved Screening Strategy. Population health management. 2017;20(s1):1–s11. [PubMed: 28920768] Systematic review
Huntington SE, Burns RM, Harding-Esch E, Harvey MJ, Hill-Tout R, Fuller SS, et al Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees. BMJ open. 2018;8(9):e020394. [PMC free article: PMC6144481] [PubMed: 30201794] Wrong intervention
Jenkins WD, Rabins C, Barnes M, Agreda P, Gaydos C. Use of the internet and self-collected samples as a sexually transmissible infection intervention in rural Illinois communities. Sexual health. 2011;8(1):79–85. [PubMed: 21371388] Wrong setting
Jenkins WD, Zahnd W, Kovach R, Kissinger P. Chlamydia and gonorrhea screening in United States emergency departments. The Journal of emergency medicine. 2013;44(2):558–67. [PubMed: 23102593] Systematic review
Kanga I, Williams D, Hatchette T, MacKinnon SB, Jung H, Black C, et al No title provided. 2018. [PubMed: 31145563] Systematic review
Kelly C, Johnston J, Carey F. Evaluation of a partnership between primary and secondary care providing an accessible Level 1 sexual health service in the community. International journal of STD & AIDS. 2014;25(10):751–7. [PubMed: 24469970] Wrong intervention
Kennedy CE, Spaulding AB, Brickley DB, Almers L, Mirjahangir J, Packel L, et al Linking sexual and reproductive health and HIV interventions: A systematic review. Journal of the International AIDS Society. 2010;13(1):26. [PMC free article: PMC2918569] [PubMed: 20642843] Systematic review
Knight V, Ryder N, Guy R, Lu H, Wand H, McNulty A. New Xpress sexually transmissible infection screening clinic improves patient journey and clinic capacity at a large sexual health clinic. Sexually transmitted diseases. 2013;40(1):75–80. [PubMed: 23250305] Wrong intervention
Lewis FM, Schillinger JA, Taylor M, Brewer TH, Blank S, Mickey T, et al Needle in a haystack: the yield of syphilis outreach screening at 5 US sites-2000 to 2007. Journal of public health management and practice : JPHMP. 2011;17(6):513–21. [PMC free article: PMC6785748] [PubMed: 21964362] Wrong setting
Malaysian Health Technology A. Point-Of-Care test for Chlamydia. Putrajaya: Malaysian Health Technology Assessment (MaHTAS). 2012. Systematic review
Nelson Hd ZBCADMPM. Screening for gonorrhea and chlamydia: systematic review to update the U.S. Preventive Services Task Force Recommendations. Agency for Healthcare Research and Quality (AHRQ). 2014. [PubMed: 25356451] Systematic review
Niza C, Rudisill C, Dolan P. Vouchers versus Lotteries: What Works Best in Promoting Chlamydia Screening? A Cluster Randomized Controlled Trial. Applied Economic Perspectives and Policy. 2014;36(1):109–24. [PMC free article: PMC4105573] [PubMed: 25061507] Wrong study design
Orozco-Olvera V, Shen F, Cluver L. The effectiveness of using entertainment education narratives to promote safer sexual behaviors of youth: A meta-analysis, 1985–2017. PloS one. 2019;14(2):e0209969. [PMC free article: PMC6372167] [PubMed: 30753185] Systematic review
Owusu-Edusei K PTABRC. Serologic testing for syphilis in the United States: a cost-effectiveness analysis of two screening algorithms. Sexually Transmitted Diseases. 2011;38(1):1–7. [PubMed: 20739911] Wrong study design
Owusu-Edusei K, Jr., Hoover KW, Gift TL. Cost-Effectiveness of Opt-Out Chlamydia Testing for High-Risk Young Women in the U.S. American journal of preventive medicine. 2016;51(2):216–24. [PMC free article: PMC6785744] [PubMed: 26952078] Wrong setting
Page C, Mounsey A, Rowland K. Is self-swabbing for STIs a good idea? Journal of Family Practice. 2013;62(11):651–3. [PMC free article: PMC3948498] [PubMed: 24288710] Wrong study design
Palmer MJ, Henschke N, Villanueva G, Maayan N, Bergman H, Glenton C, et al Targeted client communication via mobile devices for improving sexual and reproductive health. Cochrane Database of Systematic Reviews. 2020;2020(8):cd013680. [PMC free article: PMC8409381] [PubMed: 32779730] Systematic review
Peterman TA, Fakile YF. What Is the Use of Rapid Syphilis Tests in the United States? Sex Transm Dis. 2016;43(3):201–3. [PMC free article: PMC6752880] [PubMed: 26859809] Systematic review
Read PJ, Knight V, Bourne C, Guy R, Donovan B, Allan W, et al Community event-based outreach screening for syphilis and other sexually transmissible infections among gay men in Sydney, Australia. Sexual health. 2013;10(4):357–62. [PubMed: 23806620] Wrong outcomes
Rukh S, Khurana R, Mickey T, Anderson L, Velasquez C, Taylor M. Chlamydia and gonorrhea diagnosis, treatment, personnel cost savings, and service delivery improvements after the implementation of express sexually transmitted disease testing in Maricopa County, Arizona. Sexually transmitted diseases. 2014;41(1):74–8. [PMC free article: PMC6749604] [PubMed: 24326585] Wrong setting
Shih SL, Graseck AS, Secura GM, Peipert JF. Screening for sexually transmitted infections at home or in the clinic? Current opinion in infectious diseases. 2011;24(1):78–84. [PMC free article: PMC3125396] [PubMed: 21124216] Systematic review
Taylor MM, Frasure-Williams J, Burnett P, Park IU. Interventions to Improve Sexually Transmitted Disease Screening in Clinic-Based Settings. Sexually transmitted diseases. 2016;43(2suppl1):28–41. [PMC free article: PMC6751565] [PubMed: 26779685] Systematic review
Turner K, Adams E, Grant A, Macleod J, Bell G, Clarke J, et al Costs and cost effectiveness of different strategies for chlamydia screening and partner notification: an economic and mathematical modelling study. BMJ (Clinical research ed). 2011;342:c7250. [PubMed: 21205807] Wrong outcomes
Turner KME, Round J, Horner P, Macleod J, Goldenberg S, Deol A, et al An early evaluation of clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoea in genitourinary medicine clinics in England. Sexually transmitted infections. 2014;90(2):104–11. [PMC free article: PMC3932743] [PubMed: 24273127] Wrong outcomes
Turner KME, Looker KJ, Syred J, Zienkiewicz A, Baraitser P. Online testing for sexually transmitted infections: A whole systems approach to predicting value. plos one. 2019;14(2):e0212420. [PMC free article: PMC6386384] [PubMed: 30794589] Wrong outcomes
van Bergen JEAM, Fennema JSA, van den Broek IVF, Brouwers EEHG, de Feijter EM, Hoebe CJPA, et al Rationale, design, and results of the first screening round of a comprehensive, register-based, Chlamydia screening implementation programme in the Netherlands. BMC infectious diseases. 2010;10:293. [PMC free article: PMC2959064] [PubMed: 20925966] Wrong outcomes
Verougstraete N, Verbeke V, De Canniere AS, Simons C, Padalko E, Coorevits L. To pool or not to pool? Screening of Chlamydia trachomatis and Neisseria gonorrhoeae in female sex workers: Pooled versus single-site testing. Sexually Transmitted Infections. 2020;96(6):417–21. [PubMed: 32404400] Wrong outcomes
Wilson DP, Heymer K-J, Anderson J, O’Connor J, Harcourt C, Donovan B. Sex workers can be screened too often: a cost-effectiveness analysis in Victoria, Australia. Sexually transmitted infections. 2010;86(2):117–25. [PubMed: 19843534] Wrong study design
Wong WCW, Lau STH, Choi EPH, Tucker JD, Fairley CK, Saunders JM. A Systematic Literature Review of Reviews on the Effectiveness of Chlamydia Testing. Epidemiologic reviews. 2019;41(1):168–75. [PubMed: 31565737] Systematic review
Zhang Q, Huhn KJ, Tan A, Douglas RE, Li HG, Murti M, et al “Testing is Healthy” TimePlay campaign: Evaluation of sexual health promotion gamification intervention targeting young adults. Canadian journal of public health = Revue canadienne de sante publique. 2017;108(1):e85–e90. [PMC free article: PMC6972345] [PubMed: 28425904] Wrong outcomes

Appendix K. Research recommendations – full details

K.1.1. Research recommendation (PDF, 155K)

Final

Evidence reviews underpinning recommendations 1.2.1 to 1.2.9 and research recommendations in the NICE guideline

National Institute for Health and Care Excellence

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.

Copyright © NICE 2022.
Bookshelf ID: NBK588658PMID: 36689608

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (3.1M)

In this Page

Other titles in this collection

Related NICE guidance and evidence

Supplemental NICE documents

Related information

  • PMC
    PubMed Central citations
  • PubMed
    Links to PubMed

Recent Activity

ClearTurn OffTurn On

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...