背景:沙眼衣原体(Ct)和淋病奈瑟菌(Ng)感染通常无症状;筛查可增加早期发现并预防疾病,后遗症并进一步蔓延。为了增加Ct和Ng测试,一些国家已经在临床环境之外实施了标本自我采集.虽然在家中自我收集标本对患者来说是高度可接受的,并且与医疗保健提供者收集的标本一样准确,这一战略在一些国家是新的或没有被使用。要了解在家提供标本自我收集将如何影响测试吸收,测试结果,诊断和与护理的联系,与临床环境中的收集相比,我们对同行评审的研究进行了系统的文献综述和荟萃分析.
方法:我们搜索了Medline,Embase,全球卫生,科克伦图书馆,CINAHL(EBSCOHost),Scopus和临床试验。如果他们直接将在家或其他非临床环境中自我收集的标本与医疗机构(自我或临床医生)收集的标本进行Ct和/或Ng测试并评估以下结果,则包括研究:与护理的联系,以及同一个体的两种设置之间的一致性(协议)。使用Cochrane偏差风险(RoB2)工具进行随机对照试验(RCTs)评估偏差风险(RoB)。
结果:19项研究,纳入了1998年至2024年的15项RCT,共62,369名参与者,以及4项一致性研究,共906名参与者.与临床环境相比,在家接受Ct或Ng测试的比例是2.61倍。在家庭和临床环境中收集的标本之间存在高度一致性,并且与护理的关联在两种设置之间没有显著差异(患病率比0.96(95%CI0.91-1.01)).
结论:我们的荟萃分析和系统文献综述表明,在家庭或其他非临床环境中提供自我采集标本可作为增加性传播感染检测的额外策略在尚未广泛采用这种采集方法的国家。
BACKGROUND: Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) infections are often asymptomatic; screening increases early detection and prevents disease, sequelae and further spread. To increase Ct and Ng testing, several countries have implemented specimen self-collection outside a clinical setting. While specimen self-collection at home is highly acceptable to patients and as accurate as specimens collected by healthcare providers, this strategy is new or not being used in some countries. To understand how offering at home specimen self-collection will affect testing uptake, test results, diagnosis and linkage to care, when compared with collection in clinical settings, we conducted a systematic literature review and meta-analysis of peer-reviewed studies.
METHODS: We searched Medline, Embase, Global Health, Cochrane Library, CINAHL (EBSCOHost), Scopus and Clinical Trials. Studies were included if they directly compared specimens self-collected at home or in other non-clinical settings to specimen collection at a healthcare facility (self or clinician) for Ct and/or Ng testing and evaluated the following outcomes: uptake in testing, linkage to care, and concordance (agreement) between the two settings for the same individuals. Risk of bias (RoB) was assessed using Cochrane Risk of Bias (RoB2) tool for randomised control trials (RCTs).
RESULTS: 19 studies, from 1998 to 2024, comprising 15 RCTs with a total of 62 369 participants and four concordance studies with 906 participants were included. Uptake of Ct or Ng testing was 2.61 times higher at home compared with clinical settings. There was a high concordance between specimens collected at home and in clinical settings, and linkage to care was not significantly different between the two settings (prevalence ratio 0.96 (95% CI 0.91-1.01)).
CONCLUSIONS: Our meta-analysis and systematic literature review show that offering self-collection of specimens at home or in other non-clinical settings could be used as an additional strategy to increase sexually transmitted infection testing in countries that have not yet widely adopted this collection method.