Self-reported Risk History in Women Using an Internet-based Screening Program for Chlamydia trachomatis Using Self- collected Vaginal Swabs Returned by Mail Charlotte A. Gaydos, MS, MPH, DrPH 2006 National STD Prevention Conference Jacksonville, FL May 9, 2006 Johns Hopkins University, Baltimore, MD

BACKGROUND The Internet is an effective tool to reach women at risk for C. trachomatis Self-administered vaginal swabs (SAS) tested by NAATs facilitate screening for CT, are accurate and are acceptable Women will request and use SAS kits Most collection kits were requested through the Internet 86.6% requested by Internet 7.4% by phone, 5.5% picked up in the community Gayods et al. STD 2006 (in press)

OBJECTIVE To determine self- reported risk history for chlamydia in infected and uninfected women who provided questionnaires after using a home sampling kit for collecting vaginal specimens (N = 567) Websitewww.iwantthekit.org (Fingerprint Interactive-Brownstein Group)

METHODS-Use of the Kit Kits contained consent form, swab, instructions, questionnaire, contact form, mailer Publicity: Papers, Magazines, Radio, Flyers Questionnaires were taken either on line or by hard copy in the kit Each swab tested by a multiple nucleic acid amplification tests (NAATs) for CT & GC (Two different positive NAAT results required) Data analysis: Chi Square, Stata v. 8.2

RESULTS- Use of the Kit Of 567 tested 51 (9.0%) CT positives 6 GC (3 co-infected w/ CT and GC) 47.3% from Baltimore; 52.7% from Maryland Median age first sex: positives:15 yr (11-26 yr) negatives: 15 yr (8-39 yr)

RESULTS- Use of the Kit CT: 48/51 (94.1%) confirmed treated GC: 6/6 (100%) confirmed treated Median age of SAS submitters: 23 yr (range yr) Median age of positives: 20 yr (range yr)

Prevalence: Results by Race 7.9% Infected 67% 25.2% 7.8% Seven did not report race; Black Race vs. All Others, p = 0.001

Prevalence: Results by Age 8.6% Infected 9.8% Infected 14.8% Infected 29.2% 5 did not report age. There were 7 women 14 yr old, all were chlamydia negative 1.6% Infected 20.2% Age 25 yr, p = 0.01

Questionnaire Results (N =567) Infected vs. Uninfected Behavioral Risk Factors Anal sex Consist Condom P=0.012P=0.135P=0.334 P=nsP= % 90% 35.3% 46.2% 49% 41.8% 14% 12.7% 74.5% 56.8% Oral sex New sexMullti-sex

Questionnaire Results STD History Risk Factors (N= 567) All 34.4% 12.5%17.3% 1.3% 49.7% P= % 34.1% Of yes: 69.2% CT Hx GC Hx syphilis

Questionnaire Results Behavioral Factors (N= 400) P = P = 0.699P = P = Pelvic Exam Ever Pregnant Drinking before Sex Using birth control

Questionnaire Results Risk Factors (N= 567) 5.8% 12.2% 9.8% 29.6% P = P = 0.179

Univariate Analysis of Demographics and Risk Factors Black Race vs. Other(p = 0.001) Age 25 yr.(p = 0.010) Oral sex (p= 0.012) Non-consensual sex (p = 0.007) Multiple partners(p = 0.015) Chi Sq analysis: significant differences between infected & uninfected women

CONCLUSIONS The Internet method may facilitate screening of women at high risk Women rated SAS use & Internet screening easy to very easy; would use Internet screening again High level of risk behavior reported Infected women were treated High prevalence for chlamydia observed

Collaborators Karen Dwyer Mathilda Barnes Toni Flemming Patricia Rizzo-Price Terry Hogan Acknowledgements Bulbul Aumakhan

Questionnaire Results Preference for Sample Type Pelvic 14.6% Urine 9.9% SAS or Urine 29.6% SAS 45.9%

Questionnaire Results Type of Sex Partners (N= 391) P = 0.528

Questionnaire Results-Self Collection 92.2% 96.7%

Questionnaire Results SAS Collection 95.3%97.4%94.9%

Questionnaire Results (N =567) Infected vs. Uninfected Condom Use P = 0.082

Logistic Regression Analysis of Demographics and Risk Factors N =400 O.R. (95% C.I.) Black Race (ref.: White)4.1 (1.6, 11.2) Age 25 yr.2.5 (1.1, 5.3) Non-consensual sex 0.3 (0.1, 0.9) Birth Control0.5 (0.3, 0.9) Variables: Race, Age, # PN, Oral sex, Birth control, PN w/ STD, Non-consensual sex, prior CT