Chlamyweb Study II: a randomised controlled trial (RCT) of an online offer of home-based Chlamydia trachomatis sampling in France.

BACKGROUND: The number of cases of Chlamydia trachomatis (Ct) diagnosed has increased in the past 15 years in France as well as in other European countries. This paper reports a randomised controlled trial (RCT) to evaluate whether the offer of home-based testing over the internet increased the number of young people tested for chlamydia compared with the current testing strategy and to estimate the number and risks factors of the infected population. This RCT took place as an element of the Chlamyweb Study-a study aiming to evaluate an intervention (the Chlamyweb Intervention) involving the offer of a free self-sampling kit online to sexually active men and women aged 18-24 years in France. METHODS: Participants in the Chlamyweb RCT (n=11 075) received either an offer of a free self-sampling kit (intervention group) or were invited to be screened in primary care settings (control group). Risks ratios were used to compare screening rates between the intervention and control groups. Risk factors were analysed for infected people in the intervention group. RESULTS: The screening frequency was about three times higher among young people who received a self-sampling kit than those who only received a tailored recommendation to be screened (29.2% vs 8.7%). Although rates of screening among men were lower than among women (23.9% vs 33.9%), the intervention effect was greater among men (adjusted risk ratios (aRR)=4.55 vs aRR=2.94). Ct positivity (6.8%) was similar to that observed in STI clinics. It was higher in women (8.3%) than in men (4.4%). CONCLUSIONS: These results invite us to consider the establishment of a large home-based screening programme, although additional studies including economic assessments are needed to evaluate the most appropriate combination of strategies in the French context. TRIAL REGISTRAION NUMBER: AFFSAPS n° IDRCB 0211-A01000-41; Results.

Chlamyweb Study I: rationale, design and acceptability of an internet-based chlamydia testing intervention.

OBJECTIVES: In recent years, the internet has widely facilitated Chlamydia trachomatis home-sampling. In France (2012), the Chlamyweb Study evaluated an intervention (Chlamyweb) involving home-based self-sampling via the internet. One element of the study consisted of a randomised controlled trial (RCT), which is reported in detail elsewhere. The focus of this paper, however, is on describing the Chlamyweb Intervention and reporting on the non-RCT element of the evaluation of that intervention by the Chlamyweb Study. This involves (1) describing the design and roll-out of the Chlamyweb Intervention, (2) comparing the socio-behavioural profiles of the participants in the intervention with a nationally representative general population sample and (3) examining the factors that influence the acceptance and return of a self-sampling kit supplied to participants in the course of the intervention. METHODS: Self-sampling kits were offered to sexually active people aged 18-24 years living on the mainland French. Participants' characteristics were compared with the general population to describe recruited and participant populations. Multivariate analyses by conditional logistic regression were performed to determine factors that were predictors of kit acceptation and use. RESULTS: 7215 people aged 18-24 years were included. Compared with the general population, Chlamyweb reached larger proportions of women, younger people and people with several partners in the previous year. 3372 (46.7%) agreed to receive a self-sampling kit and 2084 (61.8%) returned it, with more women doing so than men. The participation rate was associated with age, place of birth, occupational status, number of partners and condom use, differently for men and women. CONCLUSION: The offer of easy-to-use, self-sampling kits free of charge appeared to be a logistically feasible strategy for testing in France and reached a large and diverse population including individuals who have limited access to the traditional healthcare system. TRIAL REGISTRATION NUMBER: AFFSAPS n° IDRCB 0211-A01000-41; pre-results.

Comparing the Information and Support Needs of Different Population Groups in Preparation for 2015 Government Approval for HIV Self-testing in France.

CONTEXT: HIV self-tests are currently being introduced in France with the aim of promoting screening both for the general population and for high-risk populations. OBJECTIVE: The current study aimed to identify and compare the information and support needs of the different target population groups. METHODS: The Delphi process was used to synthesize expert opinions for each population group. Experts were chosen for their experience and expertise in the area of HIV and HIV screening for each population. Each group developed recommendations for a specific population: six high HIV prevalence populations (men who have sex with men; transgender people; substance users; migrants from sub-Saharan Africa; French West Indies; French Guiana) and two low prevalence populations (the general population; people under 25). Each group included expertise from four areas: research, screening and care, policy-making, and community groups. RESULTS: A final total of 263 recommendations were grouped into eight main themes: Communicating at both national and community levels about self-test arrival (24% of all recommendations); Providing information adapted to the different community groups' needs (23%); Providing counselling on self-test use and access to care (15%); Making self-tests available to all in terms of accessibility and cost (13%); Preparing community healthcare and screening systems for the arrival of the self-test (11%); Approving only high quality self-tests (6%); Defending self-test users' legal rights (5%); Evaluating self-test use (3%). Although a large number of recommendations were common to several groups of experts, the study highlighted a certain number of recommendations specific to each different population group, particularly with regard to information content and access both to information and to the self-tests themselves. CONCLUSION: Results from the current study should make a significant contribution to policy decisions concerning catering for the specific access, information and support needs of different potential HIV self-test user groups in France.

[Evidence-based and promising interventions to prevent sexually transmitted diseases: a literature review]. / Interventions validées ou prometteuses en prévention des Infections Sexuellement Transmissibles (IST)?: synthèse de la littérature.

There has been a significant increase in the prevalence of sexually transmitted diseases in France over the past decade. The prevention and control of STDs are a major focus of the 2010-2014 national strategic plan on HIV and STDs. This paper reviews the current knowledge of evidence-based programs aimed at preventing sexually transmitted diseases (STDs). The study used a standard protocol to identify and review the literature and to classify the selected interventions. Twenty-seven interventions were found to have an impact on STD prevention. The study also found that most of the interventions were aimed at adolescents and were implemented in schools. This study aims to improve current interventions in this area and to promote the development and implementation of new programs.

[Evidence-based and promising interventions to prevent unplanned pregnancies: a literature review]. / Interventions validées ou prometteuses en prévention des grossesses non prévues?: synthèse de la littérature.

Despite the widespread use of contraception, the number of unplanned pregnancies in France remains high. This paper reviews the current knowledge of evidence-based programs aimed at preventing unplanned pregnancies. The study used a standard protocol to identify and review the literature and to classify the selected interventions. Sixteen interventions were found to have an effect on contraceptive use, emergency contraception use or the number of unplanned pregnancies. Interventions in this area are aimed at children, adolescents or adult women. The aim of this study is to improve interventions in this area and to promote the development and implementation of new programs.