STD Quarterly
Program launches STD at-home testing kits
What is your facility doing to stop the spread of chlamydia? Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease (STD) in the United States. The Centers for Disease Control and Prevention (CDC) estimates more than 2.8 million new cases occur each year.1 Such numbers are growing. During 2007, about 1.1 million cases of chlamydia were reported to CDC, and more than half of these were in females ages 15 to 25.2
Nowhere is the spread of "the silent STD" more evident than California's Los Angeles County. In 2008, the county Department of Public Health logged 43,431 cases of chlamydia, more than any other health jurisdiction in the nation, says Peter Kerndt, MD, MPH, director of the department's STD program. Chlamydia infections have been steadily on the rise since 1996 in Los Angeles County, accounting for three out of every four STDs reported. Most of those infected (63%) are young women between the ages of 15 and 24.
To combat the spread of STDs, the county health department has launched an innovative program to detect and treat chlamydia and gonorrhea among young women though its free STD Home Test Kit. Aimed at females in Los Angeles County ages 12 to 25 who are or have been sexually active, the kit is available for order through a designated web site, DontThinkKnow.org, or by calling the county's STD telephone hotline, (800) 758-0880. Test kits are mailed shortly after an order is received, then processed by the department's public health laboratory. Results are made available online or by phone one week later. E-mails or text messages also are sent that remind recipients that results are available online.
"The availability of a home test kit, combined with the ease of ordering the kit and getting results online or by phone, represents an unprecedented opportunity to significantly reduce the numbers of young women affected by chlamydia and gonorrhea," said Jonathan Fielding, MD, MPH, director of public health and health officer, in an announcement of the program's debut. "There is no longer any reason for any young women in Los Angeles County to become infertile, suffer chronic pain, or deal with a life-threatening tubal pregnancy because of these two STDs."
Los Angeles County launched its DontThinkKnow.org web site in 2007 as part of its "I Know" social marketing campaign. The campaign is designed to increase chlamydia and gonorrhea testing in young African-American and Latina women, based on the elevated rates of disease in those populations.3 Latinas and African-American women under age 25 in Los Angeles County account for 43% of chlamydia and gonorrhea cases, but only 10% of the population.3
As an adjunct to the social marketing campaign, local public health officials worked closely with Charlotte Gaydos, DrPH, MPH, MHS, to develop an at-home testing kit and protocol. Gaydos is professor of infectious diseases with the Johns Hopkins University School of Medicine and professor of epidemiology and population, family, and reproductive health at the university's Bloomberg School of Public Health. She has demonstrated success with at-home STD testing through establishment of a web-based program, www.iwantthekit.org.4 The educational web site targets women and men who use the Internet to acquire information about STDs. It offers them the use of a home sampling kit for free mail-back testing for STDs. The I Want the Kit testing kits are available free of charge to residents in Denver; Maryland; West Virginia; Washington, DC; and select counties in Illinois. (Editor's note: For a list of counties, go to www.iwantthekit.org/female/illinois.html or www.iwantthekit.org/male/illinois.html.)
The Los Angeles kits use Gen-Probe APTIMA self-collected vaginal swabs, which are mailed in a plain envelope and returned via U.S. mail to the county laboratory. Users who test positive can receive clinic referrals and pre-order home test kits for retesting in three months.5 The department has joined with local Planned Parenthoods and the California Family Health Council to help those tested find the most convenient care. By entering their zip codes, women can see which facility is closest for follow-up care for themselves and their partners.
According to Kerndt, the department budgeted about $43,000, plus some $10-$12,000 for web development, for the first year of the program. Each kit costs $6 for postage delivery and return, with test reagents estimated at $9 or $10, based on the volume.
Availability of the Los Angeles kit is being advertised through an expansive social marketing campaign, using outdoor advertising on buses and billboards, postcard placements in beauty salons, and cable television, movie theaters, and online advertisements. To promote the kit on a grass-roots level, the "I Know Street Team" will conduct outreach in schools, malls, and street locations, and distribute 100,000 palm cards, 4,000 posters, and 200 retail displays.5 The street team is comprised of youth who take part in Planned Parenthood Los Angeles' Ujima Teen Program, which provides reproductive health information and promotes responsible decision making to teens in South Los Angeles.
Young women are getting the word about the test kits. A total of 470 orders for the home test kit were placed in the first 11 days of media promotion, including 461 online orders and nine phone orders. A total of 174 orders (37%) were placed from postal codes in targeted high-morbidity areas, which suggests that a substantial number of young women of color ages 12-25 in targeted areas are receptive to ordering such a kit, are able to access the Internet to place their orders, and are interested in receiving electronic (e-mail or text message) notification to access results.5 Previous department research suggests that electronic communication via Internet, e-mail, and text messaging is acceptable for use in this population.3
Direct messaging and low-cost, familiar tools, such as the Internet and text messaging, remove cost, transportation, time, and other inconvenient barriers that prevent young women from safeguarding their sexual health, says Kerndt. "More importantly, we're able to disseminate critical sexual health education and information in a way that connects with young people where they are: online."
References
- Weinstock H, Berman S, Cates W, Jr. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6-10.
- Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2007. Atlanta: Department of Health and Human Services, CDC; 2009. Available at www.cdc.gov/std/stats07/toc.htm.
- Montoya JA, O'Leary CM, Plant A, et al. Designing the "I Know" social marketing campaign to promote chlamydia and gonorrhea testing among young women of color in urban Los Angeles. Presented at the National STD Prevention Conference. Chicago; March 2008.
- Gaydos CA, Dwyer K, Barnes M, et al. Internet-based screening for Chlamydia trachomatis to reach non-clinic populations with mailed self-administered vaginal swabs. Sex Transm Dis 2006; 33:451-457.
- Rotblatt H, Montoya JA, Plant A, et al. Using social marketing to promote chlamydia and gonorrhea home testing among young women of color. Presented at the 18th International Society for STD Research 2009. London; June 28-July 1, 2009.
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