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Implementation Science

Category: Self-sampling/testing

(P344) Internet-based self-sampling for Chlamydia trachomatis testing: the most important case detector in Sweden?

Wednesday, July 26, 2023
16:00 – 18:00 CST
Background: Internet-based self-sampling for Chlamydia trachomatis (CT) testing is available in all 21 Swedish public health care regions. The service is free of charge since CT is included in the Swedish Communicable Diseases Act. Persons with detected CT are asked to visit a public healthcare clinic for free treatment and mandatory partner notification. This study aimed to evaluate CT testing by internet-based self-sampling and compare with different categories of clinic-based testing.

Methods: Data about CT testing were obtained from six health care regions comprising 29% of the Swedish population. Data included the number of tests and the number of tested persons in different clinic categories during the years 2016–2021. The study is ongoing and will include 2022.

Results: Internet-based self-sampling increased during the study period (19%, n=36148 in 2016; 33 % n=57193 in 2021) to become the largest category in 2021, (figure). At the same time Primary health care clinics decreased their proportion from 30% (n=57395) in 2016 to 25 % (n=43126) in 2021 and Youth clinics (clinics focused on STI) similarly decreased from 20% (n=37510) to 12 % (n=20705).

The number of CT cases detected by internet-based self-sampling increased by 59 % from 1967 in 2016 to 3128 in 2021 and comprised 41 % of all cases respectively.

The positivity rate for internet-based self-sampling was 5.2% for the study years (range 4.7%–5.5%) while it was 4.4% (3.8-5.0) for clinic-based testing. Primary health care clinics had low positivity rates (2.9%–4.4%). STI clinics had initially a high rate (5.9%) in 2016 but it was lower (4.3%) than internet-based testing (5.5%) in 2021. Youth clinics had the highest rates (7.0%-8.1%). In contrast gynecological clinics had the lowest positivity rates ranging between 1.6%-2.1%.

Conclusions:
- After implementation of nation-wide internet-based self-sampling as a public health care service it has become the most important case detector reaching relevant target groups.
- During the COVID-19 pandemic years 2020–2021 internet-based testing appears to have compensated for a decreased clinic-based testing.
- The low CT detection rate at gynecological clinics indicates that evaluation of test indication is needed.