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RESEARCH ARTICLE

Exploring pharmacy and home-based sexually transmissible infection testing

Melissa A. Habel A E , Roberta Scheinmann B , Elizabeth Verdesoto B , Charlotte Gaydos C , Maggie Bertisch D and Mary Ann Chiasson B
+ Author Affiliations
- Author Affiliations

A Centers For Disease Control and Prevention, 1600 Clifton Road, Mailstop E-44, Atlanta, GA, USA.

B Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY, USA.

C Johns Hopkins University School of Medicine, 855 Wolfe Street, 530 Rangos Building, Baltimore, MD, USA.

D New York Walk-In Medical Group, 1627 Broadway, New York, NY, USA.

E Corresponding author. Email: mhabel@cdc.gov

Sexual Health 12(6) 472-479 https://doi.org/10.1071/SH15031
Submitted: 25 February 2015  Accepted: 22 July 2015   Published: 28 September 2015

Abstract

Background: This study assessed the feasibility and acceptability of pharmacy and home-based sexually transmissible infection (STI) screening as alternate testing venues among emergency contraception (EC) users. Methods: The study included two phases in February 2011–July 2012. In Phase I, customers purchasing EC from eight pharmacies in Manhattan received vouchers for free STI testing at onsite medical clinics. In Phase II, three Facebook ads targeted EC users to connect them with free home-based STI test kits ordered online. Participants completed a self-administered survey. Results: Only 38 participants enrolled in Phase I: 90% female, ≤29 years (74%), 45% White non-Hispanic and 75% college graduates; 71% were not tested for STIs in the past year and 68% reported a new partner in the past 3 months. None tested positive for STIs. In Phase II, ads led to >45 000 click-throughs, 382 completed the survey and 290 requested kits; 28% were returned. Phase II participants were younger and less educated than Phase I participants; six tested positive for STIs. Challenges included recruitment, pharmacy staff participation, advertising with discretion and cost. Conclusions: This study found low uptake of pharmacy and home-based testing among EC users; however, STI testing in these settings is feasible and the acceptability findings indicate an appeal among younger women for testing in non-traditional settings. Collaborating with and training pharmacy and medical staff are key elements of service provision. Future research should explore how different permutations of expanding screening in non-traditional settings could improve testing uptake and detect additional STI cases.

Additional keywords: emergency contraception, Internet, point-of-care testing, social media, United States.


References

[1]  Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Su J, Xu F, Weinstock H. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 2013; 40 187–93.
Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008.Crossref | GoogleScholarGoogle Scholar | 23403598PubMed |

[2]  Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2011. Atlanta: U.S. Department of Health and Human Services; 2012.

[3]  Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection among persons aged 14–39 years – United States, 2007–2012. MMWR Wkly Rep 2014; 53 834–8.

[4]  Friedman A, Bloodgood B. Exploring the feasibility of alternative STD-testing venues and results delivery channels for a national screening campaign. Health Promot Pract 2013; 14 96–104.
Exploring the feasibility of alternative STD-testing venues and results delivery channels for a national screening campaign.Crossref | GoogleScholarGoogle Scholar | 21965593PubMed |

[5]  Eng TR, Butler WT, editors. The hidden epidemic: confronting sexually transmitted diseases. Washington, DC: National Academy Press; 1997.

[6]  Hoover K, Parsell B, Leichliter JS, Habel MA, Gift TL. Characteristics of U.S. STD clinic patients and their access to healthcare. AJPH, 2013; in press.

[7]  Celum CL, Bolan G, Krone M, Code K, Leone P, Spaulding C, Henry K, Clarke P, Smith M, Hook EW. Patients attending STD clinics in an evolving health care environment. Sex Transm Dis 1997; 24 599–605.
Patients attending STD clinics in an evolving health care environment.Crossref | GoogleScholarGoogle Scholar |

[8]  Lichtenstein B, Bachmann LH. Staff affirmations and client criticisms: staff and client perceptions of quality of care at sexually transmitted disease clinics. Sex Transm Dis 2005; 32 281–5.
Staff affirmations and client criticisms: staff and client perceptions of quality of care at sexually transmitted disease clinics.Crossref | GoogleScholarGoogle Scholar | 15849528PubMed |

[9]  Hood JE, Friedman AL. Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections. Sex Health 2011; 8 159–70.
Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections.Crossref | GoogleScholarGoogle Scholar | 21592429PubMed |

[10]  Scoular A, Duncan B, Hart G. ‘That sort of place.. where filthy men go..’: a qualitative study of women’s perceptions of genitourinary medicine services. Sex Transm Infect 2001; 77 340–3.
‘That sort of place.. where filthy men go..’: a qualitative study of women’s perceptions of genitourinary medicine services.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrmsFOgtA%3D%3D&md5=1d4c51e27e9e05256c3850327c1aa884CAS | 11588279PubMed |

[11]  Lichtenstein B. Stigma as a barrier to treatment of sexually transmitted infection in the American deep south: issues of race, gender and poverty. Soc Sci Med 2003; 57 2435–45.
Stigma as a barrier to treatment of sexually transmitted infection in the American deep south: issues of race, gender and poverty.Crossref | GoogleScholarGoogle Scholar | 14572849PubMed |

[12]  Tilson EC, Sanchez V, Ford CL, Smurzynski M, Leone P, Fox K, Irwin K, Miller WC. Barriers to asymptomatic screening and other STD services for adolescents and you adults: focus group discussions. BMC Public Health 2004; 4 21
Barriers to asymptomatic screening and other STD services for adolescents and you adults: focus group discussions.Crossref | GoogleScholarGoogle Scholar | 15189565PubMed |

[13]  Arkell J, Osborn DP, Ivens D, King MB. Factors associated with anxiety in patients attending a sexually transmitted infection clinic: qualitative survey. Int J STD AIDS 2006; 17 299–303.
Factors associated with anxiety in patients attending a sexually transmitted infection clinic: qualitative survey.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD283jsleitg%3D%3D&md5=83d2f55a58f80e44d1c51b6830b0b654CAS | 16643678PubMed |

[14]  Pharmaceutical Care Management Association (PCMA). Consumer access to pharmacies in the United States, 2007. Washington, DC: PCMA; 2007. Available online at: http://www.pcmanet.org/images/stories/uploads/2007/05/2008-03-25_Research_SKA20Research20Consumer20Access20to20Pharmacies202007205_1_07.pdf [verified 30 September 2013].

[15]  Rudavsky R, Pollack CE, Mehrotra A. The geographic distribution, ownership, prices, and scope of practice at retail clinics. Ann Intern Med 2009; 151 315–20.
The geographic distribution, ownership, prices, and scope of practice at retail clinics.Crossref | GoogleScholarGoogle Scholar | 19721019PubMed |

[16]  Meyerson BE, Ryder P, Richey-Smith C. Achieving pharmacy-based public health: a call for public health engagement. Pub Health Rep 2013; 128 140–48.

[17]  Weidle PJ, Lecher S, Botts LW, Jones L, Spach DH, Alvarez J, Jones R, Thomas V. HIV testing in community pharmacies and retail clinics: a model to expand access to screening for HIV infection. J Am Pharm Assoc 2014; 54 486–92.
HIV testing in community pharmacies and retail clinics: a model to expand access to screening for HIV infection.Crossref | GoogleScholarGoogle Scholar |

[18]  Amesty S, Weidle PJ, Willis L, Sutton M, Lin S, Fuller C. Support for in-pharmacy HIV testing and prevention services among pharmacists registered in the New York state expanded syringe access program: findings from the PHARM-HIV study. American Pharmacists Association Annual Meeting & Exposition; March 9–12 2012; New Orleans.

[19]  Calderon Y, Cowan E, Rhee JY, Brusalis C, Leider J. Counselor-based rapid HIV testing in community pharmacies. AIDS Patient Care STDS 2013; 27 467–73.
Counselor-based rapid HIV testing in community pharmacies.Crossref | GoogleScholarGoogle Scholar | 23883320PubMed |

[20]  Wrobel JM, Scasi KK, Klepser ME, Darin KM. Potential acceptance of community pharmacy based HIV screening: a qualitative evaluation. American Society of Health-System Pharmacists Midyear Clinical Meeting & Exhibition; December 4–8 2011; New Orleans.

[21]  Dugdale C, Zaller N, Bratberg J, Berk W, Flanigan T. Missed opportunities for HIV screening in pharmacies and retail clinics. J Manag Care Pharm 2014; 20 339–45.

[22]  Gaydos CA, Barnes M, Aumakhan B, Quinn N, Agreda P, Whittle P, Hogan T. Can e-technology through the Internet be used as a new tool to address the Chlamydia trachomatis epidemic by home sampling and vaginal swabs? Sex Transm Dis 2009; 36 577–80.
Can e-technology through the Internet be used as a new tool to address the Chlamydia trachomatis epidemic by home sampling and vaginal swabs?Crossref | GoogleScholarGoogle Scholar | 19543145PubMed |

[23]  Gaydos CA, Rizzo-Price PA, Barnes M, Dwyer K, Wood BJ, Hogan MT. The use of focus groups to design an internet-based program for chlamydia screening with self-administered vaginal swabs: what women want. Sex Health 2006; 3 209–15.
The use of focus groups to design an internet-based program for chlamydia screening with self-administered vaginal swabs: what women want.Crossref | GoogleScholarGoogle Scholar | 17112429PubMed |

[24]  Huang W, Gaydos CA, Barnes MR, Jett-Goheen M, Blake DR. Cost-effectiveness analysis of Chlamydia trachomatis screening via Internet-based self-collected swabs compared to clinic-based sample collection. Sex Transm Dis 2011; 38 815–20.
Cost-effectiveness analysis of Chlamydia trachomatis screening via Internet-based self-collected swabs compared to clinic-based sample collection.Crossref | GoogleScholarGoogle Scholar | 21844736PubMed |

[25]  Gaydos CA, Barnes M, Jett-Goheen M, Quinn N, Whittle P, Hogan T, Hsieh Y-H. Characteristics and predictors of women who obtain rescreening for sexually transmitted infections using www.iwantthekit.org screening program. Internat J STD & AIDS 2013; 24 736–44.
Characteristics and predictors of women who obtain rescreening for sexually transmitted infections using www.iwantthekit.org screening program. Crossref | www.iwantthekit.org screening program. &journal=Internat J STD & AIDS&volume=24&pages=736-44&publication_year=2013&author=CA%20Gaydos&hl=en&doi=10.1177/0956462413483252" target="_blank" rel="nofollow noopener noreferrer" class="reftools">GoogleScholarGoogle Scholar |

[26]  Rose SB, Smith MC, Lawton BA. “If everyone does it, it’s not a big deal.” Young people talk about chlamydia testing. N Z Med J 2008; 4 33–42.

[27]  Gudka S, Afuwape FE, Wong B, Li Yow X, Anderson C, Clifford R. Chlamydia screening interventions from community pharmacies: a systematic review. Sex Health 2013; 10 229–39.
| 23651619PubMed |

[28]  Jamil MS, Hocking JS, Bauer HM, Hammad A, Wand H, Smith K, Walker J, Donovan B, Kaldor JM, Guy RJ. Home-based chlamydia and gonorrhea screening: a systematic review of strategies and outcomes. BMC Public Health 2013; 13 189
Home-based chlamydia and gonorrhea screening: a systematic review of strategies and outcomes.Crossref | GoogleScholarGoogle Scholar | 23496833PubMed |

[29]  Thomas G, Humphris G, Ozakinci G, O’Brien K, Roberts SA, Hopkins M, Brabin L. A qualitative study of pharmacists’ views on offering chlamydia screening to women requesting emergency hormonal contraception. BJOG 2010; 117 109–13.
A qualitative study of pharmacists’ views on offering chlamydia screening to women requesting emergency hormonal contraception.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1Mfhs1yrtw%3D%3D&md5=875ed08f6bb512a6e1a745aba986a4e1CAS | 19775305PubMed |

[30]  Kavanaugh ML, Williams SL, Schwarz EB. Emergency contraception use and counseling after changes in United States prescription status. Fertil Steril 2011; 95 2578–81.
Emergency contraception use and counseling after changes in United States prescription status.Crossref | GoogleScholarGoogle Scholar | 21457957PubMed |

[31]  Habel MA, Leichliter J. Emergency contraception and risk for sexually transmitted infections in the U.S. JWH 2012; 21 910–16.
Emergency contraception and risk for sexually transmitted infections in the U.S.Crossref | GoogleScholarGoogle Scholar |

[32]  Sander PM, Raymond EG, Weaver MA. Emergency contraceptive use as a marker of future risky sex, pregnancy and sexually transmitted infection. Am J Obstet Gynecol 2009; 201 146.e1–6.
Emergency contraceptive use as a marker of future risky sex, pregnancy and sexually transmitted infection.Crossref | GoogleScholarGoogle Scholar |

[33]  Black KI, Mercer CH, Johnson AM, Wellings K. Sociodemographic and sexual health profile of users of emergency contraception: data from a British probability sample survey. Contraception 2006; 74 309–12.
Sociodemographic and sexual health profile of users of emergency contraception: data from a British probability sample survey.Crossref | GoogleScholarGoogle Scholar | 16982231PubMed |

[34]  Verhoeven V, Peremans L, Avonts D, Van Royen P. The profile of emergency contraception users in a chlamydia prevalence study in primary care in Belgium. Eur J Contracept Reprod Health Care 2006; 11 175–80.
The profile of emergency contraception users in a chlamydia prevalence study in primary care in Belgium.Crossref | GoogleScholarGoogle Scholar | 17056447PubMed |

[35]  Bajos N, Leridon H, Goulard H, Oustry P, Job-Spira N. Contraception: from accessibility to efficiency. Hum Reprod 2003; 18 994–9.
Contraception: from accessibility to efficiency.Crossref | GoogleScholarGoogle Scholar | 12721175PubMed |

[36]  Kettle H, Cay S, Brown A, Glasier A.. Screening for Chlamydia trachomatis infection is indicated for women under 30 using emergency contraception . Contraception 2002; 66 251–3.
Screening for Chlamydia trachomatis infection is indicated for women under 30 using emergency contraception .Crossref | GoogleScholarGoogle Scholar | 12413621PubMed |

[37]  Goulard H, Bajos N, Job-Spira N. Equipe Cocon. Emergency contraception in France: the user profile. Gynecol Obstet Fertil 2003; 31 724–9.
Equipe Cocon. Emergency contraception in France: the user profile.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3svktVCluw%3D%3D&md5=6ed8e7a0311d51286d8a0794fa806950CAS | 14499717PubMed |

[38]  van Bergen J, Postma M, Peerbooms P, Spangenberg A, Tjen-A-Tak J, Bindels J. Effectiveness and cost-effectiveness of a pharmacy-based screening programme for Chlamydia trachomatis in a high-risk health centre population in Amsterdam using mailed home-collected urine samples. Int J STD AIDS 2004; 15 797–802.
Effectiveness and cost-effectiveness of a pharmacy-based screening programme for Chlamydia trachomatis in a high-risk health centre population in Amsterdam using mailed home-collected urine samples.Crossref | GoogleScholarGoogle Scholar | 15601485PubMed |

[39]  National Chlamydia Screening Programme. Maintaining momentum: annual report of the National Chlamydia Screening Programme in England 2006/07. London: Health Protection Agency; 2007. Available online at: http://www.chlamydiascreening.nhs.uk/ps/resources/annual-reports/NCSPa-rprt-06_07.pdf [verified 7 August 2015].

[40]  Free C, Lee RM, Ogden J. Young women’s accounts of factors influencing their use and non-use of emergency contraception: in-depth interview study. BMJ 2002; 325 1393–6.
Young women’s accounts of factors influencing their use and non-use of emergency contraception: in-depth interview study.Crossref | GoogleScholarGoogle Scholar | 12480855PubMed |

[41]  Baraitser P, Pearce V, Holmes J, Horne N, Boynton P. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care 2007; 16 303–7.
Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2svnsFSgsQ%3D%3D&md5=67740b53bb1f359712698e6b6efc6632CAS | 17693680PubMed |

[42]  Brabin L, Thomas G, Hopkins M, O’Brien K, Roberts SA. Delivery of chlamydia screening to young women requesting emergency hormonal contraception at pharmacies in Manchester, UK: a prospective study. BMC Womens Health 2009; 9 7
Delivery of chlamydia screening to young women requesting emergency hormonal contraception at pharmacies in Manchester, UK: a prospective study.Crossref | GoogleScholarGoogle Scholar | 19323804PubMed |

[43]  Emmerton L, Bhurer Skinner M, Gardiner E, Nissen L, Debattista J. A trail of distribution of chlamydia self-collection postal specimen kits from Australian community pharmacies. Sex Health 2011; 8 130–2.
A trail of distribution of chlamydia self-collection postal specimen kits from Australian community pharmacies.Crossref | GoogleScholarGoogle Scholar | 21371398PubMed |

[44]  Gudka S, Marhsall L, Creagh A, Clifford RM. To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia. BMJ Open 2013; 3
To develop and measure the effectiveness and acceptability of a pharmacy-based chlamydia screening intervention in Australia.Crossref | GoogleScholarGoogle Scholar | 23955190PubMed |

[45]  Friedman A, Bozniak A, Ford J, Hill A, Olson K, Lesdsky R, Inokuchi D, Brookmeyer K. Reaching youth with sexually transmitted disease testing: building on successes, challenges, and lessons learned from local Get Yourself Tested campaigns. Soc Mar Q 2014; 20 116–38.
Reaching youth with sexually transmitted disease testing: building on successes, challenges, and lessons learned from local Get Yourself Tested campaigns.Crossref | GoogleScholarGoogle Scholar |

[46]  Braun RA, Provost JM. Bridging the gap: Using schoolbased health services to improve chlamydia screening among young women. AJPH 2010; 100 1624–9.
Bridging the gap: Using schoolbased health services to improve chlamydia screening among young women.Crossref | GoogleScholarGoogle Scholar |

[47]  Kerndt P, Papp J, Rotblatt H, Montoya J, Gift T. “I know:” Combining home testing technology, social marketing, & lessons from E-commerce to fight chlamydia & gonorrhea disparities among young women. Symposium at the 2010 National STD Prevention Conference: Atlanta, GA. Atlanta: Centers for Disease Control and Prevention; 2010. Available online at: http://cdc.confex.com/cdc/std2010/webprogram/Session10492.html. [verified 7 August 2015].