Enhanced education, customized follow-up options improve STD retesting rates

ATLANTA – Educating patients treated for chlamydia or gonorrhea about reinfection and retesting, and providing customized options for follow-up care, increased patient retest return rates by 15% in a prospective cohort study.

The return rate at 1-6 months after treatment among 1,454 patients who received enhanced educational information about reinfection and the importance of retesting during the first phase of the InTOUCH study was 59%, and the return rate among 575 patients who received that educational information along with customized reminders and/or a mailed-in home testing kit in a second phase was 62%, compared with a return rate of 54% among 2,696 historical controls, Holly Howard reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The increases in return rates were statistically significant, said Ms. Howard of the California Department of Public Health, Richmond.

The initial education phase of the multicenter study occurred in 2010 and 2011 at six geographically diverse California Title X clinics. Participants were clients of the California Family Planning, Access, Care, and Treatment Program, which provides care to more than 2 million low-income women each year.

The patients were counseled about the risks and dangers of re-infection and the importance of retesting, and were given tips for remembering to return for retesting. Additionally, educational materials were updated to improve readability and user friendliness.

During 2011 and 2012, patients from the educational phase who tested positive for chlamydia or gonorrhea, and who were treated for the infections, were officially enrolled in the second phase of the study, during which they were offered the option of receiving retest reminders via postcard, text, and/or e-mail, as well as the option of retesting with a home test sent to their address 3 months after treatment.

Most patients (90%) opted to receive retest reminders, and most of those chose text and e-mail reminders. Only 5% chose to use the home test kit.

The findings have implications for improving the notoriously low return rates among women who test positive for chlamydia and gonorrhea infection. These infections are common and are associated with serious reproductive health sequelae, including an increased risk of pelvic inflammatory disease and ectopic pregnancy, Ms. Howard noted.

Routine retesting within a few months of treatment allows for early identification of reinfection, and for retreatment that can reduce the risk of adverse outcomes.

For more than a decade, national guidelines have recommended retesting of patients with chlamydia or gonorrhea, but retesting rates have remained stubbornly below 50%. Effective strategies for increasing patient retest return rates have been elusive, she noted.

In the year leading up to the InTOUCH study, only 44% of clinic patients overall were retested, and that was found to be a result both of the low (62%) return rate and low (69%) retesting rate among those who did return, she said.

The overall retesting rate improved to nearly 60% during the course of the study.

"So with a very moderate increase in patient return rates and in clinic retesting rates among returning patients, you can see that we cumulatively increased our overall retesting rates by more than 30%," she said, noting that given the consistently low return rates in prior years, this was "a very exciting result."

The current findings suggest that addressing the factors that contribute to low return rates, including lack of information about the importance of returning, forgetting to return, and difficulties getting to the clinic, can lead to significant improvement in return rates, Ms. Howard said.

"Improving is dependent on addressing both patient and clinic level causes. Through a combination of these very feasible interventions, we were able to increase the overall retesting rates by 32%," she said.

The InTOUCH study was funded by a grant from the Office of Population Affairs as a Title X Service Delivery Improvement Research Project. Ms. Howard reported having no other disclosures.

ATLANTA – Educating patients treated for chlamydia or gonorrhea about reinfection and retesting, and providing customized options for follow-up care, increased patient retest return rates by 15% in a prospective cohort study.

The return rate at 1-6 months after treatment among 1,454 patients who received enhanced educational information about reinfection and the importance of retesting during the first phase of the InTOUCH study was 59%, and the return rate among 575 patients who received that educational information along with customized reminders and/or a mailed-in home testing kit in a second phase was 62%, compared with a return rate of 54% among 2,696 historical controls, Holly Howard reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The increases in return rates were statistically significant, said Ms. Howard of the California Department of Public Health, Richmond.

The initial education phase of the multicenter study occurred in 2010 and 2011 at six geographically diverse California Title X clinics. Participants were clients of the California Family Planning, Access, Care, and Treatment Program, which provides care to more than 2 million low-income women each year.

The patients were counseled about the risks and dangers of re-infection and the importance of retesting, and were given tips for remembering to return for retesting. Additionally, educational materials were updated to improve readability and user friendliness.

During 2011 and 2012, patients from the educational phase who tested positive for chlamydia or gonorrhea, and who were treated for the infections, were officially enrolled in the second phase of the study, during which they were offered the option of receiving retest reminders via postcard, text, and/or e-mail, as well as the option of retesting with a home test sent to their address 3 months after treatment.

Most patients (90%) opted to receive retest reminders, and most of those chose text and e-mail reminders. Only 5% chose to use the home test kit.

The findings have implications for improving the notoriously low return rates among women who test positive for chlamydia and gonorrhea infection. These infections are common and are associated with serious reproductive health sequelae, including an increased risk of pelvic inflammatory disease and ectopic pregnancy, Ms. Howard noted.

Routine retesting within a few months of treatment allows for early identification of reinfection, and for retreatment that can reduce the risk of adverse outcomes.

For more than a decade, national guidelines have recommended retesting of patients with chlamydia or gonorrhea, but retesting rates have remained stubbornly below 50%. Effective strategies for increasing patient retest return rates have been elusive, she noted.

In the year leading up to the InTOUCH study, only 44% of clinic patients overall were retested, and that was found to be a result both of the low (62%) return rate and low (69%) retesting rate among those who did return, she said.

The overall retesting rate improved to nearly 60% during the course of the study.

"So with a very moderate increase in patient return rates and in clinic retesting rates among returning patients, you can see that we cumulatively increased our overall retesting rates by more than 30%," she said, noting that given the consistently low return rates in prior years, this was "a very exciting result."

The current findings suggest that addressing the factors that contribute to low return rates, including lack of information about the importance of returning, forgetting to return, and difficulties getting to the clinic, can lead to significant improvement in return rates, Ms. Howard said.

"Improving is dependent on addressing both patient and clinic level causes. Through a combination of these very feasible interventions, we were able to increase the overall retesting rates by 32%," she said.

The InTOUCH study was funded by a grant from the Office of Population Affairs as a Title X Service Delivery Improvement Research Project. Ms. Howard reported having no other disclosures.

ATLANTA – Educating patients treated for chlamydia or gonorrhea about reinfection and retesting, and providing customized options for follow-up care, increased patient retest return rates by 15% in a prospective cohort study.

The return rate at 1-6 months after treatment among 1,454 patients who received enhanced educational information about reinfection and the importance of retesting during the first phase of the InTOUCH study was 59%, and the return rate among 575 patients who received that educational information along with customized reminders and/or a mailed-in home testing kit in a second phase was 62%, compared with a return rate of 54% among 2,696 historical controls, Holly Howard reported at a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.

The increases in return rates were statistically significant, said Ms. Howard of the California Department of Public Health, Richmond.

The initial education phase of the multicenter study occurred in 2010 and 2011 at six geographically diverse California Title X clinics. Participants were clients of the California Family Planning, Access, Care, and Treatment Program, which provides care to more than 2 million low-income women each year.

The patients were counseled about the risks and dangers of re-infection and the importance of retesting, and were given tips for remembering to return for retesting. Additionally, educational materials were updated to improve readability and user friendliness.

During 2011 and 2012, patients from the educational phase who tested positive for chlamydia or gonorrhea, and who were treated for the infections, were officially enrolled in the second phase of the study, during which they were offered the option of receiving retest reminders via postcard, text, and/or e-mail, as well as the option of retesting with a home test sent to their address 3 months after treatment.

Most patients (90%) opted to receive retest reminders, and most of those chose text and e-mail reminders. Only 5% chose to use the home test kit.

The findings have implications for improving the notoriously low return rates among women who test positive for chlamydia and gonorrhea infection. These infections are common and are associated with serious reproductive health sequelae, including an increased risk of pelvic inflammatory disease and ectopic pregnancy, Ms. Howard noted.

Routine retesting within a few months of treatment allows for early identification of reinfection, and for retreatment that can reduce the risk of adverse outcomes.

For more than a decade, national guidelines have recommended retesting of patients with chlamydia or gonorrhea, but retesting rates have remained stubbornly below 50%. Effective strategies for increasing patient retest return rates have been elusive, she noted.

In the year leading up to the InTOUCH study, only 44% of clinic patients overall were retested, and that was found to be a result both of the low (62%) return rate and low (69%) retesting rate among those who did return, she said.

The overall retesting rate improved to nearly 60% during the course of the study.

"So with a very moderate increase in patient return rates and in clinic retesting rates among returning patients, you can see that we cumulatively increased our overall retesting rates by more than 30%," she said, noting that given the consistently low return rates in prior years, this was "a very exciting result."

The current findings suggest that addressing the factors that contribute to low return rates, including lack of information about the importance of returning, forgetting to return, and difficulties getting to the clinic, can lead to significant improvement in return rates, Ms. Howard said.

"Improving is dependent on addressing both patient and clinic level causes. Through a combination of these very feasible interventions, we were able to increase the overall retesting rates by 32%," she said.

The InTOUCH study was funded by a grant from the Office of Population Affairs as a Title X Service Delivery Improvement Research Project. Ms. Howard reported having no other disclosures.