TABLE 4.

Patient-Level Interventions Including Education, Incentives, and Testing Reminders

Table Position	Author (Year) Country, Study Design	Population Characteristics	Objective	Intervention	Main Findings	Absolute % Difference*	Effect Category†	Cost‡
Adolescents/Young adults
4A	Bilardi et al.53 (2009), Australia, PPI	Patients aged 16–24 y attending 3 general practice clinics	Increase CT screening	Providers referred all patients aged 16–24 y to educational Web site www.checkyourrisk.org.au after clinical consultation	There was no significant increase in testing among males during the intervention (3.0%; 30/995) compared with baseline (2.7%; 20/752) or females during intervention (6.4%; 129/2002) and at baseline (6.3%; 98/1548).	0.3 males 0.1 females	☆☆	$
4B	Chacko et al.54 (2010), USA, RCT	Females aged 16–22.5 y attending reproductive health clinic	Improve STI retesting	Offered client-centered motivational behavioral counseling to females attending clinic, encouraging them to return for STI testing in response to high-risk sexual behavior	There was no improvement in the percent of females that returned for an STI testing visit in the intervention group (46%; 78/168) as compared with the control group (54%; 90/168).	−8.0	☆☆	$$
4C	Malotte et al.55 (2004), USA, RCT	Patients aged 14–30 y treated for CT or GC at 1 STD clinic	Improve CT and GC repeat testing after initial diagnosis and treatment	Conducted motivational interviewing	Retesting was not significantly increased among patients that received motivational interviewing (12.0%) as compared with those receiving an appointment card at the treatment visit (3.4%).	8.6	★☆	$$
4D	Malotte et al.55 (2004), USA, RCT	Patients aged 14–30 y treated for CT or GC at 1 STD clinic	Improve CT and GC repeat testing after initial diagnosis and treatment	Provided motivational interviewing plus telephone or letter reminders	Retesting was significantly increased among patients that received motivational interviewing along with a reminder as compared with patients receiving an appointment card at the treatment visit (23.9% vs. 11.4%).	12.5	★☆	$$
4E	Malotte et al.55 (2004), USA, RCT	Patients aged 14–30 y treated for CT or GC at 1 STD clinic	Improve CT and GC repeat testing after initial diagnosis and treatment	Provided phone reminders to return to STD clinic for repeat testing	Retesting was significantly higher (33.3%) among patients that received a telephone reminder for rescreening as compared with those receiving an appointment card at the treatment visit (3.4%).	29.9	★★	$
4F	Malotte et al.55 (2004), USA, RCT	Patients aged 14–30 y treated for CT or GC at 2 STD clinics	Improve CT and GC repeat testing after initial diagnosis and treatment	Paid $20 patient incentive for return for repeat testing	Retesting was not significantly different among patients that received the $20 incentive (13.2%) as compared with those who did not (11.4%).	1.8	☆☆	$$
4G	Morgan and Haar56 (2009), New Zealand, NRCT	Patients aged <25 y attending 49 clinics serving Māori, low socioeconomic, or rural populations	Increase CT screening	Offered free sexual health consultations and testing in 20 clinics	Among females aged 18–24 y, screening coverage increased from 13.9% to 16.8% in the intervention group, and from 13.0% to 13.2% in the control group. No change in screening coverage was observed among males, with 13% and 13.2% in the intervention and control groups, respectively For all age and gender groups, intervention practices had higher test positivity (8.7%) compared with nonintervention practices (5.9%) (P < 0.01).	2.9 females 0.2 males	☆☆	$$$
4H	Paneth-Pollak et al.57 (2010), USA, CO	Patients diagnosed as having CT or GC at 10 STD clinics	Improve CT and GC repeat testing after initial diagnosis and treatment	Mailed reminder postcards for repeat testing to patients	Retesting was higher among patients that received a reminder postcard (14.1 %; 179/1267) compared with patients that did not receive reminder postcards (7.7%; 382/4953). There was a decrease in reinfection among persons retesting during intervention (12.3%; 22/179) compared with preintervention period (25.5%; 24/94) (P = 0.015) and compared with nonintervention clinics (20.1%; 58/288) (P = 0.05).	6.4	★☆	$
4I	Zenner et al.58 (2012), UK, NRCT	Patients aged 15–24 y attending medical care in 84 Primary Care Trusts (PCTs)	Increase CT screening	Used patient incentives including prize draws (£50 voucher, £2000 vacation), condoms, tokens and vouchers (£5–£10) to increase uptake of CT screening	Among PCTs using incentives, the mean CT screening coverage rate increased 1.08% as compared with 0.41% in matched PCTs not using incentives (P = 0.02). Positivity did not change (0.07%, P = 0.9) among PCTs using incentives.	N/A	N/A	$$$
MSM and HIV-infected patients
4J	Bourne et al.59 (2011), Australia, PPI	HIV-negative MSM at a community STI clinic	Increase STI rescreening at 3- to 6-mo intervals	Sent SMS (text) reminders to MSM for repeat STI screening	In the SMS group, 64.4% (n = 714) were retested as compared with 29.7% (322/1084) in the non-SMS group (P < 0.001). SMS cost was AU$0.05 each.	34.7	★★	$
4K	Zou et al.60 (2013) Australia, NRCT	MSM at a sexual health center	Improve asymptomatic STD screening among MSM	Sent MSM computer-generated, automated text message and e-mail reminders	MSM who chose SMS reminders had higher testing rates (49.2%; 435/885) for complete testing visits (GC and CT at genital and nongenital sites, syphilis and HIV) than those who did not choose text reminders (25.5%, 249/97S)(P < 0.001). Men receiving reminders had higher positivity rectal CT (6.6% vs. 2.8%), rectal GC (3.7% vs. 1.2%), urethral CT (3.1% vs. 1.4%), and early latent syphilis (1.4% vs. 0.4%) compared with controls. (P < 0.03 for all)	23.7	★★	$

^*Absolute difference in the percent screened (intervention group minus the comparison group).

^†Effect categories: ★★ = >20% absolute increase, ★☆ = 5%–19% absolute increase, and ☆☆ = <5% absolute increase.

^‡Cost categories (estimated): $ = <$1000, $$ = $1000–$10,000, $$$ = $10,001–$100,000, and $$$$ > $100,000.

NRCT indicates nonrandomized controlled trial; PPI, preintervention/postintervention evaluation; CO, controlled observational.