Summary of findings for the main comparison. Home‐based compared with clinic‐based specimen collection for CT and NG.
| Home‐based compared with clinic‐based specimen collection for Chlamydia trachomatis and Neisseria gonorrhoeae | ||||||
| Patient or population: Sexually active people Setting: Outpatient Intervention: Home‐based specimen collection Comparison: Clinic‐based specimen collection | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with clinic‐based specimen collection for CT and NG | Risk with Home‐based | |||||
| Index case management (6 to 12 weeks of follow‐up) | Study population | RR 0.88 (0.60 to 1.29) | 1566 (3 RCTs) | ⨁⨁⨁◯ MODERATE 1 | ||
| 65 per 1000 | 57 per 1000 (39 to 83) | |||||
| Moderate | ||||||
| 105 per 1000 | 93 per 1000 (63 to 136) | |||||
| Proportion of individuals tested (12 days to 8 weeks of follow‐upa) |
Eight of the ten trials found that home‐based specimen collection resulted in more participants being tested than clinic‐based specimen collection | Not pooledb | 10479 (10 RCTs) | ⨁⨁◯◯ LOW2 | ||
| Positive test prevalence | Study population | RR 0.72 (0.61 to 0.86) | 3041 (9 RCTs) | ⨁⨁⨁◯ MODERATE1 | ||
| 185 per 1000 | 133 per 1000 (113 to 159) | |||||
| Moderate | ||||||
| 368 per 1000 | 265 per 1000 (225 to 317) | |||||
| Adverse effects of testingc | No estimable | No estimable | ‐ | ‐ | ‐ | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
aOne study included follow‐up until 2 years
bDue to substantial heterogeneity (I2=100%)
cNo trials reported adverse effects of testing
1Downgraded one level due to serious risk of bias (concerns about blinding and attrition rate >20% in two studies)
2Downgraded two levels due to very serious risk of bias (all the trials had a high or unclear risk of bias in at least one key domain i.e. random sequence generation, allocation concealment and blinding)