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Improving the prevention of sexually transmitted infections (STIs): a study using Chlamydia trachomatis as a model infection
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Despite the current preventive strategies sexually transmitted infections (STIs) are rising. This thesis presents a model with the aim of improving the prevention of STIs. Chlamydia being the most common STI in Sweden serves as a model infection.

The presented model is based on five performed studies. First we evaluated the feasibility of taking a urine sample at home and sending it with mail for Chlamydia analysis. Postal screening was thereafter analyzed for cost effectiveness estimating the cost per prevented sequel and the prevalence threshold. A population based study of all the 22-year old men in Umeå tested the feasibility of the Internet as a tool in facilitating Chlamydia testing and also attempted to engage men who often have low participation in Chlamydia screening programs. A questionnaire to all 18-year old youths in four northern Swedish cities was analysed concerning condom use. Finally, ordering home a Chlamydia test from the Internet was tested as method for self-selective screening.

The studies showed that it was both feasible and acceptable by the population to send in urine samples with mail for Chlamydia analysis. Large-scale postal screening would be cost-effective in a female population if the C. trachomatis prevalence exceeds 5% and cost effective in a male population if the C. trachomatis prevalence exceeds 12.3%. Using the Internet as a tool in Chlamydia testing proved feasible and almost 38% of all the 22-year old men in Umeå participated. Condom usage being the most important STI preventive measure during a sexual intercourse proved to be dependent on more male factors than female factors, where the use of oral contraceptives was the strongest factor associated with non-condom use. Ordering a test on the Internet proved to be a feasible self-selective screening method.

Condom use should continuously be promoted to sexually active people especially if oral contraception is used. Success and cost effectiveness in controlling STI transmission is likely to depend on achieving consistent and regular coverage of testing and partner notification among both women and men. The suggested model uses the Internet as a tool in communicating preventive STI information and allowing a self-selective screening, which may be used as an adjunct to regular recruitment in striving for improving the STI prevention.

Key words: STI, prevention, Chlamydia, postal screening, cost effective, condom, Internet, self-selective screening.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2006. , 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1007
Keyword [en]
Public health, STI, Prevention, Chlamydia, Postal screening, cost effective, condom, Internet, self-selective screening
Keyword [sv]
Folkhälsomedicin
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-692ISBN: 91-7264-030-8 (print)OAI: oai:DiVA.org:umu-692DiVA: diva2:144242
Public defence
2006-03-03, Betula, 6M, Norrlands Universitets Sjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2006-02-07 Created: 2006-02-07 Last updated: 2009-10-26Bibliographically approved
List of papers
1. Is postal screening for Chlamydia trachomatis based on urine specimens obtained at home a feasible method in Sweden?
Open this publication in new window or tab >>Is postal screening for Chlamydia trachomatis based on urine specimens obtained at home a feasible method in Sweden?
Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-4937 (URN)
Available from: 2006-02-07 Created: 2006-02-07Bibliographically approved
2. The Internet, a simple and convinient tool in Chlamydia trachomatis screening of young people
Open this publication in new window or tab >>The Internet, a simple and convinient tool in Chlamydia trachomatis screening of young people
2003 (English)In: Eurosurveillance, ISSN 1025-496, Vol. 8, no 9, 171-176 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-4938 (URN)14512638 (PubMedID)
Available from: 2006-02-07 Created: 2006-02-07Bibliographically approved
3. A Swedish cost-effectiveness analysis of community-based Chlamydia trachomatis PCR testing of postal urine specimens obtained at home.
Open this publication in new window or tab >>A Swedish cost-effectiveness analysis of community-based Chlamydia trachomatis PCR testing of postal urine specimens obtained at home.
2004 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 32, no 5, 324-332 p.Article in journal (Refereed) Published
Keyword
Adult, Carrier State, Chlamydia Infections/economics/epidemiology/*urine, Chlamydia trachomatis/genetics/*isolation & purification, Community Health Services/*economics, Cost-Benefit Analysis, Female, Humans, Male, Mass Screening/*economics/utilization, Polymerase Chain Reaction/economics/*utilization, Postal Service, Prevalence, Sensitivity and Specificity, Sweden, Urinalysis/economics/utilization
Identifiers
urn:nbn:se:umu:diva-13749 (URN)10.1080/14034940410026282 (DOI)15513664 (PubMedID)
Available from: 2007-11-29 Created: 2007-11-29 Last updated: 2017-12-14Bibliographically approved
4. Gender differed factors affecting male condom use. A population-based study of 18-year-old Swedish adolescents.
Open this publication in new window or tab >>Gender differed factors affecting male condom use. A population-based study of 18-year-old Swedish adolescents.
2005 (English)In: International journal of adolescent medicine and health, ISSN 0334-0139, Vol. 17, no 4, 379-390 p.Article in journal (Refereed) Published
Keyword
Adolescent, Adolescent Behavior/*psychology, Condoms/*utilization, Contraception Behavior/*psychology, Contraceptives; Oral/therapeutic use, Decision Making, Female, Humans, Life Style, Male, Pilot Projects, Questionnaires, Risk Assessment, Risk-Taking, Sex Factors, Sexually Transmitted Diseases/*prevention & control, Sweden, Unsafe Sex/*psychology, Urban Population
Identifiers
urn:nbn:se:umu:diva-6275 (URN)16445076 (PubMedID)
Available from: 2007-12-08 Created: 2007-12-08 Last updated: 2009-10-07Bibliographically approved
5. Simplifying chlamydia testing: an innovative Chlamydia trachomatis testing approach using the internet and a home sampling strategy: population based study.
Open this publication in new window or tab >>Simplifying chlamydia testing: an innovative Chlamydia trachomatis testing approach using the internet and a home sampling strategy: population based study.
2006 (English)In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 82, no 2, 142-147; discussion 152 p.Article in journal (Refereed) Published
Keyword
Adolescent, Adult, Aged, Chlamydia Infections/*epidemiology, Chlamydia trachomatis, Female, Home Care Services/*utilization, Humans, Internet/*utilization, Male, Mass Screening/methods, Middle Aged, Odds Ratio, Polymerase Chain Reaction, Prevalence, Questionnaires, Specimen Handling, Sweden/epidemiology
Identifiers
urn:nbn:se:umu:diva-6277 (URN)doi:10.1136/sti.2005.016832 (DOI)16581742 (PubMedID)
Available from: 2007-12-08 Created: 2007-12-08 Last updated: 2017-12-14Bibliographically approved

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