***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To evaluate the effectiveness of register based , yearly chlamydia screening . Design Controlled trial with r and omised stepped wedge implementation in three blocks . Setting Three regions of the Netherl and s : Amsterdam , Rotterdam , and South Limburg . Participants 317 304 women and men aged 16 - 29 years listed on municipal registers at start of trial . Intervention From March 2008 to February 2011 , the Chlamydia Screening Implementation programme offered yearly chlamydia screening tests . Postal invitations asked people to use an internet site to request a kit for self collection of sample s , which would then be sent to regional laboratories for testing . Treatment and partner notification were done by the general practitioner or at a sexually transmitted infection clinic . Main outcome measures Primary outcomes were the percentage of chlamydia tests positive ( positivity ) , percentage of invitees returning a specimen ( uptake ) , and estimated chlamydia prevalence . Secondary outcomes were positivity according to sex , age , region , and sociodemographic factors ; adherence to screening invitations ; and incidence of self reported pelvic inflammatory disease . Results The participation rate was 16.1 % ( 43 358/269 273 ) after the first invitation , 10.8 % after the second , and 9.5 % after the third , compared with 13.0 % ( 6223/48 031 ) in the control block invited at the end of round two of the intervention . Chlamydia positivity in the intervention blocks at the first invitation was the same as in the control block ( 4.3 % ) and 0.2 % lower at the third invitation ( odds ratio 0.96 ( 95 % confidence interval 0.83 to 1.10 ) ) . No substantial decreases in positivity were seen after three screening rounds in any region or sociodemographic group . Among the people who participated three times ( 2.8 % of all invitees ) , positivity fell from 5.9 % to 2.9 % ( odds ratio 0.49 ( 0.47 to 0.50 ) ) . Conclusions There was no statistical evidence of an impact on chlamydia positivity rates or estimated population prevalence from the Chlamydia Screening Implementation programme after three years at the participation levels obtained . The current evidence does not support a national roll out of this register based chlamydia screening programme . Trial registration NTR 3071 ( Netherl and s Trial Register , www.trialregister.nl ) Study objective : To assess whether  opportunistic and postal screening strategies  for Chlamydia trachomatis can be compared with usual care in a r and omised trial in general practice . Design : Feasibility study for a r and omised controlled trial . Setting : Three West of Scotl and general medical practice s : one rural , one urban/deprived , and one urban/affluent . Participants : 600 women aged 16–30 years , 200 from each of three participating practice s selected at r and om from a sample of West of Scotl and practice s that had expressed interest in the study . The women could opt out of the study . Those who did not were r and omly assigned to one of three groups : postal screening , opportunistic screening , or usual care . Results : 38 % ( 85 of 221 ) of the approached practice s expressed interest in the study . Data were collected successfully from the three participating practice s. There were considerable workload implication s for staff . Altogether 124 of the 600 women opted out of the study . During the four month study period , 55 % ( 81 of 146 ) of the control group attended their practice but none was offered screening . Some 59 % ( 80 of 136 ) women in the opportunistic group attended their practice of whom 55 % ( 44 of 80 ) were offered screening . Of those , 64 % ( 28 of 44 ) accepted , representing 21 % of the opportunistic group . Forty eight per cent ( 59 of 124 ) of the postal group returned sample s. Conclusion : A r and omised controlled trial comparing postal and opportunistic screening for chlamydial infection in general practice is feasible , although re source intensive . There may be problems with generalising from screening trials in which patients may opt out from the offer of screening OBJECTIVE : To estimate completion rate and acceptability of home screening for sexually transmitted infections ( STIs ) compared with clinic-based screening in a prospect i ve cohort study . METHODS : The first 462 women enrolled in the Contraceptive Choice Project were screened at the 12-month follow-up for Chlamydia trachomatis and Neisseria gonorrhoeae using str and displacement analysis of self-collected vaginal swabs . In a telephone interview , participants were given a choice of no-cost screening with swabs mailed to the participant 's home ( home-based ) or screening that was available at area family planning clinics without an appointment ( clinic-based ) . The clinic-based group also included women who elected to screen with their regular provider according to the clinician 's normal practice . We analyzed the rates of screening , including patient preference and the proportion of completed tests by testing method . RESULTS : Women were more likely to choose to screen for STIs at home than at a clinic or with their own medical provider ( 75.7 % compared with 16.1 % compared with 8.2 % , P<.001 ) . Women choosing clinic testing were more likely to be African American than those choosing home testing . African-American women constituted 42 % of the clinic group compared with 28 % of the home group ( relative risk [ RR ] 1.63 , 95 % confidence interval [ CI ] 1.14–2.31 ) . The groups did not differ in other demographic characteristics , STI risk factors , or access to health care . Overall , 228 women ( 56.6 % ) completed screening . Women who chose home-based testing were more likely to complete a test compared with all clinic-based testers ( 64.6 % compared with 31.6 % , RR 2.04 , 95 % CI 1.51–2.76 ) . CONCLUSION : Women overwhelmingly preferred to screen for STIs at home . Future interventions to increase screening rates in young women should consider alternative screening strategies such as home-based or patient-controlled testing . LEVEL OF EVIDENCE : Background : Screening has been recommended to reduce the prevalence and morbidity associated with genital chlamydia infection in the United Kingdom . Methods : We describe the rationale and study design of the Chlamydia Screening Studies ( ClaSS ) , a collaborative project design ed to evaluate screening outside genitourinary medicine clinics . A non-selective , active screening approach in 16–39 year olds r and omly sample d from 27 general practice lists in the Bristol and Birmingham areas formed the basis of interlinked studies : a case-control study was used to investigate factors to improve the targeting of screening ; participants with chlamydia were invited to enrol in a r and omised controlled trial to evaluate partner notification conducted in primary care ; and laboratory based studies were used to assess the best specimens and tests . We also explored psychosocial effects of screening and partner notification and modelled the cost effectiveness of the programme . Conclusion : Results from four pilot practice s show that mailing of specimens for chlamydia testing is feasible but that it is difficult to achieve high response rates with postal screening . The high prevalence of asymptomatic infection in men suggests that efforts to screen men for chlamydia should be strengthened Objective : The objective of this study was to determine whether home-based screening for sexually transmitted infections ( STIs ) is acceptable , feasible , and increases the proportion of women screened among low-income women in São Paulo , Brazil . Study Design : Eight hundred eighteen women were r and omized to receive a  clinic appointment  or a kit for home-based STI self- collection and testing . All participants collected 2 vaginal swabs , one for polymerase chain reaction detection of chlamydia , gonorrhea , and trichomoniasis and another for a self-conducted rapid test for trichomoniasis . Results : Slightly more women responded to the initiative within 2 weeks in the home group ( 80 % ) than in the clinic group ( 76 % ) with younger women showing improved response to home-based screening . Ninety-four percent of home group participants successfully completed self- collection and self-testing on their first attempt . Conclusions : Home-based self- collection and self-testing was acceptable , feasible , and result ed in a slightly higher response rate . Home sampling and testing provide promising alternatives to clinic-based STI screening across diverse context The effect of 2 population -based outreach screening strategies that used in-home sampling was compared with usual care practice s for Chlamydia trachomatis infection . All 30,439 persons 21 - 23 years old in Aarhus County , Denmark , were divided r and omly into 3 groups : group 1 ( n=4500 ) had a home sampling kit mailed directly to their central ly registered home address ; group 2 ( n=4500 ) had a reply card mailed to their home address with which a home sampling kit could be ordered ; and group 3 ( n=21,439 ) had access to usual care . For women in groups 1 and 2 , the relative risks of being tested were 4.1 ( 95 % confidence interval [ CI ] , 3.8 - 4.4 ) and 3.5 ( 95 % CI , 3.2 - 3.9 ) , respectively , compared with usual care . The corresponding figures for men were 19.1 ( 95 % CI , 16.0 - 22.8 ) and 11.8 ( 95 % CI , 9.8 - 14.2 ) , respectively . Both screening strategies were highly effective , but men benefited the most from having the home sampling kit provided directly Urogenital infections caused by Chlamydia trachomatis are common and may cause female infertility and ectopic pregnancy . Such infections are treatable but as C trachomatis often causes no symptoms they may remain undetected . As screening for C trachomatis reduces the number of complications,1 and self reportable screening criteria seem to have a low predictive value for infection,2 testing people not seeking medical care seems relevant . C trachomatis can be detected by amplification of DNA from urine and vaginal secretions— sample s that can be obtained at home and mailed directly to the laboratory . 3 4 Usually a swab sample is taken by a doctor but if a patient can collect a sample at home this may result in improved screening rates and thus more infections being detected . We r and omised all 17 high schools in Aarhus County into two screening groups . In the home sampling group the females were asked to collect two urine sample s and one vaginal flush sample 3 and the males were asked to collect one first OBJECTIVE : To determine whether the use of home-based , self-obtained vaginal swabs among women who were treated for Chlamydia infection can increase rescreening rates in comparison with clinic-based rescreening , and to identify subgroups in which rescreening could be enhanced using self-obtained vaginal swabs . METHODS : Two r and omized trials were conducted : one with enrollment in sexually transmitted disease ( STD ) clinics and the other in family planning clinics . Study participants were recruited from STD ( n=880 ) and family planning clinics ( n=412 ) in three cities . Females aged 16 years or older who were treated for Chlamydia infection were r and omly assigned to the home group ( swab collection kits mailed to home ) or the clinic group ( made clinic appointments ) for rescreening at 3 months after treatment , with reminder calls about 2 weeks before the scheduled rescreening date . RESULTS : Groups were similar with respect to age and other demographic characteristics . Women assigned to the home group had higher rescreening rates than those in the clinic group . In STD clinics , rescreening rates were 26.7 % ( home ) compared with 19.1 % ( clinic ) ( P=.01 ) . In family planning clinics , rescreening rates were 40.8 % ( home ) compared with 20.7 % ( clinic ) ( P<.001 ) . Among women reached by reminder calls , rescreening rates were also significantly higher in the home groups : 43.5 % compared with 33.0 % in STD clinic participants and 59.2 % compared with 37.8 % in family planning clinic participants ( both P<.05 ) . The rates of reinfection ranged from 12.9 % to 19.4 % , and the differences by group were not statistically significant ( P≥.3 ) . CONCLUSION : In STD and family planning clinics , use of home-based , self-obtained vaginal swabs result ed in significant increases in rescreening rates compared with rescreening in the clinic . Home-based specimen collection can be an alternative to clinic-based rescreening for Chlamydia infection in women . CLINICAL TRIAL REGISTRATION : Clinical trials.gov , www . clinical trials.gov , NCT 00132457 . LEVEL OF EVIDENCE : Background  Rescreening patients after treatment of Chlamydia trachomatis or Neisseria gonorrhoeae infection has had high yield but low rates of participation . Goal The goal of this study was to determine if rescreening for gonorrhea and chlamydial infection in a largely urban sexually transmitted disease population would be more successful if individuals were given the option of su bmi tting a specimen for testing through the mail . Study Design We conducted a r and omized clinical trial involving 122 patients of whom 62 were assigned to clinic rescreening and 60 were given the option of either mailing a specimen for testing or going to a clinic for rescreening . Results Twenty-seven patients ( 45 % ) given the option of either rescreening in the clinic or through the mail and 20 ( 32 % ) assigned to clinic rescreen 
    Output:
    
The review provides evidence that home-based testing results in greater uptake of STI screening in females ( 14 - 50 years ) than clinic-based testing without compromising quality in the developed world .