***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: Background DNA amplification assays are increasingly being used to facilitate the testing of asymptomatic individuals for urogenital Chlamydia trachomatis . The long-term clinical benefit in terms of avoided infertility and ectopic pregnancy is unknown . Methods In 1997 , 15 459 women and 14 980 men aged 21–23 years were living in Aarhus County , Denmark . A r and om sample of 4000 women and 5000 men was contacted by mail and offered the opportunity to be tested for C trachomatis by means of a sample obtained at home and mailed directly to the laboratory .  The remaining 11 459 women and 9980 men received usual care  and constituted the control population . All men and women were subsequently followed for 9 years by the use of Danish health registers . Data were collected on pelvic inflammatory disease ( PID ) , ectopic pregnancy ( EP ) , infertility diagnoses , in-vitro fertilisation ( IVF ) treatment and births in women , and on epididymitis in men . The intervention and control groups were compared using Cox regression analyses and the intention-to-screen principle . Results Among women , no differences were found between the intervention group and the control group : HR ( 95 % CI ) for PID 1.12 ( 0.70 to 1.79 ) ; EP 0.97 ( 0.63 to 1.51 ) ; infertility 0.87 ( 0.71 to 1.07 ) ; IVF treatment 0.88 ( 0.62 to 1.26 ) and births 1.02 ( 0.95 to 1.10 ) . In men , the HR for epididymitis was 1.25 ( 0.70 to 2.24 ) . Conclusions A population -based offer to be tested for urogenital C trachomatis infection by the use of non-invasive sample s and DNA amplification did not reduce the long-term risk of reproductive complications in women or of epididymitis in men . Trial registration number in www . clinical trials.gov NCT 00827970 Home testing for chlamydia and gonorrhea increases screening rates , but the cost consequences of this intervention are unclear . We examined the cost differences between home-based and clinic-based testing and the cost-effectiveness of home testing based on the DAISY study , a r and omized controlled trial . Direct and indirect costs were estimated for home and clinic testing , and cost-effectiveness was calculated as cost per additional test performed . In the clinic testing group , direct costs were 49/test and indirect costs ( the costs of seeking or receiving care ) were 62/test . Home testing cost was 25/test . We found that home testing was cost saving when all testing for all patients was considered . However cost savings were not seen when only asymptomatic tests or when patient subgroups were considered . A home testing program could be cost saving , depending on whether changes in clinic testing frequency occur when home testing is available 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 Background As most genital Chlamydia trachomatis infections are asymptomatic , many patients do not seek health care for testing . Infections remain undiagnosed and untreated . We studied whether screening with information and home sampling result ed in more young people getting tested , diagnosed and treated for chlamydia in the three months following the intervention compared to the current strategy of testing in the health care system . Method We conducted a population based r and omized controlled trial among all persons aged 18–25 years in one Norwegian county ( 41 519 persons ) . 10 000 persons ( intervention ) received an invitation by mail with chlamydia information and a mail-back urine sampling kit . 31 519 persons received no intervention  and continued with usual care ( control ) . All sample s from both groups were analysed in the same laboratory . Information on treatment was obtained from the Norwegian Prescription Data base ( NorPD ) . We estimated risk ratios and risk differences of being tested , diagnosed and treated in the intervention group compared to the control group . Results In the intervention group 16.5 % got tested and in the control group 3.4 % , risk ratio 4.9 ( 95 % CI 4.5 - 5.2 ) . The intervention led to 2.6 ( 95 % CI 2.0 - 3.4 ) times as many individuals being diagnosed and 2.5 ( 95 % CI 1.9 - 3.4 ) times as many individuals receiving treatment for chlamydia compared to no intervention in the three months following the intervention . Conclusion In Norway , systematic screening with information and home sampling results in more young people being tested , diagnosed and treated for chlamydia in the three months following the intervention than the current strategy of testing in the health care system . However , the study has not established that the intervention will reduce the chlamydia prevalence or the risk of complications from chlamydia . Trial registration Clinical Trials.gov 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 Background Repeat infection with Chlamydia trachomatis is common and increases the risk of sequelae in women and HIV seroconversion in men who have sex with men ( MSM ) . Despite guidelines recommending chlamydia retesting three months after treatment , retesting rates are low . We are conducting the first r and omised controlled trial to assess the effectiveness of home collection combined with short message service ( SMS ) reminders on chlamydia retesting and reinfection rates in three risk groups . Methods / Design The REACT ( retest after Chlamydia trachomatis ) trial involves 600 patients diagnosed with chlamydia : 200 MSM , 200 women and 200 heterosexual men recruited from two Australian sexual health clinics where SMS reminders for retesting are routine practice . Participants will be r and omised to the home group ( 3-month SMS reminder and home- collection ) or the clinic group ( 3-month SMS reminder to return to the clinic ) . Participants in the home group will be given the choice of attending the clinic if they prefer . The mailed home- collection kit includes a self-collected vaginal swab ( women ) , UriSWAB ( Copan ) for urine collection ( heterosexual men ) , and UriSWAB plus rectal swab ( MSM ) . The primary outcome is the retest rate at 1 - 4 months after a chlamydia diagnosis , and the secondary outcomes are : the repeat positive test rate ; the reinfection rate ; the acceptability of home testing with SMS reminders ; and the cost effectiveness of home testing . Sexual behaviour data collected via an online survey at 4 - 5 months , and genotyping of repeat infections , will be used to discriminate reinfections from treatment failures . The trial will be conducted over two years . An intention to treat analysis will be conducted . Discussion This study will provide evidence about the effectiveness of home- collection combined with SMS reminders on chlamydia retesting , repeat infection and reinfection rates in three risk groups . The trial will determine client acceptability and cost effectiveness of this strategy .Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN12611000968976 We examined the effect of a question naire addressing sexual behaviour on participation in a systematic screening programme for asymptomatic Chlamydia trachomatis infections . Furthermore , we compared participation among persons requested to mail a home-obtained urine sample directly to the laboratory and persons requested to bring a sample to the physician 's office . Seven hundred and fifty men and women were r and omly assigned to receive a question naire with or without intimate questions and to deliver or mail the sample s. The inclusion of questions about sexual behaviour did not affect participation among both men and women . Among women there was no difference in participation between delivering or mailing the sample . Among men delivering the sample , participation was 18 % ( 95 % confidence interval [ CI ] : 5 - 32 ) lower . This study shows that questions on sexual behaviour can be included in a screening question naire without adversely affecting participation . Furthermore , mailing the specimens is the most efficient strategy for men , when screening for C. trachomatis by means of home-obtained urine specimens Background : In Engl and , screening for genital chlamydial infection has begun ; however , screening frequency for women is not yet determined . Aim : To measure chlamydia incidence and reinfection rates among young women to suggest screening intervals . Methods : An 18-month prospect i ve cohort study of women aged 16–24 years recruited from general practice s , family planning clinics and genitourinary medicine ( GUM ) clinics : baseline-negative women followed for incidence and baseline-positive women for reinfection ; urine tested every 6 months via nucleic acid amplification ; and behavioural data collected . Extra test and question naire completed 3 months after initial positive test . Factors associated with infection and reinfection investigated using Cox regression stratified by healthcare setting of recruitment . Results : Chlamydia incidence was mean ( 95 % CI ) 4.9 ( 2.7 to 8.8 ) per 100 person-years ( py ) among women recruited from general practice s , 6.4 ( 4.2 to 9.8 ) from family planning clinics and 10.6 ( 7.4 to 15.2 ) from GUM clinics . Incidence was associated with young age , history of chlamydial infection and acquisition of new sexual partners . If recently acquiring new partners , condom use at last sexual intercourse was independently associated with lower incidence . Chlamydia reinfection was mean ( 95 % CI ) 29.9 ( 19.7 to 45.4 ) per 100/person-year from general practice s , 22.3 ( 15.6 to 31.8 ) from family planning clinics and 21.1 ( 14.3 to 30.9 ) from GUM clinics . Factors independently associated with higher reinfection rates were acquisition of new partners and failure to treat all partners . Conclusions : Sexual behaviours determined incidence and reinfection , regardless of healthcare setting . Our results suggest annual screening of women aged 16–24 years who are chlamydia negative , or sooner if partner change occurs . Rescreening chlamydia-positive women within 6 months of baseline infection may be sensible , especially if partner change occurs or all partners are not treated 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 
    Output:
    
Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection .
Increases in the proportion of individuals tested as a result of home-based , compared with clinic-based , specimen collection are offset by a lower proportion of positive results .