Acceptability of urine-based screening for Chlamydia trachomatis in asymptomatic young men: a systematic review.

We performed a structured literature review of published studies from 2000-2007 that measured the acceptability and acceptance (uptake) of urine testing for C. trachomatis among asymptomatic men. Studies were categorized as three types: (a) non-STD clinic venues where men were approached in person and offered testing on site (urgent care clinics, freestanding clinics or health screening settings, corrections, community centers); (b) delivery of testing kits to men at their homes; and (c) qualitative measurement related to men's experience of screening. When offered in established nonhome-based settings (clinics, schools, corrections), acceptability and consequent uptake of testing by men is generally good (mid-60% range). However, acceptance rates even in these settings vary widely and are influenced by venue, provider, and a diversity of other factors. Acceptance of home-based testing invitations, including direct mailing of test kits, is considerably lower. Attitudinal characteristics of men who decline testing primarily include low self-perception of risk for asymptomatic infection and perceived inconvenience of providing test specimens. Given these findings, testing strategies targeting asymptomatic men in established community and clinic settings are most likely to yield relatively high acceptance rates. However, barriers to both implementation and uptake remain, even when such testing is free. Interventions to enhance uptake of testing in asymptomatic men should be developed and selected with underlying C. trachomatis population prevalence in mind.