You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study
Abstract 1:
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


Title 2:
Use of Home-Obtained Vaginal Swabs to Facilitate Rescreening for Chlamydia trachomatis Infections: Two Randomized Controlled Trials
Abstract 2:
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 :


Title 3:
Home sampling versus conventional contact tracing for detecting Chlamydia trachomatis infection in male partners of infected women: randomised study
Abstract 3:
Urogenital infections with Chlamydia trachomatis are widespread and usually asymptomatic . Major complications from infection include ectopic pregnancies and female infertility.1 Although contact tracing reduces the prevalence of chlamydia infection,2 the test rate among partners is often low , partly because male contacts have to have a urethral swab taken by a doctor . As the polymerase chain reaction can successfully detect infection in urine sample s,3 we investigated whether the test rate could be increased by asking the male contacts of infected women to send a urine sample directly from home to a laboratory instead of having a doctor take a urethral swab .  Ninety six women with C trachomati s infection seen in general practice s in Aarhus County , Denmark , were r and omly divided according to their date of birth into an intervention group ( 45 patients ) and a


Title 4:
Home screening for sexually transmitted diseases in high-risk young women: randomised controlled trial
Abstract 4:
Objective : Home screening tests could eliminate several barriers to testing sexually transmitted diseases ( STDs ) . Aim : To determine whether offering repeated home screening tests would increase the rate of testing for chlamydia and gonorrhoea in a high-risk sample of young women . Methods : In this r and omised controlled trial , 403 young women ( mean age 18.9 years , 70 % black ) with a recent STD or with STD-related risk factors were enrolled . Participants were recruited from clinics and high-prevalence neighbourhoods and then r and omly assigned to receive either a home testing kit or an invitation to attend a medical clinic for testing at 6 , 12 and 18 months after enrollment . Over 80 % of women were followed for 2 years . The trial is registered with Clinical Trials.gov , number NCT 00177437 . Results : Of 197 women in the intervention group , 140 ( 71 % ) returned at least one home test and 25 of 249 ( 10 % ) home tests were positive . Women who received home screening tests completed significantly more STD tests overall ( 1.94 vs 1.41 tests per woman-year , p<0.001 ) and more STD tests in the absence of symptoms ( 1.18 vs 0.75 tests per woman-year , p<0.001 ) . More women in the intervention group completed at least one test when asymptomatic ( 162 ( 82.2 % ) vs 117 ( 61.3 % ) , p<0.001 ) . The intervention was most effective among women recruited outside medical clinics . There was no significant difference in the overall rate of STDs detected . Conclusions : Home screening significantly increased the utilisation of chlamydia and gonorrhoea testing in this sample of high-risk young women , and thus represents a feasible strategy to facilitate STD testing in young women


Title 5:
The Evidence Project risk of bias tool: assessing study rigor for both randomized and non-randomized intervention studies
Abstract 5:
Background Different tools exist for assessing risk of bias of intervention studies for systematic review s. We present a tool for assessing risk of bias across both r and omized and non-r and omized study design s. The tool was developed by the Evidence Project , which conducts systematic review s and meta-analyses of behavioral interventions for HIV in low- and middle-income countries . Methods We present the eight items of the tool and describe considerations for each and for the tool as a whole . We then evaluate reliability of the tool by presenting inter-rater reliability for 125 selected studies from seven published review s , calculating a kappa for each individual item and a weighted kappa for the total count of items . Results The tool includes eight items , each of which is rated as being present ( yes ) or not present ( no ) and , for some items , not applicable or not reported . The items include ( 1 ) cohort , ( 2 ) control or comparison group , ( 3 ) pre-post intervention data , ( 4 ) r and om assignment of participants to the intervention , ( 5 ) r and om selection of participants for assessment , ( 6 ) follow-up rate of 80 % or more , ( 7 ) comparison groups equivalent on sociodemographics , and ( 8) comparison groups equivalent at baseline on outcome measures . Together , items (1)–(3 ) summarize the study design , while the remaining items consider other common elements of study rigor . Inter-rater reliability was moderate to substantial for all items , ranging from 0.41 to 0.80 ( median κ = 0.66 ) . Agreement between raters on the total count of items endorsed was also substantial ( κw = 0.66 ) . Conclusions Strengths of the tool include its applicability to a range of study design s , from r and omized trials to various types of observational and quasi-experimental studies . It is relatively easy to use and interpret and can be applied to a range of review topics without adaptation , facilitating comparability across review s. Limitations include the lack of potentially relevant items measured in other tools and potential threats to validity of some items . To date , the tool has been applied in over 30 review s. We believe it is a practical option for assessing risk of bias in systematic review s of interventions that include a range of study design


Title 6:
Could Home Sexually Transmitted Infection Specimen Collection With e-Prescription Be a Cost-Effective Strategy for Clinical Trials and Clinical Care?
Abstract 6:
Background Results of a recent demonstration project evaluating feasibility , acceptability , and cost of a  Web-based sexually transmitted infection ( STI ) testing and e-prescription treatment program ( eSTI ) suggest that this approach could be a feasible alternative to clinic-based testing and treatment , but the results need to be confirmed by a r and omized comparative effectiveness trial . Methods We modeled a decision tree comparing ( 1 ) cost of eSTI screening using a home collection kit and an e-prescription for uncomplicated treatment versus ( 2 ) hypothetical costs derived from the literature for referral to st and ard  clinic-based STI screening and treatment . Primary outcome was number of STIs detected . Analyses were conducted from the clinical trial perspective and the health care system perspective . Results The  eSTI strategy detected 75 infections , and the clinic referral strategy detected 45 infections .  Total cost of eSTI  was $ 94,938 ( $ 1266/STI detected ) from the clinical trial perspective and $ 96,088 ( $ 1281/STI detected ) from the health care system perspective . Total cost of clinic referral was $ 87,367 ( $ 1941/STI detected ) from the clinical trial perspective and $ 71,668 ( $ 1593/STI detected ) from the health care system perspective . Conclusions Results indicate that eSTI will likely be more cost-effective ( lower cost/STI detected ) than clinic-based STI screening , both in the context of clinical trials and in routine clinical care . Although our results are promising , they are based on a demonstration project and estimates from other small studies . A comparative effectiveness research trial is needed to determine actual cost and impact of the eSTI system on identification and treatment of new infections and prevention of their sequelae
Discussion While greater diversity in study design s , outcomes and setting s would strengthen the evidence base , findings from this review suggest that self- collection of STI sample s could be an effective additional strategy to increase STI testing uptake .