National guidelines in England recommend testing men who have sex with men (MSM) at high risk of sexually transmitted infections (STIs) every 3 months for HIV and STIs. Modelling studies suggest that 3-monthly testing is cost saving and could reduce the number of new HIV infections. Despite this, cross-sectional survey data suggests that less than a quarter of MSM in England and Scotland have four or more HIV tests per year.
Reminders in healthcare improve attendance and reattendance rates. Reminders for STI or HIV testing include text messages, emails, telephone calls or letters. Sending out a kit for home sample collection or testing is another option. National guidance recommends use of reminders for encouraging retesting of MSM, but only a quarter of sexual health clinics have a recall system in place. Healthcare providers need to know which is the most effective approach to increase reattendance/retesting rates before widespread implementation.
Several studies have examined the effectiveness of active recall for healthcare appointments in general. A review of interventions to increase rates of rescreening for chlamydia found evidence for mailing rescreening kits, to increase retesting rates and for telephone reminders, but evidence for text messages has been conflicting.
The reason for the conflicting evidence may be related to barriers to reminders that may reduce their acceptability and effectiveness in increasing reattendance or retesting and need to be explored. Concerns regarding privacy, confidentiality and data protection have led to some services providing opt-in schemes.
Text message reminders have the potential to be a useful active recall intervention if efficacy can be demonstrated. It is an inexpensive, unobtrusive and simple way of reminding patients about healthcare appointments, but it is a relatively new technology within the healthcare field. In high-income countries, 70–90% of people have a mobile phone subscription, similar among all socioeconomic groups.
Mailing rescreening kits, or home sampling in which a patient takes his/her own sample, also has the potential to access individuals for whom accessing a service is a barrier. Home sampling can increase uptake, but not necessarily frequency of testing and surveys of attitudes to self-sampling have highlighted barriers to self-sampling including timeliness of results, accuracy and lack of immediate professional support.
We conducted a systematic literature review to compare the impact of active recall interventions in increasing screening and rescreening rates as well as the detection of HIV and STIs in patients who are HIV-negative or of unknown status.