Search

Objectives: Identify and abstract data from randomized controlled trials (RCTs) examining treatment for posttraumatic stress disorder (PTSD) and comorbid PTSD/substance use disorder to update the previous Agency for Healthcare Research and Quality (AHRQ) report and National Center for PTSD (NCPTSD) PTSD Trials Standardized Data Repository (PTSD-Repository)., Data Sources: We searched PTSDpubs, Ovid ® MEDLINE ® , Cochrane CENTRAL, PsycINFO ® , Embase ® , CINAHL ® , and Scopus ® for eligible RCTs published from June 1, 2018, to January 26, 2022., Review Methods: In consultation with AHRQ and NCPTSD, we updated the evidence tables for the PTSD-Repository by including evidence published after publication of the last update and expanding abstraction of results to include calculated standardized effect sizes. The primary publication for each RCT was abstracted; data and citations from secondary publications (i.e., companion papers) appear in the same record. We assessed risk of bias (RoB) for all newly included studies using the Revised Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials. For studies already in the PTSD-Repository, we will add calculated standardized effect sizes and update RoB using the new RoB 2 tool over the next several annual updates., Results: We added 48 new RCTs examining treatments for PTSD, for a total of 437 included studies published from 1988 to July 30, 2021. Among the 48 newly added RCTs, psychotherapy interventions were the most commonly employed (50%), followed by complementary and integrative health (17%). Approximately half of studies were conducted in the United States (46%), and enrolled community participants (52%) and participants with a mix of trauma types (48%). Studies typically had sample sizes ranging from 25 to 99 participants (69%). RoB was rated as high for 52 percent of studies, 31 percent were rated as low RoB, and the remaining studies were rated as having some concerns (15%)., Conclusions: This report updates the previous AHRQ report to include 48 recently published RCTs, for a total of 437 studies. This update adds comprehensive data, standardized effect sizes for PTSD outcomes, and RoB assessment for the newly included RCTs. As with the previous AHRQ update, this report will inform updates to the PTSD-Repository, a comprehensive database of PTSD trials.

Background: In 2014, the U.S. Preventive Services Task Force (USPSTF) recommended screening for chlamydia and gonorrhea in asymptomatic, sexually active women, aged 24 years or younger and in older women who are at increased risk for infection. There was insufficient evidence to recommend for or against screening in men., Purpose: To update the 2014 systematic review and synthesize evidence for the USPSTF on the effectiveness of screening for chlamydial and gonococcal infection in adults and adolescents, including those who are pregnant., Data Sources: Cochrane Central Register of Controlled Trials (January 2014 through May 2020) and Cochrane Database of Systematic Reviews (January 2014 through May 2020), and MEDLINE (January 2014 through May 2020), and manually reviewed reference lists); with surveillance through May 21, 2021., Study Selection: English-language trials and observational studies on screening effectiveness, accuracy of risk stratification and alternative screening methods, test accuracy, and screening harms., Data Extraction: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF., Data Synthesis (results): 20 studies met inclusion criteria (N=179,515); seven studies were carried forward from the prior report. Three previously included trials of women found chlamydia screening associated with decreased risk of PID versus no screening, though effects were not statistically significant in two trials. One new, good-quality trial of young women and men in primary care clinics found screening for chlamydia associated with decreased risk of hospital diagnosed primary pelvic inflammatory disease (PID) (Relative Risk [RR] 0.6; 95% Confidence Interval [CI], 0.4 to 1.0), though absolute effects were small (absolute difference −0.137%). Screening was not associated with decreased risk of clinic diagnosed PID (RR 1.1; 95% CI, 0.7 to 1.8) or epididymitis in men (RR 0.9; 95% CI, 0.6 to 1.4). Three studies on the accuracy of risk prediction instruments in asymptomatic persons reported an area under the receiver operating characteristic curve (AUC) that ranged from 0.64 to 0.73. Using age criteria alone (<22 years) to selectively screen women for chlamydial and gonococcal infection demonstrated similar accuracy (AUC 0.687, Standard Deviation [SD] 0.014) compared with more extensive risk criteria. Nine studies of diagnostic accuracy found high specificity across anatomic sites, including urine. Sensitivity was high for chlamydial testing in females for all anatomic sites including endocervical testing (range 89 to 100%) and vaginal testing (range 90 to 100%). Studies found high sensitivity of meatal (100%) urethral (99%) and rectal (92%) testing for chlamydia in males, but evidence was limited to one study each. Evidence on pharyngeal testing was limited to one study of MSM that demonstrated low sensitivity for chlamydial infection (69.2%) and higher sensitivity for gonococcal infection (89.1%). Gonococcal testing in females demonstrated highest sensitivity in vaginal samples (>98%) followed by endocervical (>96%) and urine samples (>89%). The sensitivity of urine testing for gonococcal infection in males was 93 to 100 percent, while sensitivity ranged from 89 to 100 percent for other sites. Three studies demonstrated that self- and clinician-collected vaginal samples for chlamydia and gonorrhea diagnosis were highly sensitive (90 to 100%); no studies meeting inclusion criteria compared collection methods in males. False-positive and false-negative rates were low for testing across anatomic sites and for self- versus clinician- collection of samples. No studies evaluated screening intervals or accuracy of concurrent testing for other infections. Data was lacking for effects of screening on psychosocial harms or effect on risk behaviors or risk perception., Limitations: English language articles only; methodological limitations in the trials; most studies conducted in higher risk populations or settings; meta-analysis not performed; unable to assess for publication bias; studies lacking for pregnant individuals., Conclusions: Screening for chlamydial infection may reduce the incidence of PID in young women. Risk prediction criteria to identify persons with asymptomatic chlamydial or gonococcal infection are associated with limited accuracy and require further validation. Testing for asymptomatic chlamydial and gonococcal infections is accurate at most anatomic sites, using urine sampling, and using self-collected specimens. Research is needed to determine the effectiveness of screening in men, optimal screening intervals, and adverse effects of screening.