Abstract
BackgroundMore women are requesting Emergency Hormonal Contraception (EHC) at pharmacies where screening for Chlamydia trachomatis is not routinely offered. The objective of this study was to assess the uptake of free postal chlamydia screening by women under 25 years who requested EHC at pharmacies in Manchester, UK.MethodsSix Primary Care Trusts (PCTs) that had contracted with pharmacies to provide free EHC, requested the largest EHC providers (≥ 40 doses annually) to also offer these clients a coded chlamydia home testing kit. Pharmacies kept records of the ages and numbers of women who accepted or refused chlamydia kits. Women sent urine samples directly to the laboratory for testing and positive cases were notified. Audit data on EHC coverage was obtained from PCTs to assess the proportion of clients eligible for screening and to verify the uptake rate.Results33 pharmacies participated. Audit data for 131 pharmacy months indicated that only 24.8% (675/2718) of women provided EHC were also offered chlamydia screening. Based on tracking forms provided by pharmacies for the whole of the study, 1348/2904 EHC clients (46.4%) who had been offered screening accepted a screening kit. 264 (17.6%) of those who accepted a kit returned a sample, of whom 24 (9.1%) were chlamydia-positive. There was an increase in chlamydia positivity with age (OR: 1.2 per year; 1.04 to 1.44; p = 0.015).ConclusionChlamydia screening for EHC pharmacy clients is warranted but failure of pharmacists to target all EHC clients represented a missed opportunity for treating a well defined high-risk group.
Highlights
More women are requesting Emergency Hormonal Contraception (EHC) at pharmacies where screening for Chlamydia trachomatis is not routinely offered
The National Chlamydia Screening Programme (NCSP) is an opportunistic programme that offers screening to sexually active men and women under the age of 25 in clinical and non-clinical settings [1]
Primary Care Trusts (PCTs) are responsible for local pharmaceutical services, and six PCTs in Manchester had contracted with 76 pharmacies to provide free EHC under a Patient group directions (PGD) to women under 25 [23]
Summary
More women are requesting Emergency Hormonal Contraception (EHC) at pharmacies where screening for Chlamydia trachomatis is not routinely offered. The objective of this study was to assess the uptake of free postal chlamydia screening by women under 25 years who requested EHC at pharmacies in Manchester, UK. The National Chlamydia Screening Programme (NCSP) is an opportunistic programme that offers screening to sexually active men and women under the age of 25 in clinical and non-clinical settings [1]. In pilot studies conducted prior to the introduction of the NCSP in 2003, screening was taken up by about 50% of sexually active women aged 16–24 years [4], a level not achieved to date by the NCSP [1]. The annual screening and testing rate of sexually active young adults under 25 in a variety of healthcare and nonhealthcare settings (including tests at genitourinary medicine clinics) must be sustained above 35%, together with effective partner notification and management [5,6]. The most effective approaches for screening women for whom coverage is low have yet to be determined [10]
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