Abstract
BackgroundChlamydia trachomatis (chlamydia), the most commonly reported sexually transmitted infection (STI) in the Netherlands, can lead to severe reproductive complications. Reasons for the sustained chlamydia prevalence in young individuals, even in countries with chlamydia screening programs, might be the asymptomatic nature of chlamydia infections, and high reinfection rates after treatment. When individuals are unaware of their infection, preventive behaviour or health-care seeking behaviour mostly depends on psychological determinants, such as risk perception. Furthermore, behaviour change after a diagnosis might be vital to reduce reinfection rates. This makes the incorporation of psychological determinants and behaviour change in mathematical models estimating the impact of interventions on chlamydia transmission especially important. Therefore, quantitative real-life data to inform these models is needed.MethodsA longitudinal cohort study will be conducted to explore the link between psychological and behavioural determinants and chlamydia (re)infection among heterosexual STI clinic visitors aged 18–24 years. Participants will be recruited at the STI clinics of the public health services of Amsterdam, Hollands Noorden, Kennemerland, and Twente. Participants are enrolled for a year, and questionnaires are administrated at four time points: baseline (before an STI consultation), three-week, six-month and at one-year follow-up. To be able to link psychological and behavioural determinants to (re)infections, participants will be tested for chlamydia at enrolment and at six-month follow-up. Data from the longitudinal cohort study will be used to develop mathematical models for curable STI incorporating these determinants to be able to better estimate the impact of interventions.DiscussionThis study will provide insights into the link between psychological and behavioural determinants, including short-term and long-term changes after diagnosis, and chlamydia (re)infections. Our mathematical model, informed by data from the longitudinal cohort study, will be able to estimate the impact of interventions on chlamydia prevalence, and identify and prioritise successful interventions for the future. These interventions could be implemented at STI clinics tailored to psychological and behavioural characteristics of individuals.Trial registrationDutch Trial Register NTR-6307. Retrospectively registered 11-nov-2016.
Highlights
Chlamydia trachomatis, the most commonly reported sexually transmitted infection (STI) in the Netherlands, can lead to severe reproductive complications
We propose that incorporating these determinants in mathematical models will improve the impact assessment of interventions aimed at reducing chlamydia transmission
Chlamydia interventions that have been applied in practice have mainly focused on increasing testing uptake, and previous mathematical modelling studies have shown that, depending on the coverage of chlamydia testing in the general population, testing and treatment could be an effective strategy to reduce chlamydia prevalence, [30, 68, 69]
Summary
Chlamydia trachomatis (chlamydia), the most commonly reported sexually transmitted infection (STI) in the Netherlands, can lead to severe reproductive complications. Chlamydia trachomatis (chlamydia) is the most commonly diagnosed bacterial STI among young heterosexual men and women in many western countries, including the Netherlands with up to 55,000 diagnosed infections in STI clinics nationally each year [1] Control of this infection is of public health importance, because it can cause severe reproductive complications, including pelvic inflammatory disease (PID), ectopic pregnancy and tubal subfertility [2,3,4,5]. It is unclear why the prevalence of chlamydia remains unchanged even in countries with chlamydia screening programs, such as England, Australia, Canada, and the United States [6]. Many young people tend to underestimate their personal risk of acquiring chlamydia [8, 16], which could have a negative effect on their condom use and testing uptake [8, 10, 17]
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