The chlamydia care cascade of young people attending Australian general practices; a descriptive study to assess gaps in care.

Abstract

Most chlamydia infections in Australia are diagnosed in general practice. The care cascade concept (testing, treatment and re-testing) can be utilised to explore the management of chlamydia infections. We explored the chlamydia care cascade among young people attending general practices in Australia. We analysed de-identified electronic medical record data for 16-29-year-old individuals attending 70 Australian general practices between January 2018 and December 2020. Five outcomes: (1) chlamydia testing, (2) positivity, (3) treatment, (4) re-testing and (5) re-infection were summarised as annual counts and proportions per calendar year. Logistic regression was used to investigate the association of age, gender and clinic location with each outcome. During the study period, a total of 220909 clinical episodes involving 137358 16-29-year-olds were recorded. Of these episodes, 10.45% (n =23077, 95% CI 8.73-12.46) involved a chlamydia test. Of 1632 chlamydia cases, 88.79% (n =1449, 95% CI 86.37-90.82) had appropriate antibiotics recorded as defined in Australian sexually transmitted infection management guidelines. Of 183 chlamydia cases that did not have appropriate antibiotics recorded, 46.45% (n =85) had re-attended the clinic within 90days of diagnosis. Among 1068 chlamydia cases that had appropriate antibiotic recorded in 2018 and 2019, 22.57% (n =241, 95% CI 20.15-25.18) were re-tested within 6weeks to 4months of their diagnosis. One-third of episodes of chlamydia cases that did not have a re-test recorded (n =281) had re-attended the clinics within 4months of diagnosis. Our study provides insight into chlamydia management by analysing general practice medical records, indicating substantial gaps in testing and re-testing for 16-29-year-olds. These data can also be used to explore the impact of future interventions to optimise chlamydia management.