Chlamydia Screening Practices Research Articles

Chlamydia Screening Practices and Positivity Rates in University versus Regional Medical Centers

Chlamydia Screening Practices and Positivity Rates in University versus Regional Medical Centers

Chlamydia screening practices among physicians and community nurses in Yukon, Canada

BackgroundYukon, a territory in northern Canada, has one of the highest reported sexually transmitted chlamydia infection rates in the country.ObjectiveWe examined screening practices among physicians and community nurses to elucidate factors that may be contributing to the high rates.DesignCross-sectional survey.MethodsA questionnaire was distributed to all physicians in Yukon and all community nurses in Yukon's communities. We surveyed sexual health assessment frequency, chlamydia testing frequency and barriers to screening. Comparison of physician testing practices was performed to another Canadian jurisdiction, which previously undertook a similar survey. Survey results were compared to the available laboratory data in Yukon.ResultsEligible physicians and nurses, 79% and 77%, respectively, participated in the survey. Physicians tested 15 to 24-year-old females more frequently than 15 to 24-year-old males for chlamydia (p=0.007). Physicians who asked sexual health assessment questions were more likely to test for chlamydia in both females (p<0.001) and males (p=0.032). More physicians screened females based on risk factors compared to males. General practice physicians in Yukon were more likely to test females for chlamydia than general practice physicians in Toronto, Canada (p<0.001). Community nurses had different testing patterns than physicians, with a lower overall frequency of testing, equal frequency of testing males and females, and in applying risk factor-based screening to both males and females. Barriers to screening included testing causing patient discomfort, patients reluctant to discuss screening, health provider uncomfortable conducting sexually transmitted infection tests and sexual health assessments, among others. Laboratory data in Yukon appear to confirm provider screening patterns.ConclusionsThis survey provides valuable information on health provider screening patterns. We have some evidence which suggests that chlamydia testing rates may be higher among patients seen by physicians in Yukon in comparison to another Canadian jurisdiction. However, more consistent application of optimal screening methods with support to “start the conversation” around sexual health may assist in overcoming barriers to screening and in addressing Yukon's high rate of chlamydia.

Chlamydia trachomatis Infections Among Women Attending Prenatal Clinics

Chlamydia screening practices, positivity, and trends from 2004 to 2009 in publicly funded prenatal clinics have not been described. A phone-based survey assessing chlamydia screening practices was conducted among a random sample of clinics providing prenatal services (prenatal, family planning, and integrated clinics: "prenatal clinics") that reported data to the Infertility Prevention Project (IPP) in 2008. Using existing IPP data, chlamydia positivity and trends were assessed among women aged 15 to 24 years seeking care in any prenatal clinic reporting ≥3 years of data to IPP from 2004 to 2009. Linear trends of the effect of year (a continuous variable) on positivity were evaluated using a correlated modeling approach with a random intercept where the unit of analysis was the individual clinic performing chlamydia tests (clinic-based analysis). Covariates included race, age, test technology, and geography. Of 210 sampled clinics, 166 (79%) completed the survey. Of these, 163 (98.2%) had documented chlamydia screening criteria. Most clinics screened all women during their first trimester and reported 100% screening coverage. From 2004 to 2009, 267,416 tests among women aged 15 to 24 years were reported to IPP from eligible prenatal clinics. Overall chlamydia positivity was 8.3%. Controlling for all covariates, positivity decreased from 2004 to 2009 (odds ratio: 0.93 per year, 95% confidence interval: 0.92, 0.95, 35% decrease overall). The substantial burden of chlamydia among young women tested in prenatal clinics reporting data to IPP suggests the continued need for routine screening. Decreasing trends from 2004 to 2009 in the IPP prenatal population correspond to findings of overall decreasing chlamydia prevalence in the United States.

Chlamydia Screening of Adolescent Females: A Survey of Providers in Hawaii

Hawaii currently ranks first among states for chlamydia screening of young women based on recent Healthcare Effectiveness Data and Information Set (HEDIS) measures and has consistently ranked in the top ten states in the US for annual reported chlamydia rates since 2002. A statewide provider survey was conducted in October 2007 and March 2008 to assess chlamydia screening practices and beliefs and identify potential barriers to screening. The overall reported screening rate for 15-19year old females was 66.9% with significant differences by practice specialty (obstetrician/gynecologists were more likely to screen than family practitioners or pediatricians) and practice setting (higher rates of screening in non-private practice settings). Providers who were unaware of health plan reimbursement for screening and those who targeted screening only for clients perceived to be at "high risk" were significantly less likely to routinely provide screening. The Hawaii State Department of Health is currently working in consort with health care providers and the state's dominant health insurance carriers to address these issues through targeted provider educational interventions.

Upsurge of Chlamydial Reinfection in a Large Canadian City: An Indication of Suboptimal Chlamydia Screening Practices?

Objectives: Given the limited knowledge on chlamydial reinfection (CR) in Canada, we examined the extent and predictors of CR in Montreal, a large Canadian city. Methods: We retrospectively studied all Montreal residents aged =>10 years for whom =>1 laboratory-confirmed chlamydial infection was reported to the public health department between 1988 and 2007 (n=44,580). Each person was passively followed for two years after baseline infection or until reinfection. Socio-demographic factors and histories of other notifiable diseases were examined as potential predictors. Cox multivariate regression was used to model the time to CR. Survival analyses were stratified by age group ( 25 years). Results: We estimated an overall two-year CR rate of 6.4%, an incidence density of 3.5 per 100 person-years, and a median time to reinfection of nine months. CR significantly increased over time. Among persons 25 years, a history of sexually transmitted infections increased the risk of reinfection (AHR: 1.79). Conclusion: CR is a significant and growing problem in Montreal. The current recommendation for a single repeat screening six months post-treatment might be usefully complemented with additional screenings. Our results also underscore the importance of screening high-risk populations, particularly young women. Key words: Chlamydia trachomatis; urban spatial distribution; epidemiologic determinant; public health; infectious disease reporting; survival analysis

Upsurge of chlamydial reinfection in a large Canadian city: an indication of suboptimal chlamydia screening practices?

Given the limited knowledge on chlamydial reinfection (CR) in Canada, we examined the extent and predictors of CR in Montréal, a large Canadian city. We retrospectively studied all Montréal residents aged > or =10 years for whom > or =1 laboratory-confirmed chlamydial infection was reported to the public health department between 1988 and 2007 (n = 44,580). Each person was passively followed for two years after baseline infection or until reinfection. Socio-demographic factors and histories of other notifiable diseases were examined as potential predictors. Cox multivariate regression was used to model the time to CR. Survival analyses were stratified by age group (<25 vs. > or =25 years). We estimated an overall two-year CR rate of 6.4%, an incidence density of 3.5 per 100 person-years, and a median time to reinfection of nine months. CR significantly increased over time. Among persons <25 years, reinfection was significantly more likely among females [adjusted hazard ratio (AHR): 1.58] and younger participants (10-14 years: AHR: 2.98; 15-19 years: AHR: 1.81). Residing within the South Central sector was deleterious for six months following initial infection after which it became protective. Among persons > or =25 years, a history of sexually transmitted infections increased the risk of reinfection (AHR: 1.79). CR is a significant and growing problem in Montreal. The current recommendation for a single repeat screening six months posttreatment might be usefully complemented with additional screenings. Our results also underscore the importance of screening high-risk populations, particularly young women.

Overcoming the barriers to chlamydia screening in general practice--a qualitative study

There is low uptake of chlamydia screening in general practices registered with the English National Chlamydia Screening Programme (NCSP). Aims. To explore staff's attitudes and behaviour around chlamydia screening and how screening could be optimized in general practice. A qualitative study with focus groups and interviews, in general practices in seven NCSP areas. Twenty-five focus groups and 12 interviews undertaken with a purposively selected diverse group of high and low chlamydia-screening practices in 2006-08. Data were collected and analysed using a framework analytical approach. Higher screening practices had more staff with greater belief in patient and population benefits of screening and, as screening was a subjective norm, it was part of every day practice. Many staff in the majority of other practices were uncomfortable raising chlamydia opportunistically and time pressures meant that any extra public health issues covered within a consultation were determined by Quality Outcomes Framework (QOF) targets. All practices would value more training and feedback about their screening rates and results. Practices suggested that use of computer prompts, simplified request forms and more accessible kits could increase screening. Practice staff need more evidence of the value of opportunistic chlamydia screening in men and women; staff development to reduce the barriers to broaching sexual health; simpler request forms and easily accessible kits to increase their ability to offer it within the time pressures of general practice. Increased awareness of chlamydia could be attained through practice meetings, computer templates and reminders, targets and incentives or QOF points with feedback.

Adolescent chlamydia testing practices and diagnosed infections in a large managed care organization.

To determine chlamydia screening practices and the resulting positive test results for adolescents enrolled in a large nonprofit managed care organization. The electronic medical records of all 12- to 19-year-olds enrolled in a large nonprofit managed care organization serving a demographically diverse patient population from January 1998 through December 1999 were reviewed retrospectively. Among the 43,205 female and 44,133 male managed care organization members, ages 12 to 19 years in 1998-1999, 7575 adolescents (8.7%) (6914 females [16%] and 661 males [1.5%]) were tested for chlamydia. Among the members tested, chlamydia was diagnosed in 1109 adolescents (14.6%) (983 females [14.2] and 126 males [19.1%]); 761 (68.6%) adolescents were retested for chlamydia; and 182 (16.4%) had repeat positive test results. The median time to diagnosis of a repeat infection was 6 months. Chlamydia imposes a large disease burden in the private, organized healthcare sector. Managed care organizations can use operational data to enhance chlamydia prevention services by defining testing practices and local disease prevalence.

Barriers to screening sexually active adolescent women for chlamydia: a survey of primary care physicians.

To determine the proportion of primary care physicians who screen sexually active teenage women for chlamydia and to determine demographic factors, practice characteristics, and attitudes associated with chlamydia screening. We obtained a random sample of 1600 Pennsylvania physicians from the American Medical Association masterfile, stratified to include at least 40% women and equal numbers of family physicians, internists, obstetricians/gynecologists, and pediatricians. In January 1998, physicians received mailed questionnaires; nonrespondents received two follow-up mailings. Physician characteristics associated with chlamydia screening were determined using bivariate and logistic regression analyses. Only one-third of physicians responded that they would screen asymptomatic, sexually active teenage women for chlamydia during a routine gynecologic examination. In multivariate analysis, physicians were significantly (p <.05) more likely to screen if they were female (43% vs. 24%), worked in a clinic versus solo practice (60% vs. 18%), worked in a metropolitan location (46% vs. 26%), or had a patient population > or = 20% African-American (54% vs. 25%). Attitudes associated with screening included the belief that most 18-year-old women in their practice were sexually active (36% vs. 12%), feeling responsible for providing information about the prevention of sexually transmitted diseases to their patients (42% vs. 21%), or knowing that screening for chlamydia prevents pelvic inflammatory disease (37% vs. 13%). Physicians were less likely to screen if they believed that the prevalence of chlamydia was low (10% vs. 41%). A majority of physicians do not adhere to recommended chlamydia screening practices for teenage women. Interventions to improve chlamydia screening might target physicians who are male, in private practice, or who practice in rural areas, and should focus on increasing awareness of the prevalence of chlamydia and benefits of screening.

From the Centers for Disease Control and Prevention. Chlamydia screening practices of primary-care providers--Wake County, North Carolina, 1996

From the Centers for Disease Control and Prevention. Chlamydia screening practices of primary-care providers--Wake County, North Carolina, 1996

Chlamydia Screening Practices of Primary-Care Providers—Wake County, North Carolina, 1996

Chlamydia Screening Practices of Primary-Care Providers—Wake County, North Carolina, 1996