Chlamydia Testing Rates Research Articles

P09.13 Impact and cost-effectiveness of point-of-care testing for chlamydia: accounting for geographic variation in infection burden and testing rates, health service configuration, and implementation strategy

Introduction Point-of-care tests (PoCTs) for Chlamydia trachomatis potentially improve control by reducing transmission through reduced treatment delay, reduced loss to follow up, and greater convenience for patients leading to increased testing. However, with ~3–5 fold variation in rates of Chlamydia testing and diagnosis across geographic settings in England, in assessing cost-effectiveness the epidemiological context needs to be considered. Methods We developed a transmission-dynamic model to capture geographic variation in rates of testing and diagnosis using current technology to allow assessment of the impact of implementing PoCTs in different clinical services in different localities. The model incorporates heterogeneity in sexual partner change rates and is stratified by age and sex. It uses behavioural and prevalence data from the Natsal national survey, and Public Health England surveillance data on testing and diagnosis rates. Uncertainty in natural history and behavioural parameters is captured by Monte Carlo methods. Health service reconfiguration using PoCT is considered, including rates of PoCT introduction and reduction in presumptive treatment. Results The model captures observed geographic variation in rates of testing and diagnosis in females and males, which affects the impact and cost-effectiveness of PoCT introduction. In general, whilst PoCTs may reduce incidence by increasing diagnosis and treatment, if sensitivity is lower than conventional testing then there is potentially increased transmission from false-negative patients. The net effect depends upon characteristics of the particular PoCT. Conclusion PoCT sensitivity and specificity are key determinants of whether replacing conventional testing is likely to reduce or increase the incidence of infection. Importantly, if the convenience of PoCT increases testing rates then diagnoses might initially increase even though incidence falls; interpretation of surveillance data needs to account for this. This work is the foundation of a user-friendly web-based tool assessing the (cost-) effectiveness of introducing PoCTs in different local settings. Disclosure of interest statement CED, ESS, NG, EHE, RHJ, YC, CML, and PJW thank Innovate UK for funding. PJW thanks the UK Medical Research Council for Centre funding (grant MR/K010174/1), and also thanks the UK National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Modelling Methodology at Imperial College London in partnership with Public Health England (PHE) for funding (grant HPRU-2012–10080). The funding sources had no involvement in the study design or conduct; the collection, analysis and interpretation of data; the preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health, or Public Health England. CED was employed for part of the project by the National Chlamydia Screening Programme. The other authors declare no competing interests.

P13.09 Evaluation of a pilot to improve primary care sexual health services in england: analysis of chlamydia testing and diagnosis rate changes

Introduction Provision of sexual health services in primary care is necessary to reduce STIs, such as chlamydia. We piloted an educational training programme, based on the theory of planned behaviour, for general practice staff with the aim of increasing chlamydia and HIV testing, and provision of condoms and contraceptive information (3Cs and HIV). Methods The pilot was delivered with a step wedge design over three phases. Chlamydia testing and diagnosis rates pre and post-training were compared separately for men and women using a multivariable negative binomial regression model with general practice fitted as a random effect. Month of test and practice population size were adjusted for and an interaction between the intervention and area of implementation fitted. Results 460 general practices agreed to participate in the pilot. These conducted 2448 tests across the pre and post intervention period. Intention to treat analysis showed decreased median test and diagnoses per month post-intervention (2.68 vs 2.67; 0.14 vs 0.13 respectively). The multivariable regression analysis did not find a significant change in testing or diagnoses of men. There was a significant increase in testing (IRR 1.15 CI 1.01–1.31) of women but no change in diagnoses (IRR 0.98 CI 0.84–1.18). Interaction between the intervention and area of implementation was found in both testing rate models for women. Conclusion This large national pilot found that educational support sessions slightly increased chlamydia testing in women within general practices after they received the 3Cs and HIV training but not diagnoses. The area of implementation had an impact on the programme’s effect, so further exploration of the factors that contribute to this increase is required. Disclosure of interest statement Public Health England is funded by the UK Department of Health.

S09.1 How can chlamydia screening work in australian general practice?

General practice potentially has an important role in the prevention and management of chlamydia in Australia, as most chlamydia infections are diagnosed in this setting. Although 80% of young adults attend their general practitioner (GP) annually, general practice chlamydia testing rates remain quite low. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) is a randomised controlled trial that aims to evaluate whether annual chlamydia testing for 16 to 29 year olds attending general practice can reduce the prevalence of chlamydia in the population. ACCEPt drew on the Normalisation Process Theory (NPT) to guide the design of the intervention for this trial. NPT argues that successfully embedding a complex intervention into routine clinical practice requires a ‘whole of practice’ approach which engages all clinic staff including GPs, practice managers and practice nurses. The intervention designed to facilitate increased chlamydia testing in ACCEPt intervention clinics consisted of computer alerts, incentive payments to GPs and practice nurses for each chlamydia test conducted, quarterly audit and feedback on testing performance to individual GPs, GP and practice nurse training, and patient recall and reminders for follow-up testing. A total of 143 clinics servicing over 70,000 16 to 29 year olds were recruited across Victoria, Queensland, NSW and South Australia. Clinics where the practice manager was engaged and interested in research were better equipped to enable the establishment of a chlamydia testing pathway and the necessary systems to allow chlamydia testing to be successfully adopted within the clinic. Testing rates almost doubled in intervention clinics compared with control clinics (RR = 1.9; 95% CI: 1.8, 2.0). Following three years of intervention, the numbers of 16–29 year olds who were screened annually for chlamydia rose to approximately 27% of women and 15% of men in intervention clinics.

Supporting general practices to provide sexual and reproductive health services: protocol for the 3Cs & HIV programme

ObjectivesSexually transmitted infections, HIV and unplanned pregnancies continue to be a major public health problem in England, especially in young adults. Strengthening the provision of free condoms, HIV testing, chlamydia screening and contraception within primary care will contribute to reducing poor sexual and reproductive health outcomes. Recent research demonstrated the benefit for general practices of educational support visits based on behaviour change theory. Public Health England (PHE) has piloted an educational training programme to improve the delivery of sexual health services and HIV testing within general practice. Study design & methodsThe 3Cs & HIV programme used practice based workshops to improve staffs' awareness and skills in order to increase opportunistic offers of chlamydia testing, provision of contraceptive service information and free condoms (the ‘3Cs’) to 15–24 year olds and HIV testing according to national guidelines. The programme was based on the theory of planned behaviour and has been implemented using a stepped wedge design. Process evaluation, testing and diagnosis data, plus qualitative interviews were all used in the evaluation. The primary outcome measures were chlamydia testing and diagnosis rates. Secondary outcome measures were HIV testing and diagnoses rates within each practice and rates of consultations where long acting reversible contraceptives had been discussed. ConclusionA key strength of the 3Cs & HIV programme has been the evidence base underpinning the development of the resources and the formal process evaluation of its implementation. The programme was designed to encourage sustainable relationships between general practice staff and local sexual health services as well as the knowledge, awareness and behaviours cultivated during the programme.

Understanding sexual activity and Chlamydia testing rate based on linked national survey and Medicaid claims data.

BackgroundMonitoring adherence to national recommendations for annual chlamydia screening of female adolescents and young adult women is important for targeting quality improvement interventions to improve low screening rates. However, accurate measurement of rates may vary depending on the data source used to determine eligible sexually-active women.MethodsThe 2001–2004 NHANES data linked with Medicaid administrative data by respondent’s unique identifier, the 2011–2012 NHANES data, and the 2004 and 2010 Medicaid data were used in this cross-sectional analysis. We defined self-reported sexual activity by self-reported sexual behaviors, claim-identified sexual activity by reproductive-related claims among women who had ≥ one healthcare claim, HEDIS-defined sexual activity by reproductive-related claims among women who were enrolled in Medicaid for ≥330 days and had ≥ one healthcare claim, and chlamydia tests by claims submitted in the 12 months prior to the survey interview.ResultsOf Medicaid women aged 18–25 years, 91.5% self-reported to be sexually-active. Of self-reported sexually-active women aged 18–25 years, 92.0% had ≥ one healthcare claim in the 12 months prior to the survey interview; of this subpopulation, only 58.8% were enrolled in Medicaid for ≥ 330 days in the 12 months prior to the survey interview; of this further subpopulation, 74.1% had healthcare claims identifying them as sexually-active in the 12 months prior to the survey interview. Of HEDIS-defined sexually-active women, 42.4% had chlamydia testing.ConclusionOur study suggests that the number of sexually-active women aged 18–25 years used as the denominator in the chlamydia testing measure could be significantly different, depending upon the definition applied and the data used. Our data highlight the limited representativeness of Medicaid population in the current HEDIS measure on chlamydia testing when a high proportion of women who were enrolled in Medicaid for <330 days had been excluded from the measure. The interventions that can improve the proportion of women who were enrolled in Medicaid for ≥ 330 days among all young Medicaid women are needed not only for improving health care services, but also for measuring quality of healthcare.

Practice nurse chlamydia testing in Australian general practice: a qualitative study of benefits, barriers and facilitators

BackgroundChlamydia infection is a significant public health issue for young people; however, testing rates in Australian general practice are low. Practice nurses (PNs) could have an important role in contributing to increasing chlamydia testing rates. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a large cluster randomised control trial of annual testing for 16 to 29 year olds in general practice, is the first to investigate the role of PNs in maximising testing rates. In order to assess the scope for PN involvement, we aimed to explore PN’s views in relation to involvement in chlamydia testing in general practice.MethodsSemi structured interviews were conducted between June 2011 and April 2012 with a purposive sample of 23 PNs participating in ACCEPt. Interview data was thematically analysed using a conventional content analysis approach.ResultsThe participants in our study supported an increased role for PNs in chlamydia testing and identified a number of patient benefits from this involvement, such as an improved service with greater access to testing and patients feeling more comfortable engaging with a nurse rather than a doctor. An alleviation of doctors’ workloads and expansion of the nurse’s role were also identified as benefits at a clinic level. Time and workload constraints were commonly considered barriers to chlamydia testing, along with concerns around privacy in the “small town” rural settings of the general practices. Some felt negative GP attitudes as well as issues with funding for PNs’ work could also be barriers. The provision of training and education, streamlining chlamydia testing pathways in clinics and changes to pathology ordering processes would facilitate nurse involvement in chlamydia testing.ConclusionThis study suggests that PNs could take a role in increasing chlamydia testing in general practice and that their involvement may result in possible benefits for patients, doctors, PNs and the community. Strategies to overcome identified barriers and facilitate their involvement must be further explored.

Do Australian general practitioners believe practice nurses can take a role in chlamydia testing? A qualitative study of attitudes and opinions.

BackgroundChlamydia notifications continue to rise in young people in many countries and regular chlamydia testing is an important prevention strategy. Although there have been initiatives to increase testing in primary care, none have specifically investigated the role of practice nurses (PNs) in maximising testing rates. PNs have previously expressed a willingness to be involved, but noted lack of support from general practitioners (GPs) as a barrier. We sought GPs’ attitudes and opinions on PNs taking an expanded role in chlamydia testing and partner notification.MethodsIn the context of a cluster randomised trial in mostly rural towns in 4 Australian states, semi structured interviews were conducted with 44 GPs between March 2011 and July 2012. Data relating to PN involvement in chlamydia testing were thematically analysed using a conventional content analysis approach.ResultsThe majority of GPs interviewed felt that a role for PNs in chlamydia testing was appropriate. GPs felt that PNs had more time for patient education and advice, that patients would find PNs easier to talk to and less intimidating than GPs, and that GPs themselves could benefit through a reduction in their workload. Although GPs felt that PNs could be utilised more effectively for preventative health activities such as chlamydia testing, many raised concerns about how these activities would be renumerated whilst some felt that existing workload pressures for PNs could make it difficult for them to expand their role. Whilst some rural GPs recognised that PNs might be well placed to conduct partner notification, they also recognised that issues of patient privacy and confidentiality related to living in a “small town” was also a concern.ConclusionThis is the first qualitative study to explore GPs’ views around an increased role for PNs in chlamydia testing. Despite the concerns raised by PNs, these findings suggest that GPs support the concept and recognise that PNs are suited to the role. However issues raised, such as funding and remuneration may act as barriers that will need to be addressed before PNs are supported to make a contribution to increasing chlamydia testing rates in general practice.

Attendance patterns and chlamydia and gonorrhoea testing among young people in Aboriginal primary health centres in New South Wales, Australia.

Background To inform a sexual health quality improvement program we examined chlamydia and gonorrhoea testing rates among 15-29 year olds attending Aboriginal Community Controlled Health Services (ACCHS) in New South Wales, Australia, and factors associated with chlamydia and gonorrhoea testing. From 2009 to 2011, consultation and testing data were extracted from four ACCHS. Over the study period, we calculated the median number of consultations per person and interquartile range (IQR), the proportion attending (overall and annually), the proportion tested for chlamydia and gonorrhoea, and those who tested positive. We examined factors associated with chlamydia and gonorrhoea testing using logistic regression. Overall, 2896 15-29-year-olds attended the ACCHSs, 1223 were male and 1673 were female. The median number of consultations was five (IQR 2-12), four (IQR 1-8) for males and seven (IQR 3-14) for females (P<0.001). Nineteen percent of males and 32% of females attended in each year of the study (P<0.001). Overall, 17% were tested for chlamydia (10% of males and 22% of females, P<0.001), and 7% were tested annually (3% of males and 11% of females, P<0.001). Findings were similar for gonorrhoea testing. In the study period, 10% tested positive for chlamydia (14% of males and 9% of females, P<0.001) and 0.6% for gonorrhoea. Factors independently associated with chlamydia testing were being female (adjusted odds ratio (AOR) 2.64, 95% confidence interval (CI) 2.07-3.36), being 20-24 years old (AOR: 1.58, 95% CI: 1.20-2.08), and having >3 consultations (AOR: 16.97, 95% CI: 10.32-27.92). More frequent attendance was strongly associated with being tested for chlamydia and gonorrhoea. To increase testing, ACCHS could develop testing strategies and encourage young people to attend more frequently.

Estimating incidence of sexually transmissible infections in Australia

The reported numbers of notifiable sexually transmitted infections in Australia are subject to a myriad of biases and limitations, including demographic, clinical, behavioural, and temporal factors. As such, trends in reported diagnosis rates may not reflect trends in true underlying incidence, thereby confounding any direct interpretation of raw notification data for public health research. The development of new methods to determine the true incidence and prevalence of an infection is a critical step for furthering the understanding of disease in the population. Here we devise a statistical model for chlamydia testing, and apply it to routinely available data to estimate the true incidence and prevalence of chlamydia infection within the Australian population. We preview in-progress work towards a yet more sophisticated methodology and outline how the approach may be extended to provide estimates for a number of other bacterial sexually transmitted infections of public health importance. References T. Vos, A. D. Flaxman, M. Naghavi, R. Lozano, C. Michaud, M. Ezzati, K. Shibuya, J. A. Salomon, and 348 coauthors. Years lived with disability (ylds) for 1160 sequelae of 289 diseases and injuries 1990&ndash;2010: a systematic analysis for the global burden of disease study 2010. The Lancet, 380(9859):2163&ndash;2196, Dec 2012. doi:10.1016/S0140-6736(12)61729-2 Communicable Disease Network Australia. National Notifiable Diseases Surveillance System (NNDSS). http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-nndss-nndssintro.htm United States Centres for Disease Control and Prevention. The Role of STD Detection and Treatment in HIV Prevention&ndash;-CDC Fact Sheet, 2012. http://www.cdc.gov/std/hiv/stdfact-std-hiv.htm Australian Government Department of Health and Ageing. Second National Sexually Transmissible Infections Strategy 2010&ndash;2013, 2010. http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-national-strategies-2010-sti The Kirby Institute. National Blood-borne Virus and Sexually Transmissible Infections Surveillance and Monitoring Report, 2011. The Kirby Institute, The University of New South Wales, Sydney, NSW 2052. The Kirby Institute. HIV, Viral Hepatitis and Sexually Transmissible Infections in Australia Annual Surveillance Report, 2012. The Kirby Institute, The University of New South Wales, Sydney, NSW 2052. M. Y. Chen, M. Karvelas, V. Sundararajan, J. S. Hocking, and C. K. Fairley. Evidence for the effectiveness of a chlamydia awareness campaign: increased population rates of chlamydia testing and detection. International Journal of STD and AIDS, 18(4):239&ndash;243, 2007. doi:10.1258/095646207780658854 P. M. Konowitz, G. A. Petrossian, and D N. Rose. The underreporting of disease and physicians' knowledge of reporting requirements. Public Health Reports, 99(1):31&ndash;35, 1984. http://www.ncbi.nlm.nih.gov/pubmed/6422492 P. S. Mead, L. S., V. D., L. F. McCaig, J. S. Bresee, C. Shapiro, P. M. Griffin, and R. V. Tauxe. Food-related illness and death in the United States. Emerging Infectious Diseases, 5(5):607&ndash;625, 1999. doi:10.3201/eid0505.990502 R. Marier. The reporting of communicable diseases. American Journal of Epidemiology, 105(6):587&ndash;590, Jun 1977. http://www.ncbi.nlm.nih.gov/pubmed/868863 M. C. Kaczmarek, L. Valenti, H. A. Kelly, R. S. Ware, H. C. Britt, and S. B. Lambert. Sevenfold rise in likelihood of pertussis test requests in a stable set of Australian general practice encounters, 2000&ndash;2011. The Medical Journal of Australia, 198(11):624&ndash;628, 2013. doi:10.5694/mja13.10044 D. A. Cohen, M. Nsuami, D. H. Martin, and T. A. Farley. Repeated school-based screening for sexually transmitted diseases: a feasible strategy for reaching adolescents. Pediatrics, 104(6):1281&ndash;1285, Dec 1999. doi:10.1542/peds.104.6.1281 Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 8th edition. Royal Australian College of General Practitioners, East Melbourne, Australia, 2012. J. E. van Bergen, J. J. Kerssens, F. G. Schellevis, T. G. Sandfort, T. T. Coenen, and P. J. Bindels. Sexually transmitted infection health-care seeking behaviour in the Netherlands: general practitioner attends to the majority of sexually transmitted infection consultations. International Journal of STD and AIDS, 18(6):374&ndash;379, 2007. doi:10.1258/095646207781024883 C. H. Mercer, L. Sutcliffe, A. M. Johnson, P. J. White, G. Brook, J. D. C. Ross, J. Dhar, P. Horner, and 7 coauthors. How much do delayed healthcare seeking, delayed care provision, and diversion from primary care contribute to the transmission of STIs? Sexually Transmitted Infections, 83(5):400&ndash;405, 2007. doi:10.1136/sti.2006.024554 J. S. Hocking, M. S. C. Lim, J. Vidanapathirana, T. R. H. Read, and M. Hellard. Chlamydia testing in general practice&ndash;-a survey of Victorian general practitioners. Sexual Health, 3(4):241&ndash;244, Dec 2006. doi:10.1071/SH06042 R. L. Cook, S. L. Hutchison, L. \T1\O stergaard, R. S. Braithwaite, and R. B. Ness. Systematic review: noninvasive testing for chlamydia trachomatis and neisseria gonorrhoeae. Annals of Internal Medicine, 142(11):914&ndash;925, Jun 2005. doi:10.7326/0003-4819-142-11-200506070-00010 S. A. Morre, A. J. C. van den Brule, L. Rozendaal, A. J. P. Boeke, F. J. Voorhorst, S. de Blok, and C. J. L. M. Meijer. 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Improving chlamydia knowledge should lead to increased chlamydia testing among Australian general practitioners: a cross-sectional study of chlamydia testing uptake in general practice.

BackgroundFemale general practitioners (GPs) have higher chlamydia testing rates than male GPs, yet it is unclear whether this is due to lack of knowledge among male GPs or because female GPs consult and test more female patients.MethodsGPs completed a survey about their demographic details and knowledge about genital chlamydia. Chlamydia testing and consultation data for patients aged 16-29 years were extracted from the medical records software for each GP and linked to their survey responses. Chi-square tests were used to determine differences in a GP’s knowledge and demographics. Two multivariable models that adjusted for the gender of the patient were used to investigate associations between a GP and their chlamydia testing rates ― Model 1 included GPs’ characteristics such as age and gender, Model 2 excluded these characteristics to specifically examine any associations with knowledge.ResultsFemale GPs were more likely than male GPs to know when to re-test a patient after a negative chlamydia test (18.8% versus 9.7%, p = 0.01), the correct symptoms suggestive of PID (80.5% versus 67.8%, p = 0.01) and the correct tests for diagnosing PID (57.1% versus 42.6%, p = 0.01). Female GPs tested 6.5% of patients, while male GPs tested 2.2% (p < 0.01). Model 1 found factors associated with chlamydia testing were being a female GP (OR = 2.5, 95% CI: 1.9, 3.3) and working in a metropolitan clinic (OR = 3.2; 95% CI: 2.4, 4.3). Model 2 showed that chlamydia testing increased as knowledge of testing guidelines improved (3-5 correct answers – AOR = 2.0, 95% CI: 1.0, 4.2; 6+ correct answers – AOR = 2.9, 95% CI: 1.4, 6.2).ConclusionsHigher rates of chlamydia testing are strongly associated with GPs who are female, based in a metropolitan clinic and among those with more knowledge of the recommended guidelines. Improving chlamydia knowledge among male GPs may increase chlamydia testing.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0584-2) contains supplementary material, which is available to authorized users.

Narrative review of the barriers and facilitators to chlamydia testing in general practice.

As the cornerstone of Australian primary health care, general practice is a setting well suited for regular chlamydia testing but testing rates remain low. This review examines the barriers and facilitators to chlamydia testing in general practice. Six databases--Medline, PubMed, Meditext, PsycInfo, Scopus and Web of Science--were used to identify peer-reviewed publications that addressed barriers and facilitators to chlamydia testing in general practice using the following terms: 'chlamydia test*', 'STI test*' 'general practice', 'primary care', 'family medicine', 'barriers', 'facilitators' and 'enablers' from 1997 until November 2013. Data about the study design and key findings were extracted from the publications. A framework method was used to manage the data and organise publications into three categories -patient, general practitioner, and general practice. Key findings were then classified as a barrier or facilitator. Sixty-nine publications were included, with 41 quantitative studies, 17 qualitative studies, and 11 using mixed methods. Common barriers identified in all three groups included a lack of knowledge, awareness or training, demands on time and workload, and the social context of testing. Facilitators included the normalisation of testing, the use of nurses and other practice staff, education and incentives. Numerous barriers and facilitators to chlamydia testing in general practice have been identified. While the barriers are well studied, many of the facilitators are not as well researched, and highlight areas for further study.

Chlamydia among Australian Aboriginal and/or Torres Strait Islander people attending sexual health services, general practices and Aboriginal community controlled health services.

BackgroundChlamydia infections are notified at much higher rates in Aboriginal and/or Torres Strait Islander people compared to non-Indigenous people. The Australian Collaboration Chlamydia Enhanced Sentinel Surveillance System (ACCESS) was established to complement population-based surveillance.MethodsWe describe patient demographics, completeness of recording of Aboriginal and/or Torres Strait Islander (‘Aboriginal’) status, chlamydia testing rates and positivity rates from the Aboriginal Community Controlled Health Service (ACCHSs), General Practice (GP) clinics and Sexual Health Services (SHSs) networks in ACCESS during 2009. Data were extracted from electronic medical records of each participating health service for consultations with patients aged 16–29 years and for chlamydia testing and positivity.ResultsData were included from 16–29 year olds attending six ACCHSs (n = 4,950); 22 SHSs (n = 20,691) and 25 GP clinics (n = 34,462). Aboriginal status was unknown for 79.3% of patients attending GP clinics, 4.5% attending SHSs and 3.8% of patients attending ACCHSs. Chlamydia testing rates among Aboriginal patients were 19.8% (95%CI:18.6%-21.0%) at ACCHSs, 75.5% (95% CI:72.5%-78.4%) at SHSs and 4.3% (95% CI: 2.6%-6.6%) at GP clinics. Positivity rates were highest in Aboriginal patients tested at SHSs at 22.7% (95% CI:19.5%-26.2%), followed by 15.8% (95% CI:3.8%-43.4%) at GP clinics and 8.6% at ACCHSs (95% CI:7.9%-12.4%). This compared with non-Indigenous patients positivity rates at SHSs of 12.7% (95% CI:12.2-13.2%); 8.6% (7.2%-11.3%) at GP clinics and 11.3% at ACCHSs (95% CI:15.4%-24.9%).ConclusionsHigher chlamydia positivity in Aboriginal people across a range of clinical services is reflected in national notification data. Targeted efforts are required to improve testing rates in primary care services; to improve identification of Aboriginal patients in mainstream services such as GP clinics; and to better engage with young Aboriginal Australians.

Provider Barriers Prevent Recommended Sexually Transmitted Disease Screening of HIV-Infected Men Who Have Sex With Men

HIV-infected men who have sex with men (MSM) are at increased risk for transmitting and acquiring sexually transmitted diseases (STDs). Guidelines recommend at least annual screening of HIV-infected MSM for syphilis and for chlamydia and gonorrhea at exposed anatomical sites, to protect their health and their sexual partners' health. Despite these guidelines, STD screening has been suboptimal, with very low nongenital chlamydia and gonorrhea testing rates. Our objective was to better understand barriers encountered by HIV care providers in adhering to STD screening guidelines for HIV-infected MSM. We conducted 40 individual semistructured interviews with health care providers (physicians, midlevel providers, nurses, and health educators) of HIV-infected MSM at 8 large HIV clinics in 6 US cities. Providers were asked about their STD screening practices and barriers to conducting sexual risk assessments of their patients. Emerging themes were identified by qualitative data analysis. Although most health care providers reported routine syphilis screening, screening for chlamydia and gonorrhea at exposed anatomical sites was less frequent. Obstacles that prevented routine chlamydia and gonorrhea screening included time constraints, difficulty obtaining a sexual history, language and cultural barriers, and patient confidentiality concerns. Providers reported many obstacles to routine chlamydia and gonorrhea screening. Interventions are needed to help to mitigate barriers to STD screening, such as structural and patient-directed health services models that might facilitate increased testing coverage of these important preventive services.

The effect of financial incentives on chlamydia testing rates: Evidence from a randomized experiment

Financial incentives have been used in a variety of settings to motivate behaviors that might not otherwise be undertaken. They have been highlighted as particularly useful in settings that require a single behavior, such as appointment attendance or vaccination. They also have differential effects based on socioeconomic status in some applications (e.g. smoking). To further investigate these claims, we tested the effect of providing different types of non-cash financial incentives on the return rates of chlamydia specimen samples amongst 16–24 year-olds in England. In 2011 and 2012, we ran a two-stage randomized experiment involving 2988 young people (1489 in Round 1 and 1499 in Round 2) who requested a chlamydia screening kit from Freetest.me, an online and text screening service run by Preventx Limited. Participants were randomized to control, or one of five types of financial incentives in Round 1 or one of four financial incentives in Round 2. We tested the effect of five types of incentives on specimen sample return; reward vouchers of differing values, charity donation, participation in a lottery, choices between a lottery and a voucher and including vouchers of differing values in the test kit prior to specimen return. Financial incentives of any type, did not make a significant difference in the likelihood of specimen return. The more deprived individuals were, as calculated using Index of Multiple Deprivation (IMD), the less likely they were to return a sample. The extent to which incentive structures influenced sample return was not moderated by IMD score. Non-cash financial incentives for chlamydia testing do not seem to affect the specimen return rate in a chlamydia screening program where test kits are requested online, mailed to requestors and returned by mail. They also do not appear more or less effective in influencing test return depending on deprivation level.

P6.044 Scaling Up STI Resource and Educational Capacity For General Practise in New South Wales, Australia

BackgroundIncreasing access to STI resources and education for general practise (GP) and improving referral pathways to specialised STI care were key objectives of the 2006 STI Strategy, New South Wales...

P5.017 The Australian Chlamydia Control Effectiveness Pilot (ACCEPt): Early Results from a Randomised Trial of Annual Chlamydia Screening in General Practise

BackgroundACCEPt is a cluster randomised controlled trial to evaluate annual opportunistic chlamydia screening for 16–29 year olds in general practise (GP). Towns in which GP clinics are enrolled, are randomised...

P3.290 High Rates of Chlamydia Positivity in Aboriginal and Torres Strait Islander People Attending Australian Sexual Health Services; The Australian Collaboration For Chlamydia Enhanced Sentinel Surveillance (ACCESS)

IntroductionAustralia has a widely dispersed network of public sexual health services that see large numbers of people at risk of genital Chlamydia trachomatis infection. ACCESS was established to monitor chlamydia...

P5.057 Do You GYT? Evaluation of the First Two Years of the United States’ National Get Yourself Tested Campaign

BackgroundThe National Get Yourself Tested (GYT) Campaign was launched in 2009 to promote STD communication and testing among youth (≤ 25 years) through multimedia platforms, on-the-ground outreach, and linking youth...

Automated, computer generated reminders and increased detection of gonorrhoea, chlamydia and syphilis in men who have sex with men.

BackgroundGuidelines recommend frequent screening of men who have sex with men (MSM) for sexually transmissible infections (STIs) but few interventions have demonstrated increased testing and detection of bacterial STIs among MSM in controlled studies.MethodsWe used automated text message and email reminders generated by computer assisted self-interview (CASI) to remind MSM to retest for syphilis. We compared clinic visits, STI testing and detection rates over 12 month between men receiving reminders (reminder group) and men not offered the reminders (concurrent control group).ResultsMen who chose 3-monthly reminders had more clinic visits (median 3 vs 1) and higher testing rates for pharyngeal gonorrhoea (67.0% vs 33.6%), rectal gonorrhoea (62.7% vs 31.1%), urethral chlamydia (67.3% vs 39.3%), rectal chlamydia (62.9% vs 31.3%), syphilis (67.0% vs 39.3%) and HIV (64.9% vs 36.7%) (all p<0.001) than concurrent controls, within 12 months after their first visit. Also, men receiving reminders had a higher combined testing rate for all the aforementioned STIs at a same visit (55.7% vs 25.5%, p<0.001) compared with concurrent controls. This association remained after adjusting for differences in characteristics between the two groups (adjusted odds ratio:1.77, 95% confidence interval:1.51-2.08). Men receiving reminders also had a higher detection rate of: rectal gonorrhoea (3.7% vs 1.2%, p = 0.001), urethral chlamydia (3.1% vs 1.4%, p = 0.027), rectal chlamydia (6.6% vs 2.8%, p<0.001), and early, latent syphilis (1.7% vs 0.4%, p = 0.008) compared with concurrent controls.ConclusionThis is the first study to demonstate that a fully automated reminder system using CASI was associated with increased detection of bacterial STIs among MSM.

Effects of Population Based Screening for Chlamydia Infections in The Netherlands Limited by Declining Participation Rates

BackgroundA large trial to investigate the effectiveness of population based screening for chlamydia infections was conducted in the Netherlands in 2008–2012. The trial was register based and consisted of four rounds of screening of women and men in the age groups 16–29 years in three regions in the Netherlands. Data were collected on participation rates and positivity rates per round. A modeling study was conducted to project screening effects for various screening strategies into the future.Methods and FindingsWe used a stochastic network simulation model incorporating partnership formation and dissolution, aging and a sexual life course perspective. Trends in baseline rates of chlamydia testing and treatment were used to describe the epidemiological situation before the start of the screening program. Data on participation rates was used to describe screening uptake in rural and urban areas. Simulations were used to project the effectiveness of screening on chlamydia prevalence for a time period of 10 years. In addition, we tested alternative screening strategies, such as including only women, targeting different age groups, and biennial screening. Screening reduced prevalence by about 1% in the first two screening rounds and leveled off after that. Extrapolating observed participation rates into the future indicated very low participation in the long run. Alternative strategies only marginally changed the effectiveness of screening. Higher participation rates as originally foreseen in the program would have succeeded in reducing chlamydia prevalence to very low levels in the long run.ConclusionsDecreasing participation rates over time profoundly impact the effectiveness of population based screening for chlamydia infections. Using data from several consecutive rounds of screening in a simulation model enabled us to assess the future effectiveness of screening on prevalence. If participation rates cannot be kept at a sufficient level, the effectiveness of screening on prevalence will remain limited.