Effectiveness Of Chlamydia Screening Research Articles

PL03.2 Screening for chlamydia: does it work, results from accept

<h3></h3> <i>Chlamydia trachomatis</i> is the most commonly reported bacterial sexually transmitted infection and its greatest burden is among young adults with community-based studies reporting prevalence estimates of 3 to 5% among 16 to 29 year olds in Australia. As over 80% of infections are asymptomatic, screening is the main way to detect cases. However, there is considerable debate about the effectiveness of chlamydia screening. In response to this concern, the Australian Government funded the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) to assess the feasibility, acceptability, efficacy and cost-effectiveness of annual chlamydia testing for sexually active 16 to 29 year old men and women attending general practice. ACCEPt is being evaluated using a cluster randomised controlled trial design. A total of 143 general practice clinics in 52 geographical areas (clusters) are participating. An intervention to support increased chlamydia testing, including incentive payments for each test done, quarterly feedback on testing performance and computer prompts, has been allocated at the cluster level and all general practice clinics within each cluster are participating. The primary outcome of ACCEPt is change in chlamydia prevalence among 16 to 29-year-old men and women attending general practice. This will be assessed as the difference in chlamydia prevalence between a baseline prevalence survey conducted among a consecutive sample of 16- to 29-year-old men and women attending all participating clinics prior to randomisation and a follow-up survey conducted at the conclusion of the trial. The fundamental premise of this trial is that increased levels of testing can be achieved by providing support to clinics, and that once levels of chlamydia testing are sufficiently increased, the prevalence of chlamydia will fall. Preliminary results from ACCEPt will be presented.

Self-Reported Impact of Chlamydia Testing on Subsequent Behavior: Results of an Online Survey of Young Adults in England.

The National Chlamydia Screening Programme performs 1.7 million tests annually among young adults in England. The effect of chlamydia screening on subsequent behavior is unknown. This study examined the self-reported impact of testing on young adults' subsequent health care-seeking and sexual behavior. We conducted a cross-sectional Web-based anonymous survey using an online panel to recruit 1521 young adults aged 16 to 24 years and resident in England. Survey questions were developed using the theory of planned behavior. Multivariate log-binomial regression was used to identify the variables associated with an impact on subsequent behavior after testing. Most respondents reported that being tested for chlamydia had a positive effect on their subsequent sexual behavior (68.6%; 422/615) or health care-seeking behavior (80.0%; 492/615). In multivariate analysis, being female and having a high level of engagement at last test were both associated with positive impacts on sexual behavior (72.7% [adjusted prevalence ratio {aPR}, 1.19; 95% confidence interval {CI}, 1.07-1.33] and 82.7% [aPR, 1.55; 95% CI, 1.27-1.89], respectively), and health care-seeking behavior (84.4% [aPR, 1.13; 95% Cl, 1.04-1.24] and 86.3% [aPR, 1.23; 95% CI, 1.07-1.41], respectively). Among respondents with minimum level of engagement, 72.4% (76/105) reported an increase in subsequent health care-seeking behavior. Chlamydia testing had a positive impact on young adults' self-reported health care-seeking and sexual behavior. This suggests that chlamydia screening has a wider effect on young adults' sexual health beyond that of treatment alone.

Management of Chlamydia trachomatis genital tract infection: screening and treatment challenges.

Chlamydia trachomatis is a prevalent sexually transmitted infection that can lead to serious reproductive morbidity. Management and control of C. trachomatis is a challenge, largely due to its asymptomatic nature and our incomplete understanding of its natural history. Although chlamydia screening programs have been implemented worldwide, several countries have observed increasing rates of reported chlamydia cases. We reviewed the literature relating to the long-term complications of C. trachomatis, as well as screening strategies, treatment, and prevention strategies for reducing chlamydia in the population. Articles from 1950–2010 were identified through a Medline search using the keyword “Chlamydia trachomatis” combined with “screening”, “pelvic inflammatory disease”, “endometritis”, “salpingitis”, “infertility”, “ectopic pregnancy”, “urethritis”, “epididymitis”, “proctitis”, “prostatitis”, “reinfection”, “cost-effectiveness”, “treatment”, “vaccines”, or “prevention”. Progression of C. trachomatis varies, and recurrent infections are common. Currently, there is limited evidence on the effectiveness of chlamydia screening. Higher quality studies are needed to determine the efficacy of more frequent screening, on a broader range of sequelae, including infertility and ectopic pregnancy, in addition to pelvic inflammatory disease. Studies should focus on delineating the natural history of recurrent infections, paying particular attention to treatment failures. Furthermore, alternatives to screening, such as vaccines, should continue to be explored.

Effectiveness of Chlamydia screening overestimated

Effectiveness of Chlamydia screening overestimated

Effectiveness of chlamydia screening: systematic review

Screening programmes are promoted to control transmission of and prevent female reproductive tract morbidity caused by genital chlamydia. The objective of this study was to examine the effectiveness of register-based and opportunistic chlamydia screening interventions. We searched seven electronic databases (Cinahl, Cochrane Controlled Trials Register, DARE, Embase, Medline, PsycINFO and SIGLE) without language restrictions from January 1990 to October 2007 and reference lists of retrieved articles to identify studies published before 1990. We included studies examining primary outcomes (pelvic inflammatory disease, ectopic pregnancy, infertility, adverse pregnancy outcomes, neonatal infection, chlamydia prevalence) and harms of chlamydia screening in men and non-pregnant and pregnant women. We extracted data in duplicate and synthesized the data narratively or used random effects meta-analysis, where appropriate. We included six systematic reviews, five randomized trials, one non-randomized comparative study and one time trend study. Five reviews recommended screening of women at high risk of chlamydia. Two randomized trials found that register-based screening of women at high risk of chlamydia and of female and male high school students reduced the incidence of pelvic inflammatory disease in women at 1 year. Methodological inadequacies could have overestimated the observed benefits. One randomized trial showed that opportunistic screening in women undergoing surgical termination of pregnancy reduced post-abortal rates of pelvic inflammatory disease compared with no screening. We found no randomized trials showing a benefit of opportunistic screening in other populations, no trial examining the effects of more than one screening round and no trials examining the harms of chlamydia screening. There is an absence of evidence supporting opportunistic chlamydia screening in the general population younger than 25 years, the most commonly recommended approach. Equipoise remains, so high-quality randomized trials of multiple rounds of screening with biological outcome measures are still needed to determine the balance of benefits and harms of chlamydia screening.

Cost and Effectiveness of Chlamydia Screening Among Male Military Recruits: Markov Modeling of Complications Averted Through Notification of Prior Female Partners

Despite rising rates of female screening, a high economic burden remains associated with Chlamydia infection from high rates of undetected asymptomatic disease and its associated sequelae of pelvic inflammatory disease (PID) and chronic pelvic pain (CP). Males comprise the majority of US military recruits and represent an ideal population in which to achieve identification and interruption of sexually transmitted infection among infected partners through mass tandem screening. We developed a static decision tree incorporating a calibrated Markov model to predict the differences in healthcare payer direct healthcare costs, cases of PID and CP averted among female partners of male recruits through implementation of either selective (aged 24 and younger) or universal recruit screening policies incorporating partner notification. A policy of selective male screening added $10.30 in direct costs per recruit, whereas universal male screening added an additional $1.60. A policy of selective male screening yielded an incremental cost-effectiveness ratio of $3.7K per case of PID averted, and $7.3K per case of CP averted, whereas universal screening yielded an incremental cost-effectiveness ratio of $8.2K per additional case of PID and $16.4K per additional case of CP averted beyond selective screening. Neither policy was dominant, and results were qualitatively robust to single-variable and probabilistic sensitivity analysis. In consonance with other studies of mass tandem screening, we found both selective and universal male recruit screening cost-effective as compared with other interventions. Our results argue in favor of universal screening of male recruits for Chlamydia infection, linked to partner notification.

The cost effectiveness of screening for genital Chlamydia trachomatis infection in Australia

In Australia, there is no published study on the cost effectiveness of screening for chlamydia. The aim of this study was to examine the cost effectiveness of a hypothetical screening programme for chlamydia based on annual opportunistic testing of all women 25 years of age or younger consulting a general practitioner, compared with no screening. A decision-analytic modelling approach was used to determine the incremental cost effectiveness ratio (ICER) of screening compared with no screening over 25 years. The analysis measured Australian health-care costs and benefits were assessed in terms of quality-adjusted life years (QALYs). The analysis resulted in a cost per QALY of 2968 dollars for screening. One-way sensitivity analyses on all variables, and multi-way sensitivity analyses on some variables, showed a wide range for the cost effectiveness, from dominance (where screening is effective and saves money overall) to an ICER of 67,715 dollars per QALY. The results indicate that annual opportunistic screening for chlamydia in women under 25 is a potentially worthwhile undertaking. However, the analysis also highlights uncertainties around the natural history of chlamydia and the effectiveness of chlamydia screening. Given these uncertainties, the need for further primary data collection in these areas becomes apparent.

Analysing the Effectiveness of Chlamydia Screening

Analysing the Effectiveness of Chlamydia Screening

Analysing the effectiveness of Chlamydia screening

Chlamydia is a highly prevalent sexually transmitted infection which is normally asymptomatic. Chlamydia is a major public health concern since it is one of the biggest causes of infertility in the UK. A screening programme has been proposed and here we analyse its potential cost-effectiveness. Previous modelling analyses for Chlamydia screening have been inadequate at representing the dynamic complexity of the impact. Most notably, the impact on the population prevalence has been overlooked as well as the possibility for an individual to become re-infected after treatment. A system dynamics model was built using the array facility in the ithink software to represent a heterogeneous population. This population was disaggregated along two dimensions: age and sexual activity levels. Results suggest that the proposed screening programme would prevent significant numbers of infertility cases annually. Additionally, it could be paying for itself after about four years and recouping the initial outlay after about twelve years.