English National Chlamydia Screening Programme Research Articles

Who is coming back for more chlamydia testing within non-specialist health services and where do they go? England, 2013–2016

ObjectivesTo investigate patient demographics and venue type preferences within community settings associated with re-attendance for chlamydia testing. Study designData used for this analysis were obtained from the English National Chlamydia Screening Programme (NCSP) which focuses on prevention, control and treatment of chlamydia in sexually active under-25 year olds. A greater understanding of how young adults attend services helps to inform commissioners regarding where to focus resources within community settings. MethodsData from the Chlamydia surveillance system (CTAD) were used to count patient attendances at non-specialist sexual health services (SHSs) among 15–24-year-olds and monitor re-attendance for chlamydia testing within and between community services between 6 and 18 months of their first visit. ResultsFrom January 2013 to December 2016, 866,847 young people underwent 1,041,245 tests for chlamydia. Re-attendance for chlamydia testing was 20.1% (174,398/866,847). Re-attendance rate was 28.5% after a positive test and 19.5% after a negative test. For re-attenders, 64.2% used the same venue type for both visits. General practice (GP) and sexual and reproductive health services (SRH) were the most commonly re-attended services (31.0% and 30.6% respectively). ConclusionsOnly one in five re-attended for chlamydia testing. Re-attendance was associated with having a positive result, accessibility and convenience. Patients are likely to return for testing to services they know. This should be considered by commissioners implementing new re-attendance guidance based on the NCSP.

P08.13 What can probability surveys tell us about changes in chlamydia prevalence in britain? evidence from the national surveys of sexual attitudes and lifestyles (natsal)

Introduction The National Surveys of Sexual Attitudes and Lifestyles (Natsal) estimated the prevalence of Chlamydia trachomatis (chlamydia) among the sexually-experienced British population in 1999–2001 (Natsal-2) and 2010–12 (Natsal-3). Chlamydia testing among young adults increased substantially between these years, partly due to the introduction of the English National Chlamydia Screening Programme, which achieved national implementation in 2008. We explored what these data might tell us about changing chlamydia prevalence among young adults over the last decade. Methods We compared estimated chlamydia prevalence among sexually-experienced 18–24 year old men and women between Natsal-2 (n = 680) and Natsal-3 (n = 1,511). We carried out a sensitivity analysis which accounted for differences in the accuracy of the urine collection procedure and assay used in Natsal-2 (standard universal tube for urine collection; ligase chain reaction) and Natsal-3 (FirstBurst urine collection device; AptimaCombo2). Results There was no significant difference between the chlamydia prevalence estimates for 18 to 24 year olds in Natsal-3 vs Natsal-2: for men, 2.6% (95% CI: 1.7%–4.0%) vs 2.9% (1.3%–6.3%); OR: 0.91 (0.36–2.27); for women, 3.2% (2.2%–4.6%) vs 3.1% (1.8%–5.2%); OR 1.04 (0.53–2.01). The test-adjusted chlamydia prevalence estimate was slightly lower than the reported prevalence in Natsal-2 among men (2.2% (95% CI, 0.4%–6.1%)) and women (2.5% (1.0%–4.9%)), due to the dominance of specificity error in a low prevalence population. However, there remained no statistically significant difference between surveys. Conclusion Given the wide confidence intervals on prevalence estimates, the Natsal surveys are consistent with prevalence among sexually-experienced young adults in 2009–2012 being as little as half, or as much as double that in 1999–2001. Even large, national, population-based surveys face limitations in statistical power to detect moderate changes in population prevalence of chlamydia. Analyses of testing uptake, diagnoses rates and prevalence by the rich behavioural data in the Natsal surveys can contribute more to evaluation of chlamydia control. Disclosure of interest statement Natsal-3 is collaboration between University College London (London, UK), the London School of Hygiene and Tropical Medicine (London, UK), NatCen Social Research, Public Health England (formerly the Health Protection Agency) and the University of Manchester (Manchester, UK). The study was supported by grants from the Medical Research Council and the Wellcome Trust, with contributions from the Economic and Social Research Council and Department of Health.

Screening for gonorrhoea using samples collected through the English National Chlamydia Screening Programme and risk of false positives: a national survey of Local Authorities

ObjectivesTo investigate use of dual tests for Chlamydia trachomatis and Neisseria gonorrhoeae on samples collected through the National Chlamydia Screening Programme (NCSP) in England.Design and settingDuring May–July 2013, we delivered...

O13.6 Focusing the Delivery of the English National Chlamydia Screening Programme: Exploring Opportunities to Expand Testing Within Local Services

BackgroundThe National Chlamydia Screening Programme (NCSP) seeks to increase rates of chlamydia diagnosis amongst young people aged 15–24 across the 326 English Local Authorities (LA). 68% of screens and 79%...

The English National Chlamydia Screening Programme: where next?

The English National Chlamydia Screening Programme: where next?

Could a peer-led intervention increase uptake of chlamydia screening? A proof of principle pilot study

BackgroundUptake of the English National Chlamydia Screening Programme is lower than predicted necessary to result in a rapid fall in chlamydia prevalence. Peer-led approaches may increase screening uptake but their...

Chlamydia screening in England: a qualitative study of the narrative behind the policy

BackgroundThe rationale for the English National Chlamydia Screening Programme (NCSP) has been questioned. There has been little analysis, however, of what drove the NCSP’s establishment and how it was implemented. Such analysis will help inform the future development of the NCSP. This study used a qualitative, theory-driven approach to evaluate the rationale for the NCSP’s establishment and implementation.MethodsSemi-structured interviews with 14 experts in chlamydia screening were undertaken. The interview data were analysed with policy documents and commentaries from peer-reviewed journals (published 1996–2010) using the Framework approach.ResultsTwo themes drove the NCSP’s establishment and implementation. The first, chlamydia control, was prominently referenced in documents and interviews. The second theme concerned the potential for chlamydia screening to advance wider improvements in sexual health. In particular, screening was expected to promote sexual health services in primary care and encourage discussion of sexual health with young people. While this theme was only indirectly referenced in policy documents, it was cited by interviewees as a strong influence on implementation in the early years. However, by full rollout of the Programme, a focus on screening volume may have limited the NCSP’s capacity to improve broader aspects of sexual health.ConclusionsA combination of explicit and implicit drivers underpinned the Programme’s establishment. This combination may explain why there was widespread support for its introduction and why implementation of the NCSP was inconsistent. The potential to improve young people’s sexual health more comprehensively should be made explicit in future planning of the NCSP.

Will chlamydia screening reach young people in deprived areas in England? Baseline analysis of the English National Chlamydia Screening Programme Delivery in 2008

Will chlamydia screening reach young people in deprived areas in England? Baseline analysis of the English National Chlamydia Screening Programme Delivery in 2008

Will Chlamydia Screening Reach Young People in Deprived Areas in England? Baseline Analysis of the English National Chlamydia Screening Programme Delivery in 2008

The National Chlamydia Screening Programme (NCSP) was established in England to control chlamydia in people <25 years. This study examined variations in NCSP delivery in 2008, its first full year of national coverage, by comparing the distribution of screening venues and coverage with the risk of testing positive in men and women by socioeconomic circumstances (SEC) and age. A total of 550,000 NCSP screening records from 2008 were linked to the Index of Multiple Deprivation 2007. NCSP provision (venues/1000 population aged 13-24 years) was examined by SEC. NCSP coverage (tests/target population) and chlamydial positivity (positive results/[positive + negative results]) were examined separately in men and women by SEC and age. Odds ratios for positivity were calculated, adjusted for socioeconomic quintile, age, ethnicity, behavior, and screening provider. NCSP coverage was just 4.1% (95% confidence interval [CI]: 4.0-4.1) in men and 9.6% (95% CI: 9.5-9.6) in women. Screening provision and coverage were highest in more socioeconomically deprived areas where chlamydia positivity was also highest. The adjusted odds for testing positive in the most deprived areas was 1.4 (95% CI: 1.3-1.5) times higher in men and 1.4 (95% CI: 1.4-1.5) times higher in women than the least deprived areas. In the first year in which all areas delivered screening, the NCSP's total coverage was low, particularly in men. However, coverage was higher in deprived populations, who were also at increased risk of testing positive for infection. This analysis provides a baseline by which to monitor social variations in NCSP delivery as coverage expands.

Who is being tested by the English National Chlamydia Screening Programme? A comparison with national probability survey data

ObjectivesWe compare data collected by England's National Chlamydia Screening Programme (NCSP) with national probability survey data to examine demographic and behavioural differences that may be important in understanding who the...

Costs and cost effectiveness of different strategies for chlamydia screening and partner notification: an economic and mathematical modelling study

Objectives To compare the cost, cost effectiveness, and sex equity of different intervention strategies within the English National Chlamydia Screening Programme. To develop a tool for calculating cost effectiveness of...

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.

Promoting chlamydia screening with posters and leaflets in general practice - a qualitative study

BackgroundGeneral practice staff are reluctant to discuss sexual health opportunistically in all consultations. Health promotion materials may help alleviate this barrier. Chlamydia screening promotion posters and leaflets, produced by the English National Chlamydia Screening Programme (NCSP), have been available to general practices, through local chlamydia screening offices, since its launch. In this study we explored the attitudes of general practice staff to these screening promotional materials, how they used them, and explored other promotional strategies to encourage chlamydia screening.MethodsTwenty-five general practices with a range of screening rates, were purposively selected from six NCSP areas in England. In focus groups doctors, nurses, administrative staff and receptionists were encouraged to discuss candidly their experiences about their use and opinions of posters, leaflets and advertising to promote chlamydia screening. Researchers observed whether posters and leaflets were on display in reception and/or waiting areas. Data were collected and analysed concurrently using a stepwise framework analytical approach.ResultsAlthough two-thirds of screening practices reported that they displayed posters and leaflets, they were not prominently displayed in most practices. Only a minority of practices reported actively using screening promotional materials on an ongoing basis. Most staff in all practices were not following up the advertising in posters and leaflets by routinely offering opportunistic screening to their target population. Some staff in many practices thought posters and leaflets would cause offence or embarrassment to their patients. Distribution of chlamydia leaflets by receptionists was thought to be inappropriate by some practices, as they thought patients would be offended when being offered a leaflet in a public area. Practice staff suggested the development of pocket-sized leaflets.ConclusionThe NCSP should consider developing a range of more discrete but eye catching posters and small leaflets specifically to promote chlamydia screening in different scenarios within general practice; coordinators should audit their use. Practice staff need to discuss, with their screening co-ordinator, how different practice staff can promote chlamydia screening most effectively using the NCSP promotional materials, and change them regularly so that they do not loose their impact. Education to change all practice staff's attitudes towards sexual health is needed to reduce their worries about displaying the chlamydia materials, and how they may follow up the advertising up with a verbal offer of screening opportunistically to 15-24 year olds whenever they visit the practice.

The English National Chlamydia Screening Programme: Variations in Positivity in 2007/2008

The purpose of this study was to examine variation in positivity within the English National Chlamydia Screening Programme during 2007/2008. Data were analyzed using multivariable logistic regression. The outcome measure was positivity. Funnel plots were used to explore variation in positivity according to screening volume. Three hundred and thirty-four thousand nine hundred and two screening tests were done, 29% of which were in men. Overall positivity was 7.6% in men and 9.3% in women. For men, positivity increased rapidly to plateau from ages 19 to 24. For women, rates peaked at 18 years-those aged 21 being at the same risk of chlamydial infection as 16-year-olds. For men and women, positivity was generally higher for those of black or mixed ethnicity compared with whites, whereas Asians were at lower risk. Similarly, risk of infection for men and women varied by screening venue. Multivariable analysis showed that, for men and women positivity varied significantly with age, ethnicity, screening venue attended, whether the young people had had a new sexual partner in the past 3 months, and whether the patient had had 2 or more sexual partners in the past year. Positivity did not vary significantly with implementation phase. This is the largest description of testing for Chlamydia trachomatis in healthcare and nonhealthcare settings outside Genitourinary Medicine clinics in England and allowed a detailed analysis of positivity by age and ethnic group. Considerable heterogeneity exists and local health service commissioners need to ensure that the implementation of chlamydial screening reflects these differences.

Chlamydia screening: the role of general practice

AbstractThe English National Chlamydia Screening Programme is an important public health intervention that has the potential to make a substantial difference to the sexual health of young people. The authors outline practical ways in which general practice can help to make this a reality. Copyright © 2007 Wiley Interface Ltd