National Chlamydia Screening Programme Research Articles

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...

P67 Estimation of population coverage of chlamydia testing among young adults in England in 2010

BackgroundThe National Chlamydia Screening Programme (NCSP), established nationally in England in 2008, aims to prevent and control chlamydia infection in young adults under 25 years of age through opportunistic community...

P149 Evolution of the NCSP: Integrating chlamydia screening into community health services; policy and practice developments in England

BackgroundThe National Chlamydia Screening Programme is a major component of sexual health provision in England. Over 1.4 million tests were performed on asymptomatic under 25-year olds in 2010/2011, and over...

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.

Where do young men want to access STI screening? A stratified random probability sample survey of young men in Great Britain

ObjectivesRates of sexually transmitted infections (STIs) in UK young people remain high in men and women. However, the National Chlamydia Screening Programme has had limited success in reaching men. The...

Prevalence of human papillomavirus (HPV) infections in sexually active adolescents and young women in England, prior to widespread HPV immunisation

IntroductionThe introduction of an HPV immunisation programme in England should result in a significant reduction in the prevalence of vaccine type infections in young women. Here we describe type-specific HPV prevalence in three samples of the young female population in England, prior to the beginning of mass immunisation in 2008. MethodsResidual vulva-vaginal swab samples from females aged under 25 years undergoing chlamydia testing as part of the National Chlamydia Screening Programme (NCSP) or Prevention of Pelvic Infection (POPI) trial were collected from sites across England, together with available demographic and sexual behaviour data. Residual samples were screened for HPV infection using the Hybrid Capture 2 (hc2) HPV DNA Test, including the high-risk (HR) and low-risk (LR) probes. Hc2 positive samples were genotyped using the Roche Linear Array (LA) HPV Genotyping Test. ResultsA total of 3829 samples were included: 2369 from 16 to 24 year old NCSP participants, 275 from 13 to 15 year old NCSP participants and 1185 from 16 to 24 year old POPI participants. Variations in HPV prevalence between and within the different samples followed a pattern largely consistent with differences in sexual behaviour. The prevalence of total HR HPV infection, of HPV 16 and/or 18 (16/18) infection and of five HR HPV types closely related to HPV 16/18 (HPV 31, 33, 45, 52 or 58) amongst 16–24 year old NCSP participants was 35% (95% CI 33–37%), 18% (95% CI 16–19%), and 16% (95% CI 14–18%), respectively. Risk of HR HPV infection increased with age during the teen years and was higher in women who reported two or more sexual partners in the last year and in women with chlamydia infection. Approximately half of women with HPV 16/18 infection also had another non-vaccine HR HPV type present. ConclusionsPrior to HPV immunisation, there was a high prevalence of HPV infections in the lower genital tract of young, sexually active females in England. The overall, type-specific, and multiple infection prevalence closely reflected age and sexual activity. These data provide a baseline against which the early impact of HPV immunisation on the prevalence of HPV 16/18 and closely related types in young women can be measured, in order to inform immunisation and cervical screening policies.

Sexually transmitted infections (5/6): Chlamydia

Chlamydia is one of five key sexually transmitted infections (STIs). The other four are: gonorrhoea, syphilis, warts and herpes. Poor sexual health in the UK causes serious concern with the rising numbers of STIs, high rates of teenage pregnancies and increasing numbers of HIV. Genital Chlamydia trachomatis is the most common STI diagnosed in the UK. This article discusses the epidemiology concerning chlamydia, the aetiology and signs and symptoms associated with the infection. A discussion is undertaken concerning the National Chlamydia Screening Programme and its functions. The signs and symptoms associated with the infection are highlighted, care and treatment options are outlined and the role of the healthcare assistant and assistant practitioner (HCA and AP) described.

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

Evaluation of a systematic postal screening and treatment service for genital Chlamydia trachomatis, with remote clinic access via the internet: a cross-sectional study, East of England

ObjectiveEngland's National Chlamydia Screening Programme provides opportunistic testing for all 15–24-year-olds in healthcare and non-healthcare settings. The authors undertook an evaluation of a population service-based postal chlamydia screening and treatment...

Exploring attitudes and practices of General Practice staff towards offers of opportunistic screening for chlamydia: a UK survey

This study applied a theory-based questionnaire to examine the behaviours and beliefs of all practice staff who may be involved in offering chlamydia screens to young people aged 15-25 years old. We aimed to identify potential influencing factors and examine the organisational constraints, which may be amenable to change. The National Chlamydia Screening Programme offers opportunistic screening to men and women between 15 and 25 years old who have ever had sexual intercourse and primary care is the second largest source of screens. In England 15.9% of the target group were screened against a target of 17% in 2008. Interventions to improve the frequency of offers have shown effects with volunteer practices. A survey of 85 General Practices was completed by 55 doctors, nurses and receptionists. Interviews were conducted with 12 staff from three practices. Respondents were unable to identify the national screening target. Only half record if a patient is sexually active. Half the sample had some recollection of the frequency of offers they made, with a mean of 4 per month. These were predominantly in consultations concerning sexual health. Perceived social norms are favourable to screening and respondents have strong perceived control over offering screens, including to those under 16 who are sexually active. Attitudes towards screening were positive but disadvantages and barriers related to increased pressure on practice resources for longer consultations and contact tracing. There were no differences in beliefs and practice behaviours between medical and nursing staff. Future interventions should be targeted at increasing the range of consultations in which offers are made, demonstrating how to make offers without increasing consultation time, providing more complete records of sexual activity, screens and results, and encouraging audit and review within the practice to promote practice wide approaches to increasing opportunistic screening.

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.

P5-S7.07 Chlamydia screening in Cornwall: How often do young people get retested?

AimTo analyse the uptake of screening and rescreening in Cornwall, UK within the National Chlamydia Screening Programme (NCSP).MethodsWe tested for any association between gender, age, test result and the probability...

P1-S1.35 Declining positivity among 15–24-year-olds screened for chlamydia in England - a sign of falling prevalence or a symptom of changing uptake?

BackgroundThe number of tests performed as part of the National Chlamydia Screening Programme (NCSP) has increased since the start of the programme in 2003 and the positivity has declined. We...

Positive nucleic acid amplification tests for Neisseria gonorrhoeae in young people tested as part of the National Chlamydia Screening Programme

Little information is available on the prevalence of Neisseria gonorrhoeae (GC) infections outside genitourinary (GU) medicine clinics. A number of National Chlamydia Screening Programme areas now carry out simultaneous testing for Chlamydia trachomatis (CT) and GC in a single sample using nucleic acid amplification tests (NAATs). The aim of this study was to gather together data on dual testing from community settings. Information was collected from five programme areas. A total of 219,412 results were recorded with 18,370 CT positives, 1226 GC positives and among these 554 were with dual CT/GC infection. These figures highlight the fact that substantial numbers of positive GC NAAT results are found outside GU settings. An assessment of both the prevalence of GC and the proportion of extra cases that can be detected in all settings is needed, together with the implementation of robust plans to confirm, treat and manage these patients.

P1-S6.27 Could a peer driven intervention increase uptake of chlamydia screening? Proof of principle

BackgroundUptake of the opportunistic National Chlamydia Screening Programme in England is low and below model estimates of the optimal level to reduce Chlamydia incidence. Peer led approaches may increase screening...

How do young adults perceive the risk of chlamydia infection? A qualitative study

This study aimed to improve understanding of how young UK genito-urinary medicine (GUM) patients perceive the risk of chlamydia, and identify implications for health education. A qualitative methodology was chosen. Semi-structured interviews with 27 respondents aged 16-22 years old were conducted. Data were subjected to thematic analysis. Respondents made assessments of the perceived seriousness of, and their personal susceptibility to, chlamydia infection. Judgements about seriousness were related to beliefs about the controllability of symptoms and the long-term health consequences of infection. Susceptibility estimates were related to beliefs about the extent to which personal exposure put them in contact with chlamydia, and about the prevalence of infection amongst their peer group. This is consistent with the content of illness risk representations proposed by Cameron (2003). Respondents demonstrated some beliefs, which appeared to influence perceptions of seriousness and susceptibility in unhelpful ways. Young people may be underestimating their risk of chlamydia infection due to the presence of unhelpful beliefs. Dialogue between health professionals and patients within GUM clinics, or through consultations as part of the National Chlamydia Screening Programme (NCSP), could provide vehicles to deliver health education to target these. Suggested health education includes highlighting false reassurance provided by treatment beliefs and exposing the fallibility of using overt characteristics to judge the likelihood that a potential sexual partner poses a risk of infection.

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...

Chlamydia screening in primary care

Recent figures revealed an increase in chlamydia diagnoses. Barry Hill examines the role the National Chlamydia Screening Programme can play in this context

Mapping of sexual health promotion in North West England, 2008

To map sexual health promotion activity and resources across North West England. Survey. A survey of all sexual health promotion activity commissioned by primary care trusts (PCTs) was carried out using a self-completion questionnaire for PCT sexual health commissioners in North West England. Sixteen out of 24 PCTs responded. Some PCTs had difficulty in identifying the relevant commissioner. Most activity was focused on young people, especially around the National Chlamydia Screening Programme (NCSP) and teenage pregnancy, and on particular high-risk groups such as lesbian, gay and bisexual people, those living with human immunodeficiency virus and commercial sex workers. All PCTs commissioned education/training and a condom distribution service. Other common activities included outreach work, and producing and disseminating materials. Most services were confined to one PCT. Most PCTs were unable to identify the resources committed to sexual health promotion. The emergent themes in the analysis of service development ideas and comments were all linked to commissioning: commissioning and strategy; funding; needs assessment; service development and provision; contracting and monitoring; evaluation and evidence; and regional perspective. A simple tool to map sexual health promotion activities commissioned by PCTs was developed. Many PCTs could not identify a commissioner for sexual health or the resources committed to sexual health promotion. Sexual health promotion activity focused on young people (linked to the NCSP and teenage pregnancy) and particular high-risk groups, with resultant gaps and a mismatch with the epidemiology. The most frequently commissioned activities were education/training and condom provision (despite the limited evidence base). A series of recommendations to PCTs, sexual health networks and providers are made.

Surveillance of community genital Chlamydia trachomatis testing in the East of England, 2008-2010

Widespread testing for chlamydia is expected to result in a reduction in prevalence. In 2008, coverage indicators introduced by the Department of Health (DH) required collection and submission of all tests performed outside of genitourinary medicine clinics. No mechanism existed to collect community-based tests conducted outside of the National Chlamydia Screening Programme. The Health Protection Agency Regional Epidemiology Unit in the East of England (EoE) set up a new system to routinely collect and submit these tests on behalf of the regional Primary Care Organizations (PCOs). Testing data were requested from all laboratories commissioned to undertake chlamydia testing by EoE PCOs. Data were imported into a bespoke Structured Query Language server database and automated data processing routines were run. Data fulfilling national criteria were submitted for inclusion in the DH indicators. High-quality data were submitted to set deadlines with minimum impact on laboratories. Completeness of data variables varied by laboratory and by variable type. After complex data processing, 96% of laboratory reported tests in the 15-24 year age range were eligible for submission. This centralized method of data collection provides high-quality data, allowing for further analysis, which can be used to inform improvements in health care. These methods could be transferred to any of the hundreds of organisms for which similar laboratory data exist.