Adherence to Regional Chlamydia Screening Criteria and Opportunities to Increase Screening Coverage for Female Clients of Family Planning and STD Clinics

Background:
The goal of the Infertility Prevention Project (IPP) is to decrease the prevalence of chlamydial infections and sequelae through targeted screening. Region II IPP criteria recommend screening all females under age 25 years attending family planning (FP) clinics for an initial or annual (i.e. pelvic) exam, and all women under age 30 years attending STD clinics. In 2005, chlamydia positivity for females who met age criteria was 5.6% in FP and 11.7% in STD clinics.

Objective:
Pilot a methodology for assessing adherence to regional chlamydia screening criteria, and examine opportunities for increasing screening among at-risk women to maximize limited resources.

Method:
A random sample of 2,723 FP and 1,763 STD eligible client medical records was selected for the year 2005, where “eligible” referred to clients meeting regional criteria. Each client's age and whether a chlamydia test was performed were recorded. Where no test was performed, the reason was noted.

Result:
Overall, 86.0% of females in FP and 74.4% of females in STD clinics who met the minimum criteria were screened. Among those not screened in FP (n=380), common reasons included “client refused” (27.1%), “no new risk” (10.8%), and “not sexually active” (10.5%). In STD clinics, common reasons for not screening (n=451) were “tested or treated in the past 30 days” (25.3%), and “other reason for visit” (25.3%), including emergency contraception and HIV testing services.

Conclusion:
While adherence to regional screening criteria is high, screening coverage among sexually-active females <25 years could be increased by providing urine-based screening to at-risk clients who do not undergo a pelvic exam, including clients seeking pregnancy testing, emergency contraception or HIV testing services.

Implications:
The Region II IPP Advisory Committee is reviewing its chlamydia screening policies and protocols in response to these findings. Redirecting resources away from older women not at risk could facilitate expanded screening of younger women.