Chlamydia Positivity Among American Indian/Alaska Native Women: Comparing Indian Health Service and Infertility Prevention Project Clinic Populations, Region X

Background:
Beginning 2006, Indian Health Service (IHS) clinics implementing the Stop Chlamydia (CT) program expanded data collection to include capturing CT negative test results along with positive case reports. Infertility Prevention Project (IPP) family planning (FP) clinics collect comparable data.

Objective:
To compare CT testing volume and positivity among American Indian/Alaska Native (AI/AN) women aged 15-24 years screened in IHS and IPP FP clinics in 3 Region X states.

Method:
We analyzed 4,535 IHS and 1,494 IPP CT test records from AI/AN women aged 15-24 years seen at 6 IHS and 92 IPP FP clinics in Alaska (AK), Idaho (ID) and Washington (WA) during 2006. CT positivity was calculated by program, clinic, state and age groups.

Result:
In 2006, IHS sites reported 4,126 CT tests in AK, 190 tests in ID and 219 in WA. IHS CT positivity was 10.0% (AK: 10.3%; ID: 5.3%; WA: 9.1%). IPP FP clinics reported 437 CT tests in AK, 76 tests in ID and 981 in WA for a total of 1,494 tests, which accounted for only 3.1% of total IPP records among women aged 15-24 years across all race/ethnic groups. IPP CT positivity was 9.4% (AK: 13.5%; ID: 8.6%; WA: 7.7%). For teens aged 15-19 years IHS and IPP CT positivities were 12.1% and 11.7%, respectively.

Conclusion:
CT positivity was significant for AI/AN young women seen in both IHS and IPP. AI/AN testing volume among IPP FP clinics was surprisingly limited; IHS clinic penetration is also modest within the three states. This may be due to IPP clinic locations, client access challenges, or misclassification of patient race.

Implications:
Future work should address factors affecting community screening coverage, clinic strategies to expand testing in this high risk population, and factors associated with CT within each program.