To Screen or Not to Screen—Maximizing Chlamydia Screening of Adolescent Females in School Based Health Centers in California

Background:
The highest rates of Chlamydia in the United States are among adolescent females. Increasing access to screening for this population is an important Chlamydia control strategy. School based health centers (SBHCs) may be an effective setting to reach adolescents who may not otherwise present for care at traditional screening venues.

Objective:
To assess Chlamydia screening coverage and prevalence among female family planning clients at SBHCs.

Method:
Seven SBHCs in rural and urban settings in California who participated in the Educational Partnerships to Increase Chlamydia Screening (EPICS) program, a CDC funded Chlamydia screening program, collected data from July 2006 to June 2007 on all female family planning clients: demographics, chlamydia test details, and descriptive information (sexual activity, pelvic exam). Chlamydia screening coverage and positivity were assessed among unduplicated, sexually-active clients.

Result:
Participating SBHCs provided family planning services to 1321 adolescents. Of these, 1186 were tested for Chlamydia – a screening coverage of 89.7%. Testing was associated with race; 94.1% of black women (p<.0001) and 93.3% of women identifying as ‘other race' (p<.0407) were tested compared with 84.6% of white women. Chlamydia infections were detected among 77 women (6.5%). Positivity was associated with race; black women (9.6%, p<.0001), Asian women (6.5%, p<.0334) and women identifying as ‘other race' (7.5%, p<.0010) were all more likely than white women (1.7%) to test positive for Chlamydia. Positivity also increased with age; adolescents under 15 years (3.2%) had a lower infection rate then those 15-17 years (6.0%) and 17-19 years (6.4%).

Conclusion:
Participating SBHCs were able to establish high screening coverage and detect significant disease prevalence. Young women of color and older adolescents were more likely to test positive for Chlamydia.

Implications:
Providing Chlamydia screening at SBHCs is an effective method for achieving high screening coverage among high prevalence adolescents. SBHCs should focus on effective outreach and risk-reduction strategies for these populations.