New Reminder System Does Not Improve Chlamydia Re-Screening Rate

Background: A history of chlamydia is known to be a strong predictor of future infection. Following CDC screening guidelines, women diagnosed with chlamydia at San Francisco's municipal STD clinic have been told to return for testing at three months, but many do not come back.

Objectives: Our objective was to see if a reminder system would increase the proportion of women who get re-screened.

Methods: Beginning in 2009, women with positive chlamydia tests three months before were called to remind them to get screened again. When the patient did not come into the clinic within one week, the woman was also sent a reminder letter. To assess the impact of this system, the proportion of women with chlamydia in the six months from 10/1/2008 through 3/31/2009 (i.e., those who were contacted) who were re-screened was compared to the proportion of women diagnosed with chlamydia twelve months before. Successful follow-up was defined as being tested between one and five months after the initial infection.

Results: There were 88 female chlamydia cases at City Clinic in the 07-08 time period, and 32 of them (36.4 percent) were re-screened. During the 08-09 period, there were 65 cases, and 24 (36.9 percent) were re-screened. This difference was not statistically significant. The positivity rate decreased from 18.8 percent for women from the 07-08 period (6 positives) to 12.5 percent for the 08-09 period (3 positives), but this difference was not statistically significant, either.

Conclusions: Our reminder system did not result in any significant increase in three-month re-screening for women diagnosed with chlamydia. Further analysis may indicate factors that led to successful re-screening, which may help refine our system.

Implications for Programs, Policy, and/or Research: A simple reminder system may not not be sufficient to improve chlamydia re-screening rates in female STD clinic patients.