The Case for Screening at Non-Routine Exams: Evaluating IPP Screening Policy

Background: Women under age 25 should be screened annually for chlamydia. Region X Infertility Prevention Project (IPP) emphasizes screening during routine pelvic exams at family planning (FP) clinics, based on a historical need for cervical specimens. However, many FP visits are non-routine—precluding pelvic exams—and new test technologies allow other specimen types. Accessing IPP and FP Title X data allows assessment of chlamydia positivity (CT+) and screening coverage within FP client populations.

Objectives: Assess effectiveness and efficiency of screening during routine visits. Evaluate alternative screening strategies for young female FP clients.

Methods: Analyses were performed using FP clinic visit records of female clients age<25 during 2007. CT+ was computed from 87,960 IPP test records. Chlamydia screening coverage (% clients tested) was calculated from Title X FP visits aggregated to the client level (n=152,013). Positivity and screening coverage were compared by visit type and age using univariate and multivariate analyses.

Results: Forty-five percent of both samples were age <20. In IPP, CT+ was 6.5% and ranged from 7.7% (age 10-18) to 4.5% (23-24 years). Positivity was higher at non-routine (9.0%) than routine visits (4.9%) (OR=1.9). 39% of Title X FP clients were screened; 38% had routine visits. Chlamydia screening was associated with visit type. FP screened 78% of women who had routine visits, versus 15% who had non-routine visits (OR=5.2). Screening coverage was positively associated with age (OR=1.7, oldest relative to youngest age group), but this association reversed when adjusted for likelihood of routine visit (AOR=0.8).

Conclusions: Screening patterns reflect policy rather than client’s risk. Teens have highest CT+ but are least likely to undergo routine exams. Consequently, screening at routine exams favors older women with lower CT+.

Implications for Programs, Policy, and/or Research: Region X IPP policy limits screening coverage. Screening efficiency would be improved by emphasizing testing at non-routine visits (via urine or vaginal specimens), particularly for adolescent females.