Second Chlamydia Positive Tests Among Previously Infected Adolescent Family Planning Clients, Region VIII Infertility Prevention Project, 1994-2007

Background: Since 1992 the Region VIII Infertility Prevention Project (IPP) has provided chlamydia (CT) testing and treatment of women in family planning (FP) , STD, Indian Health Service, and other clinic types. The project uses a soundex system to generate regional unique patient identifiers.

Objectives: Assess second CT infection rates and characteristics associated with 2^nd infections among adolescent female FP clients.

Methods: We analyzed female clients with ≥1 FP visit (1994-2007), initial CT+ by age<20, and ≥1 visit after initial CT+ (n=13,823). Data were aggregated to client level via soundex and birthdate. Second infection was defined as CT+ ≥30 days after initial infection. Univariate and Cox regression analyses performed. Kaplan-Meier survival functions explored time to 2^nd infection.

Results: At first visit 34% were age 18-19 years. 61% were white, 6% black, 16% American Indian, and 17% Hispanic. Clients averaged 4.3 CT tests (range 2-30) and 70% attended only FP clinics. 2^nd infection rate was 23.7%, ranging from 19.4% (whites) to 34.7% (blacks). Of those infected before age 15, 2^nd infection=31.5% compared to 20.6% among clients with 1^st infection age 18-19. 2^nd infections were lower for FP-only clients compared to those also visiting non-FP clinics (21.0% vs. 29.6%). Risk factors for 2^nd infection included race/ethnicity (black: AHR=1.47; American Indian: AHR=1.69; Hispanic: AHR=1.11); age 1^st infection (<15: AHR=1.13; 15-17: AHR=1.09); and attending non-FP clinics (AHR=1.29). Median time to 2^nd infection was 13.0 months. 13% had 2^nd infection within one year; 21% within two.

Conclusions: A quarter of adolescent female FP clients had a subsequent CT+. Half occurred ≥13 months after initial positive. Second infections were more likely for racial/ethnic minorities, 1^st infections at young age, and clients accessing multiple systems.

Implications for Programs, Policy, and/or Research: Project capacity to monitor client testing over time and across clinic types can improve program assessment, coordination and client services. Identifying women with multiple CT+ should be prioritized.