Maximizing Opportunities for Chlamydia Screening Among Adolescent Females – A Lesson From School Based Health Centers

Background: Many young women access family planning services for non-pelvic examination visits suggestive of unprotected intercourse, such as emergency contraception (EC) or pregnancy tests (PT); yet these women often do not receive STD services at the time of their visit. Considering that women 25 and under account for more than 50% of all reported Chlmaydia cases, increasing screening among these women during these time limited visits is an essential chlamydia control strategy.

Objectives: To illustrate an effective model of targeted chlamydia screening among females that present for non-pelvic time limited services in the School Based Health Center (SBHC).

Methods: In 2008, nine Title X agencies in California partnered with 19 SBHCs in the Educational Partnerships to Increase Chlamydia Screening (EPICS) program, developed by the California Family Health Council and funded by the CDC. SBHCs collected data on all clients served: demographics, chlamydia test results, and reason for visit.

Results: SBHCs provided services to 3433 unduplicated, sexually active females, ages 25 and under; 3074 were tested (89%) and 198 were positives detected (6.4%). Of completed responses (41 missing), 3068 presented for a non-pelvic examination visit. Of women that requested EC only (332), 83% were screened and 18 cases (6.5%) were detected; 547 women requested PT only, 92% were screened and 27 cases (5.4%) were detected; 123 women had both EC and PT, 96% were screened and 13 cases (11%) were detected.

Conclusions: SBHCs were able to establish a high screening coverage among females with visits suggestive of unprotected sex and detected significant disease morbidity.

Implications for Programs, Policy, and/or Research: The SBHC model effectively provides comprehensive reproductive health care to adolescents using clinical strategies such as identifying opportunities for screening during time limited non-pelvic examination visit types. To improve chlamydia control efforts, this model should be adapted in the general family planning setting.