Chlamydia Positivity Among Men and Women Seen at Texas Border and Non-Border Family Planning Clinics, 2008

Background: Reproductive healthcare and STD testing and treatment along Texas border areas have been impacted by cross-border population flows. Infertility Prevention Project (IPP) family planning (FP) clinics provide services to all individuals without residency or citizenship determinations.

Objectives:  Assess factors associated with chlamydia positivity (CT+) among Hispanic women and men aged 15-25 years attending Texas IPP FP clinics, 2008. Compare border and non-border client characteristics and CT+. 

Methods: CT+ was calculated by demographics (sex, age) and clinic location for 15,738 female and male Hispanic tests from 29 Texas IPP FP clinics, 2008.  Univariate and multivariate analyses performed.

Results: 45% of tests came from 8 border clinics; 55% from 21 non-border sites. Border clinics were more likely to see male clients (9.8% vs. 6.3%) and patients age 20-25 (70.1% vs. 54.9%). Overall CT+ was 11.5%; male CT+=19.1%, female CT+=10.7%. CT+ for age <20=13.6%; for age 20-25 CT+=10.1%. CT+ at border clinics was 12.6% and non-border was 10.5%. Border sites had significantly higher CT+ than non-border clinics for women (11.5% vs. 10.1%, p=0.01) and men (22.9% vs. 16.2%, p=0.004). Border clinics also had higher CT+ for adolescents (15.5% vs. 12.6%, p=0.003) and clients age 20-25 (11.4% vs. 8.8%, p<0.001). After controlling for age and sex, CT+ was still higher at border clinics (AOR=1.27, 95% CI=1.15, 1.40).

Conclusions: Border FP clinics saw an older Hispanic client population and were much more likely to provide services to Hispanic males. Compared to non-border Texas FP clinics, chlamydia positivity was higher at border sites across all demographic characteristics and categories.

Implications for Programs, Policy, and/or Research: Work is needed to: 1) identify how border FP clinics succeed at serving Hispanic males; 2) whether those strategies could translate to non-border clinics, and 3) assess other community resources impacting CT testing/treatment. Border services may be particularly relevant in terms of clinic cultural competency and larger healthcare reform issues.