Social Determinants, Epidemiologic Context, and Individual Risk Factors for Chlamydia (CT) Among Women Attending Family Planning (FP) Clinics in the Region X Infertility Prevention Project (IPP), 2010

Background: : IPP prioritizes CT screening for adolescent and young adult women, and is the only regional-level database available to assess CT positivity (CT+). Comprehensive models of CT acquisition include individual factors, their epidemiological context, and social determinants. IPP—and supplemental databases—can be used to assess these multi-level models.

Objectives: Assess individual-level risks, sexual network measures, clinic service characteristics, and area-based socioeconomic measures (ABSM) associated with CT among Region X female FP clients aged 15-24 years.

Methods: We analyzed 39,623 CY2010 IPP tests from women ages 15-24 at 106 Region X FP clinics. Clinic service/population measures from FP Client Visit Records (n=140,181) aggregated to patient (n=85,723) then clinic (n=106) were matched to IPP tests via clinic identifiers; social determinants (ABSM) from U.S. Census 2000 ZIP code records (n=1,485) (2010 data forthcoming) matched to tests via client ZIP code. CT+ assessed by individual (demographics, risk behaviors, clinical signs), sexual network (sex partner (SP) with concurrent SPs), clinic service characteristics (%CT screening coverage) and social determinants (categorical ABSM: poverty, low educational attainment). Multivariate models generated.

Results: 43% of 39,623 tests were from clients aged 15-19y; 73% white; CT+=7.2%. Clinic CT screening coverage averaged 51% (SD=14.6). CT+ was associated with: age<20 years (AOR=1.33), race (black AOR=1.50; API AOR=1.31), CT infection past year (AOR=1.84), SP with CT (AOR=5.79), recent sexual risk behaviors (AOR=1.40), clinical findings (AOR=1.82); SP with concurrent SPs (AOR=1.40); clinic’s CT screening coverage (Ref: 35%-65%, <35%: AOR=1.22, >65%: AOR=1.08); ABSM: percentage of adults without a high school degree (AOR=1.06 per 5% increase).  

Conclusions: Results support a comprehensive model of CT acquisition including individual and sexual network risks, clinic service patterns, and community-level socioeconomic factors.

Implications for Programs, Policy, and Research: Reducing individuals’ CT risk may need broader service agency collaborations and community engagement. Linking and analyzing IPP data with larger clinic and community-level databases can serve to guide comprehensive program planning and interventions.