Closing the Gap: Missed Opportunities for Chlamydia Screening Among Young Females Seeking Reproductive Health Care

Background: Chlamydia (CT) screening among young women has increased during the past ten years, but a significant proportion does not receive annual testing, despite the ability to test non-invasive urogenital specimens.  There are few data that describe frequency and type of visits among untested women that may inform clinic-level interventions to improve screening coverage.

Objectives: To describe the number and type of clinical encounters among young female family planning clients who were not tested for CT in the past year to identify missed screening opportunities.

Methods: We analyzed paid and denied claims data for 2008-2010 from the Family PACT reproductive health services program serving low-income Californians.  We determined the number and proportion of females aged 25 years or younger who received reproductive health services but were untested for CT in the past 12 months.  We used CPT-4 procedure codes to describe the number and type of clinical encounters among untested women.

Results:  Among 219,319 female enrollees aged 25 years or younger, 163,414 (74%) were tested for CT in the previous 12 months.  Of the 55,915 untested young females, 23,816 (43%) received clinical services with either a pelvic examination, collection of a urine specimen or both.  Of these, 89% submitted a urine specimen, 29% had only a pregnancy test, and 73% had only one visit.  In the following 12 months, 52% of all untested females did return, and of these, half were tested.

Conclusions: Despite high CT screening rates, there are clinical opportunities to increase CT screening rates among untested clients by targeting visits with urine specimens, especially those including pregnancy tests.  Most clients who were not tested within 12 months had only one visit opportunity.

Implications for Programs, Policy, and Research: Clinical protocols are needed to ensure that CT testing history is reviewed with young female clients regardless of visit type, especially as most untested clients had only one visit.