Chlamydia Screening in Family Planning: Maximizing Screening Yield Using Existing Testing Resources

Background: The Infertility Prevention Project (IPP) subsidizes chlamydia screening and treatment prioritizing all sexually-active women aged <26 years. However, resources are limited. Since prevalence is highest among adolescents, we hypothesized that targeted screening of adolescents could increase the number of infections detected.

Objectives: 1) Estimate the additional chlamydia cases that could potentially be detected by re-allocating existing testing resources to adolescents; 2) Identify opportunities to increase adolescent screening.

Methods: We determined chlamydia screening coverage, test volume, and positivity in family planning clinics by age, using programmatic data (Title X and IPP data, and Family Planning Annual Reports) in IPP Region X (northwest), Region V (midwest), and nationally.  We calculated the additional infections that could have been detected by re-allocating testing resources to cover 100% of female clients aged 10-19 years, with remaining tests allocated to clients aged 20-24 years; re-allocation model assumed equal chlamydia prevalence among females screened and not screened.  We assessed current screening coverage by visit characteristics in Region X.

Results: Adolescent screening coverage was 40% (Region X, 2010), 48% (Region V, 2010), and 33% (nationally, 2009). Re-allocating tests to screen all adolescents could have detected 1,257 more infections (28% increase) in Region X, 4,068 more (35% increase) in Region V, and 43,032 more (33% increase) nationally. Among adolescents, screening was more common at initial/annual visits compared to other visit types (OR=7.0 (6.7, 7.3)).

Conclusions: Theoretically, there are enough testing resources to cover 100% of adolescent females in IPP family planning clinics, and targeting adolescents could potentially detect 33% more infections. Additionally, ensuring that all non-initial/annual visits include chlamydia screening may increase adolescent screening coverage.

Implications for Programs, Policy, and Research: This exploratory analysis suggests chlamydia screening of adolescents should be prioritized when resources are limited. A pilot intervention targeting adolescents in family planning clinics is needed to determine actual screening yield.