Maximizing Use of Limited Resources by Reducing Chlamydia Screening Outside of Criteria Among Females Ages >25 Years Receiving Family Planning Services

Background: The goal of the Region II Infertility Prevention Project (IPP) is to decrease the prevalence of chlamydial infections and sequelae through targeted screening of sexually active females aged ≤25 years. Diagnostic testing of females aged >25 years with risk factors is recommended.  High rates of screening among females aged >25 years with low identification of infection (<3%) has been observed in family planning clinics.

Objectives: Assess the impact of a team-based approach to reducing Chlamydia screening among a cohort of low prevalence females aged >25 years receiving family planning services in NYC.

Methods: IPP Prevalence Monitoring Data for 21,809 Chlamydia tests in non-pregnant females aged >25 years that attended 6 clinics providing family planning services in New York City was analyzed. Trends in test volume, number of positive tests and CT positivity rates from CY2005-CY 2010 were examined to determine the impact of the team-based approach.

Results: From CY2005-CY2010, CT test volume among females aged >25 years decreased by 60.4% from 6,781 to 2,685 tests. The number of CT cases identified decreased by 18.5% from 92 to 75 cases.  CT positivity among females >25 years across all years remained less than 3%. 

Conclusions: Activities to reduce over-screening among females aged >25 years resulted in a significant decrease in test volume and a minor decrease in CT cases identified.

Implications for Programs, Policy, and Research: Reducing rates of CT screening in a low prevalence population is possible using a team-based approach and should be applied in other settings. Resources saved can be used to target screening to populations most in need.