A Closer Look: Barriers and Opportunities to Improve Chlamydia Retesting Rates

Background: All women should be retested 3-12 months after chlamydial infection due to increased risk of reinfection and sequelae. Programs consistently report low retesting rates, but lack data on why clients were not retested––most importantly, whether the client ever returned to the clinic. Region X Title X family planning (FP) clinics document all client visits and services received.

Objectives: 1) Assess client return rates and missed opportunities to retest; 2) explore client- and provider-level factors predictive of return and retesting.

Methods: Using all Region X Title X clinic visit records for females that received chlamydia treatment in CY2009, we determined the rate of return (any clinic visit within 90-365 days post-treatment) and of missed opportunities (i.e. client returned but was not retested), and explored predictors of return and retesting (age, race, clinician type) using multivariate models.

Results: In 2009, 3,329 females received chlamydia treatment (median age=21 years, range=13-57 years; 62% white, 16% Hispanic, 9% black, 4% Asian). Return rate was 39% (23% within 90-179 days; 16% within 180-365 days). Another 8.6% of clients returned too early for retesting (30-89 days after treatment). 52% of returning clients were retested at first return visit and 10% at a subsequent visit; 38% were missed. Overall retesting rate was 24%. Return and retesting were associated with young age (age 10-19 vs. age 25+: Return AOR=1.8, Retest AOR = 2.0) and Asian race (Asian vs. white: Return AOR=1.7; Retest AOR=2.2). Retesting was highest among mid-level clinicians (AOR=3.3).

Conclusions: Together, a low client return rate combined with many missed opportunities resulted in only 24% of clients retested. Retesting was associated with client and clinician characteristics.

Implications for Programs, Policy, and Research: Individual and/or systems interventions targeted at patients (e.g. patient reminder systems) and providers (e.g. education and Electronic Health Record prompts) could improve retesting rates. Retesting could begin as early as 1 month post-treatment.