A Silver Lining of Budget Cuts: Improved Efficiency and Effectiveness of Chlamydia and Gonorrhea (CT/GC) Screening in New Mexico (NM)

Background: The Infertility Prevention Program (IPP) funds routine CT/GC screening for young women.  This can reduce CT prevalence.  Recent budget cuts have reduced screening resources in many states.

Objectives: 1) Describe collaborative interventions in NM to maintain or improve chlamydia/gonorrhea case detection while reducing total test volume; 2) Use programmatic data to evaluate intervention impact.

Methods: In 2010, NM Department of Health (DOH) changed clinical protocols, aiming to stay within budget and increase the proportion of tests allocated to women aged ≤25 years to 75%.  Title X Family Planning Program (FPP) limited screening to women aged ≤25 years and pre-IUD insertion.  The STD program recommended prioritizing women aged ≤25 years, and older women with risk factors.  STD and FP Program staff met with clinic administrators statewide and each clinic was allotted a fixed number of tests based on 2009 test volume, screening history, and CT/GC positivity.  Thus, clinics testing more women ≤25 years and finding more infections received fewer cuts.  Quarterly performance reports were provided to clinics.

Results: From 2009 to 2010, FPP increased the proportion of tests provided to women aged ≤25 from 68% to 75%.  Comparing three quarters of 2010 and 2009 overall NM data, NM DOH had 21% fewer tests (21,180 vs. 26,789 tests, respectively), and found 5% fewer CT infections (2,816 vs. 2,954, respectively) and 15% more GC infections (479 vs. 416, respectively).  The screening program stayed within budget.

Conclusions: Using a combination of clinical protocol changes and site-based testing caps, NM successfully increased screening of young women while reducing overall test volume, resulting in a substantial increase in GC case detection and only slight decrease in CT case detection.

Implications for Programs, Policy, and Research: Program can stay within budget and still improve screening efficiency.  Inter-agency collaboration, straightforward guidelines, regular feedback and follow-up are critical.