Chlamydia (CT) Screening Coverage in Female Adolescent and Young Adult Family Planning (FP) Clients: Region X Title X FP Clinics, 2009-2011

Background:   CDC recommends annual CT screening of all sexually active adolescent and young adult women, but FP clinic CT screening coverage (CCSC) in this population averages about 50%. However, little is known about CCSC. We assessed levels of and factors associated with CCSC in Region X FP clinics. Methods:   CY2009-2011 FP client clinic visit records (CVRs) (n=635,333) for female clients aged 15-24 years were aggregated to patient (n=291,096) and clinic levels (n=236). CVRs document client demographics and clinical services, including whether a CT test was done. We selected 125 clinics with >100 patients/year (range=102--4,137). We generated annual clinic-level measures, including patient volume and the number/percentage of clients: aged 15-19; non-white race; with comprehensive examinations; uninsured visits; and tested for CT (i.e., CCSC). We computed differences in CCSC between 2011 and prior years. Descriptive statistics and correlations were calculated. Results:   Annual CCSC averaged 50.6% (2009), 49.1% (2010) and 44.9% (2011). Individual CCSCs ranged from 10%-90%. Annual CCSC absolute differences averaged 11.5% (2011-2009) and 7.7% (2011-2010). Within-clinic annual 2009, 2010 and 2011 CCSC differences ranged from <1% to 66%. 52% of clinics had <10% variation between 2011 and their 2009/2010 CCSCs; 32% varied 10%-19%; 18% varied >20%. 2011 CCSC was correlated with 2009/2010 CCSCs (r=0.58/0.75; p<0.05). 2011 CCSC was not associated with 2011 clinic patient volume or percent non-white race, age 15-19, and comprehensive exam. For FP clinics in the Infertility Prevention Project (IPP) (n=85), 2011 CCSC was correlated with clinic %uninsured visits (r=0.47; p<0.05); for non-IPP FP sites (n=45) %uninsured was not associated with CCSC (r=0.30, p=NS).

Conclusions:   CCSC varied significantly between clinics and within clinics over time. IPP supported a safety net service strategy for uninsured FP clients' CT testing. Other clinic client and service characteristics were unrelated to CCSC. Work is needed to identify client, provider, program, fiscal, and policy factors affecting CT testing decisions in this population.