Chlamydia Screening Coverage and CT Positivity (%CT+) in Family Planning/Reproductive Health (FP/RH) Clinics: Does It Matter Which Female Patients We Screen?

Background: The Region X Infertility Prevention Project (IPP) monitored %CT+ and risk factors for infection among adolescent and young adult women tested in FP/RH clinics.  Broader agency information systems found FP/RH Clinic CT Screening Coverage (CCSC) averages ~50% but varies significantly. We asked if variation in CCSC reflects variation in criteria used to make screening decisions, and how that might affect clinic CT+? We assessed aggregate clinic-level variation and associations among patient demographics, CT risk factors, service characteristics, CCSC and %CT+.

Methods: We aggregated 2011 IPP FP/RH CT tests (n=47,896) for women aged 15-24 to the clinic level (n=186). We generated clinic characteristics: %age 15-19; %non-Hispanic white; %diagnostically tested (STD exposure, clinical signs, or re-screening), %reporting 1+ behavioral risks (multiple or new sex partner (SP); SP with concurrent SPs; no condom use), %routine visit, %self-collected specimen, and %CT+. CCSC, created from FP/RH Title X clinic visit records (n=197,660) aggregated to patient and clinic, was merged into IPP records via clinic ID#. We selected the 58 FP/RH IPP clinics with >100 female clients aged 15-24 and >50 IPP CT tests. We computed the median (M) and interquartile range (IQR) for each clinic characteristic, and explored associations among characteristics, CCSC, and %CT+ via correlations and scatterplots.

Results: Median (IQR): screening coverage=55%(IQR=23%) (range=32%-91%), %CT+= 6.5%(4%), %diagnostic testing=14%(12%), %behavioral risks=61%(31%), %no exam=54%(46%), %routine visit=83%(22%), %white=95%(8%), %self-collected specimen=57%(51%), %age15-19=44%(11%). CCSC was not associated with other aggregate measures or clinic %CT+. Clinic %CT+ was significantly (p<0.05) correlated with %reporting behavioral risks (r=0.274), %non-routine exam (r=-0.274), and %re-testing (r=0.288).

Conclusions: FP/RH CCSC varied significantly, but was unrelated to %CT+.  Demographic, behavioral, and service characteristics did not explain variation in CCSC. Clinic %CT+ was related to the mix of clients tested. Further research should explore system, fiscal, clinic, and provider factors affecting decisions to screen young female FP/RH clients for CT.