Efficiency and Effectiveness of Selectively Screening Men Who Have Sex with Women (MSW) for Chlamydia Trachomatis (CT) in Family Planning/Reproductive Health (FP/RH) Settings

Background: CDC recommends male CT screening only in high prevalence settings (e.g. STD, Corrections). Few studies have explored selectively screening men in other settings with moderate to high infection rates, e.g. FP/RH. Further, with the recent trend in stand-alone STD clinic closures and growing emphasis on medical home models, FP/RH client mix may shift. Washington (WA) State uniquely funds universal male screening, and documents risk factors and testing reason. We assessed CT positivity (%CT+) stratified by individual risk factors, sexual network and area-based socioeconomic measures (ABSM) among males screened in WA IPP FP/RH clinics; and compared efficiency and effectiveness of male CT screening algorithms.

Methods: %CT+ was calculated by demographics, risk behaviors, sex partner (SP) concurrency, and ABSM for 7,918 tests among men ages 15-44 screened in WA IPP FP/RH clinics from 2009-2011. We excluded men who have sex with men and diagnostic tests. We assessed efficiency (% of males that would be screened) and effectiveness (% of cases that would be detected) of 11 algorithms based on measures identified in univariate and multivariate analyses.

Results: 51% were aged 20-25; 60% non-Hispanic whites. %CT+ was 7.3%. Multivariate factors related to %CT+ (p<0.05): non-Hispanic black (10.7%CT+/AOR=2.31), Hispanic (9.1%CT+/AOR=1.28); other race/ethnicity (7.3% CT+/AOR=3.34); age 15-19 (7.4%CT+/AOR=5.33), age 20-25 (8.3%CT+/AOR=6.14); multiple SPs (9.5%CT+/AOR=1.60); no condom use (7.7%CT+/AOR=1.45); and living areas where >20% of adults lack a HS diploma (11.3%CT+/AOR=3.77). Algorithms ranged from 24-85% efficient and 21-91% effective. Screening based on multiple SPs, age 18-22, and low community education was the most efficient (58%) and effective (71%).

Conclusions: %CT+ among FP/RH screened males is high. Young and minority males have increased infection risk. Programs should document behavioral risk and reason for testing, and use local male and female %CT+ and resource levels to inform optimal test allocation. Future work should evaluate cost effectiveness of selective male screening.