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THP 125 Temporal Patterns in Chlamydia Repeat Testing in Pregnant Women Vs Non-Pregnant Women Vs Men in Eastern Massachusetts, 2007-2015

Thursday, September 22, 2016
Galleria Exhibit Hall
Michael Klompas, MD, MPH1, Benjamin Kruskal, MD, PhD2, John Menchaca, BA3, Rebecca Hawrusik, MS4, Bob Zambrano, PhD5, Katherine Hsu, MD, MPH4 and Elizabeth Torrone, PhD6, 1Harvard Medical School / Harvard Pilgrim Health Care Institute Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 2Atrius Health, Somerville, MA, 3Harvard Pilgrim Health Care Institute, Boston, MA, 4Massachusetts Department of Public Health, Jamaica Plain, MA, 5Commonwealth Informatics, Waltham, MA, MA, 6Surveillance and Data Management Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Background:  Sexually transmitted disease treatment guidelines have incrementally added repeat testing recommendations for Chlamydia trachomatisinfections over time, including test-of-cure in pregnant women 3-4 weeks after infection and test-of-reinfection for all patients ~3 months after infection.  Little is known, however, about chlamydia repeat testing rates overall, whether they differ for pregnant women versus non-pregnant women versus men, and whether rates are changing over time.  We measured annual repeat testing patterns within a diverse population in Eastern Massachusetts.

Methods:  We developed a chlamydia testing and reinfection report for the Electronic medical record Support for Public Health (ESP) surveillance platform.  ESP is open source software that extracts data from any electronic health record system, maps the data into standardized tables, runs algorithms to detect events of public health interest, and reports findings to state or local public health.  We programmed the report to identify all patients with laboratory-confirmed Chlamydia trachomatis infections between 2007-2015 and the frequency, timing, and results of all subsequent chlamydia tests in the following year.  We implemented the report in Atrius Health, a multispecialty ambulatory practice group serving over 800,000 patients in Eastern Massachusetts.

Results:  Between 2007 and 2015, there were 9009 index cases of chlamydia.  Repeat testing within 28 days of infection occurred for 113/484 pregnant women (23%), 841/6017 non-pregnant women (14%), and 206/2508 men (8.2%).  An additional 230/484 pregnant women were tested 29-90 days after infection (48%), as were 1857/6017 non-pregnant women (31%), and 336/2508 men (13%).  The percentage of pregnant women with repeat tests within 90 days after infection increased from 64% to 73% between 2007-2015 whereas the rate declined from 53% to 38% in non-pregnant women and 26% to 17% in men.

Conclusions:  Chlamydia repeat testing rates are low for all patients, however, the rate of repeat testing may be rising over time amongst pregnant women.

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