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Background: Chlamydia screening decreases risk for reproductive sequelae, and is recommended annually for sexually active women under 25 years. Little is known about screening prevalence among women at increased risk for sexually transmitted infections, particularly those without health insurance. Using data from National HIV Behavioral Surveillance (NHBS), we assessed self-reported past 12 month history of chlamydia testing among heterosexual women at increased risk for HIV infection.
Methods: Respondent-driven sampling was used to recruit adults of low socioeconomic status (income at or below poverty level or no more than high school education) in 20 U.S. cities conducting NHBS in 2013. Among women aged 18-24 years who reported ≥1 male sex partner in the past 12 months, we estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) from log-linked Poisson regression models with generalized estimating equations to explore differences in chlamydia testing by selected characteristics.
Results: Of 1,012 respondents, 727 (72%) were non-Hispanic black, 213 (21%) were Hispanic, all were HIV-negative, 272 (27%) had no health insurance, and 861 (85%) saw a healthcare provider in the past 12 months. Chlamydia testing was reported by 61% overall, and was higher among women with public health insurance versus none (65% vs 51%, PR 1.3, 95% CI 1.1-1.4), who were tested for HIV in the past year vs not (74% vs 49%, aPR 1.4, 95% CI 1.3-1.5), and who saw a healthcare provider in the past year versus not (67% vs 25%, aPR 2.4, 95% CI 1.9-3.0).
Conclusions: Many women at risk for chlamydia did not report a test in the past 12 months, with self-reported testing lowest among uninsured women and those without a healthcare provider visit. Implementing low-cost screening in non-clinical settings, opt-out screening in clinic settings, and opportunistic screening in other clinical settings where uninsured patients seek care might increase chlamydia screening.