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Hui BB, Hocking JS, Braat S, Donovan B, Fairley CK, Guy R, Spark S, Yeung A, Low N, Regan D. Intensified partner notification and repeat testing can improve the effectiveness of screening in reducing Chlamydia trachomatis prevalence: a mathematical modelling study. Sex Transm Infect 2021; 98:414-419. [PMID: 34815362 DOI: 10.1136/sextrans-2021-055220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/08/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a cluster randomised controlled trial designed to assess the effectiveness of annual chlamydia testing through general practice in Australia. The trial showed that testing rates increased among sexually active men and women aged 16-29 years, but after 3 years the estimated chlamydia prevalence did not differ between intervention and control communities. We developed a mathematical model to estimate the potential longer-term impact of chlamydia testing on prevalence in the general population. METHODS We developed an individual-based model to simulate the transmission of Chlamydia trachomatis in a heterosexual population, calibrated to ACCEPt data. A proportion of the modelled population were tested for chlamydia and treated annually at coverage achieved in the control and intervention arms of ACCEPt. We estimated the reduction in chlamydia prevalence achieved by increasing retesting and by treating the partners of infected individuals up to 9 years after introduction of the intervention. RESULTS Increasing the testing coverage in the general Australian heterosexual population to the level achieved in the ACCEPt intervention arm resulted in reduction in the population-level prevalence of chlamydia from 4.6% to 2.7% in those aged 16-29 years old after 10 years (a relative reduction of 41%). The prevalence reduces to 2.2% if the proportion retested within 4 months of treatment is doubled from the rate achieved in the ACCEPt intervention arm (a relative reduction of 52%), and to 1.9% if the partner treatment rate is increased from 30%, as assumed in the base case, to 50% (a relative reduction of 59%). CONCLUSION A reduction in C. trachomatis prevalence could be achieved if the level of testing as observed in the ACCEPt intervention arm can be maintained at a population level. More substantial reductions can be achieved with intensified case management comprising retesting of those treated and treatment of partners of infected individuals.
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Affiliation(s)
- Ben B Hui
- The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.,MISCH (Methods and Implementation Support for Clinical and Health) Research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Simone Spark
- School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Anna Yeung
- MAP Centre for Urban Health Solutions, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - David Regan
- The Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
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Abstract
BACKGROUND Chlamydial infections are common among young women and can lead to serious reproductive health complications. We assessed the risk of reported repeat chlamydial infection among young women in Louisiana and time interval between infections by age and race/ethnicity. METHODS We analyzed surveillance data on chlamydial infections reported among women in Louisiana from January 1, 2000, to December 31, 2015. Multiple reports for the same person were matched using unique codes. Chlamydial infections reported more than 30 days after a previous positive test were considered new infections. Women aged 15 to 34 years at first infection during 2000 to 2012 were censored after 3 years or after they had a repeat infection. Cumulative incidence and incidence rate of repeat chlamydial infection among women were determined by year of first infection. Race- and age-specific results were obtained using stratified analyses. RESULTS One in 4 women diagnosed with a chlamydial infection at 15-34 years of age in Louisiana had a reported repeat infection in 3 years or less. Risk of repeat infection increased for younger women, racial/ethnic minorities, and women in more recent cohorts. Young black women aged 15 to 19 years in 2012 had the highest risk (44%). Black women also had shorter intervals between infections than white women. CONCLUSIONS Repeat chlamydial infections were common, especially among young black women. The true number is likely higher because surveillance data only count infections that were detected and reported. Comprehensive prevention strategies are needed to address high rates of repeat chlamydial infections among women.
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Dee EC, Hsu KK, Kruskal BA, Menchaca JT, Zambarano B, Cocoros N, Herrick B, Weiss MDP, Hafer E, Erani D, Josephson M, Young J, Torrone EA, Flagg EW, Klompas M. Temporal Patterns in Chlamydia Repeat Testing in Massachusetts. Am J Prev Med 2019; 56:458-463. [PMID: 30777163 PMCID: PMC6931253 DOI: 10.1016/j.amepre.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION National guidelines recommend test-of-cure for pregnant women and test-of-reinfection for all patients with chlamydia infections in order to interrupt transmission and prevent adverse sequelae for patients, partners, and newborns. Little is known about retesting and positivity rates, and whether they are changing over time, particularly in private sector practices. METHODS Electronic health record data on patients with chlamydia tests were extracted from three independent clinical practice groups serving ≅20% of the Massachusetts population. Records were extracted using the Electronic medical record Support for Public Health platform (esphealth.org). These data were analyzed for temporal trends in annual repeat testing rates by using generalized estimating equations after index positive chlamydia tests between 2010 and 2015 and for differences in intervals to first repeat tests among pregnant females, non-pregnant females, and males. Data extraction and analysis were performed during calendar years 2017 and 2018. RESULTS An index positive C. trachomatis result was identified for 972 pregnant female cases, 10,309 non-pregnant female cases, and 4,973 male cases. Test-of-cure 3-5 weeks after an index positive test occurred in 37% of pregnant females. Test-of-reinfection 8-16 weeks after an index positive test occurred in 39% of pregnant females, 18% of non-pregnant females, and 9% of males. There were no significant increases in test-of-cure or test-of-reinfection rates from 2010 to 2015. Among cases with repeat tests, 16% of pregnant females, 15% of non-pregnant females, and 16% of males had positive results. CONCLUSIONS Chlamydia test-of-cure and test-of-reinfection rates are low, with no evidence of improvement over time. There are substantial opportunities to improve adherence to chlamydia repeat testing recommendations.
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Affiliation(s)
- Elizabeth C Dee
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Katherine K Hsu
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - John T Menchaca
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Noelle Cocoros
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | | | - Ellen Hafer
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Diana Erani
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Mark Josephson
- Massachusetts League of Community Health Centers, Boston, Massachusetts
| | - Jessica Young
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Elizabeth A Torrone
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elaine W Flagg
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School, Harvard University, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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McArdle BJ, Buser GL, Hedberg K, Schafer S. Chlamydia Retesting Among Safety-Net Clinic Patients: Infertility Prevention Project. J Womens Health (Larchmt) 2018; 27:1135-1141. [PMID: 29694796 DOI: 10.1089/jwh.2017.6747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Due to high reinfection rates, the Centers for Disease Control and Prevention (CDC) recommend retesting everyone diagnosed with chlamydia after treatment. However, retesting rates are often low, and research on retesting is limited. METHODS Infertility Prevention Project (IPP) was a national chlamydia screening and treatment project in the United States. We completed a retrospective longitudinal analysis using IPP testing data from 8,266 women with at least 1 positive test result from 2010 to 2013. We calculated the proportion of women retested 2-12 months after a chlamydia diagnosis and used Cox proportional hazards models to explore associated factors. RESULTS Only 32% of women had evidence of retesting by 12 months of follow-up. Being younger (multivariate hazard ratio [mHR]: 0.96; 95% confidence interval [CI]: 0.95-0.96), black (mHR: 1.29; 95% CI: 1.12-1.50), or attending a county sexually transmitted diseases (STD; mHR: 1.91; 95% CI: 1.68-2.17), county family planning (mHR: 1.53; 95% CI: 1.39-1.69), or school-based (mHR: 2.34; 95% CI: 2.07-2.65) clinic relative to a nonprofit community health clinic were associated with increased retesting rates. CONCLUSIONS Less than one-third of women are retested. Our results show that some clinic settings may have systematic differences which facilitate retesting, such as use of automated reminders, closed patient populations, and makeup of patient populations. Investigation of clinical environments through site visits and further data analyses may be keys to improving retesting rates.
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Affiliation(s)
- Breanna J McArdle
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Genevieve L Buser
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Katrina Hedberg
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
| | - Sean Schafer
- HIV/STD/TB Program, Center for Public Health Practice , Oregon Public Health Division, Portland, Oregon
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Salow KR, Cohen AC, Bristow CC, McGrath MR, Klausner JD. Comparing mail-in self-collected specimens sent via United States Postal Service versus clinic-collected specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in extra-genital sites. PLoS One 2017; 12:e0189515. [PMID: 29240781 PMCID: PMC5730150 DOI: 10.1371/journal.pone.0189515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/28/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives To evaluate the concordance between clinic-collected extra-genital specimens and self-collected mailed-in extra-genital specimens among participants seeking sexually transmitted infection testing at a free clinic in Hollywood, CA. Methods A convenience sample of 210 men who have sex with men were enrolled between February 29, 2016 and December 21, 2016 and received mail-in testing kits for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). All testing was performed using the GeneXpert® CT/NG (Cepheid, Sunnyvale, CA). Results From the 210 mail-in kits distributed, 149 mail-in kits (71.0%) were returned to the laboratory, resulting in 145 pairs (clinic-collected and mail-in) of rectal test results and 148 pairs of pharyngeal test results for both CT and NG detection. The concordance was 95.0% for all CT rectal tests, 99.3% for all CT pharyngeal tests, 95.7% for all NG rectal tests, and 97.2% for all NG pharyngeal tests. Conclusion Roughly two-thirds of mail-in test kits were returned and concordance was generally high, however more than one-third of positive results were missed in mail-in samples. The prevalence of potential false-negative results among mail-in samples warrants caution when implementing mail-in STI testing strategies.
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Affiliation(s)
- Katheryn R. Salow
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, California, United States of America
- * E-mail:
| | - Adam C. Cohen
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, California, United States of America
| | - Claire C. Bristow
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Mark R. McGrath
- Public Health Division, AIDS Healthcare Foundation, Los Angeles, California, United States of America
| | - Jeffrey D. Klausner
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
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Nattabi B, Gudka S, Ward J, Rumbold A. Quality improvement interventions for improving the detection and management of curable sexually transmitted infections in primary care. Hippokratia 2016. [DOI: 10.1002/14651858.cd012374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Barbara Nattabi
- The University of Western Australia; Western Australia Centre for Rural Health, School of Primary, Aboriginal and Rural Health Care; 167 Fitzgerald Street Geraldton Western Australia Australia 6530
| | - Sajni Gudka
- The University of Western Australia; Pharmacy, School of Medicine and Pharmacology; M315, Pharmacy, School of Medicine and Pharmacology, University of Western Australia Crawley Australia
| | - James Ward
- South Australian Health and Medical Research Institute; Infection and Immunity; North Terrace Adelaide Australia
| | - Alice Rumbold
- The University of Adelaide; The Robinson Research Institute; Ground Floor, Norwich Centre 55 King William Road Adelaide NT Australia SA 5006
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Taylor MM, Frasure-Williams J, Burnett P, Park IU. Interventions to Improve Sexually Transmitted Disease Screening in Clinic-Based Settings. Sex Transm Dis 2016; 43:S28-41. [PMID: 26779685 PMCID: PMC6751565 DOI: 10.1097/olq.0000000000000294] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The asymptomatic nature and suboptimal screening rates of sexually transmitted diseases (STD) call for implementation of successful interventions to improve screening in community-based clinic settings with attention to cost and resources. METHODS We used MEDLINE to systematically review comparative analyses of interventions to improve STD (chlamydia, gonorrhea, or syphilis) screening or rescreening in clinic-based settings that were published between January 2000 and January 2014. Absolute differences in the percent of the target population screened between comparison groups or relative percent increase in the number of tests or patients tested were used to score the interventions as highly effective (>20% increase) or moderately effective (5%-19% increase) in improving screening. Published cost of the interventions was described where available and, when not available, was estimated. RESULTS Of the 4566 citations reviewed, 38 articles describing 42 interventions met the inclusion criteria. Of the 42 interventions, 16 (38.1%) were categorized as highly effective and 14 (33.3%) as moderately effective. Effective low-cost interventions (<$1000) included the strategic placement of specimen collection materials or automatic collection of STD specimens as part of a routine visit (7 highly effective and 1 moderately effective) and the use of electronic health records (EHRs; 3 highly effective and 4 moderately effective). Patient reminders for screening or rescreening (via text, telephone, and postcards) were highly effective (3) or moderately effective (2) and low or moderate cost (<$1001-10,000). Interventions with dedicated clinic staff to improve STD screening were highly effective (2) or moderately effective in improving STD screening (1) but high-cost ($10,001-$100,000). CONCLUSIONS Successful interventions include changing clinic flow to routinely collect specimens for testing, using EHR screening reminders, and reminding patients to get screened or rescreened. These strategies can be tailored to different clinic settings to improve screening at a low cost.
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Affiliation(s)
- Melanie M Taylor
- From the *Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA; †Arizona Department of Health Services, STD Program, Phoenix, AZ; ‡STD Control Branch, Division of Communicable Disease Control (DCDC), Center for Infectious Diseases (CID), California Department of Public Health (CDPH), Sacramento, CA; and §Baltimore Department of Public Health, Baltimore, MD
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Ten Hoor GA, Ruiter RAC, van Bergen JEAM, Hoebe CJPA, Dukers-Muijrers NHTM, Kok G. Predictors of Chlamydia Trachomatis testing: perceived norms, susceptibility, changes in partner status, and underestimation of own risk. BMC Public Health 2016; 16:55. [PMID: 26790411 PMCID: PMC4719691 DOI: 10.1186/s12889-016-2689-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 01/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background It is hard to convince people to participate in chlamydia screening programs outside the clinical setting. In two earlier studies (BMC Public Health. 2013;13:1091; J Med Internet Res. 2014;16(1):e24), we identified explicit and implicit determinants of chlamydia screening behavior and attempted, unsuccessfully, to improve participation rates by optimizing the recruitment letter. In the present study, we examined the links between a number of social-cognitive determinants (e.g., stereotypical beliefs about a person with chlamydia, intentions, changes in partner status), and self-reported chlamydia testing behavior six months after the initial study. Methods The present study is a follow-up to our first study (T0). We assessed self-reported testing behavior 6 months after the first measure by means of an online questionnaire (T1; N = 269). Furthermore, at T1, we measured the social-cognitive determinants in more detail, and explored the influence of stereotypical beliefs and any changes in partner status during this six month period. Results In total, 25 (9.1 %) of the participants tested for chlamydia at some point during the six months between baseline (T0) and follow up (T1). Testing behavior was influenced by testing intentions in combination with changes in risk behavior. The higher the participants’ own numbers of partners ever, the higher they estimated the number of partners of the stereotypical person with chlamydia. Testing intentions were most strongly predicted by perceived norms and susceptibility, and having had multiple partners in the last 6 months (R2 = .41). Conclusion The most relevant determinants for testing intentions and behavior were susceptibility, subjective norms and changes in partner status. We found a systematic tendency for individuals to underestimate their own risk, especially the risk of inconsistent condom use. Future research should focus on more promising alternatives to population-based interventions, such as online interventions, screening in primary care, the rescreening of positives, and clinic-based interventions. This future research should also focus on making testing easier and reducing barriers to testing, as well as using social and sexual networks in order to reach more people. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2689-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gill A Ten Hoor
- Department of Work & Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Robert A C Ruiter
- Department of Work & Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jan E A M van Bergen
- STI AIDS Netherlands, Keizersgracht 390, 1016GB, Amsterdam, The Netherlands.,Department of General Practice, AMC-University of Amsterdam, P.O. Box 19268, 1000GG, Amsterdam, Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Disease and Environmental Health, Public Health Service South Limburg, P.O. Box 2022, 6160HA, Geleen, The Netherlands.,Department of Medical Microbiology, Maastricht University, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Disease and Environmental Health, Public Health Service South Limburg, P.O. Box 2022, 6160HA, Geleen, The Netherlands.,Department of Medical Microbiology, Maastricht University, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
| | - Gerjo Kok
- Department of Work & Social Psychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Angel G, Horner PJ, O'Brien N, Sharp M, Pye K, Priestley C, Macleod J, Looker KJ, Turner KME. An observational study to evaluate three pilot programmes of retesting chlamydia-positive individuals within 6 months in the South West of England. BMJ Open 2015; 5:e007455. [PMID: 26510723 PMCID: PMC4636643 DOI: 10.1136/bmjopen-2014-007455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate 3 pilot chlamydia retesting programmes in South West England which were initiated prior to the release of new National Chlamydia Screening Programme (NCSP) guidelines recommending retesting in 2014. METHODS Individuals testing positive between August 2012 and July 2013 in Bristol (n=346), Cornwall (n=252) and Dorset (n=180) programmes were eligible for inclusion in the retesting pilots. The primary outcomes were retest within 6 months (yes/no) and repeat diagnosis at retest (yes/no), adjusted for area, age and gender. RESULTS Overall 303/778 (39.0%) of participants were retested within 6 months and 31/299 (10.4%) were positive at retest. Females were more likely to retest than males and Dorset had higher retesting rates than the other areas. CONCLUSIONS More than a third of those eligible were retested within the time frame of the study. Chlamydia retesting programmes appear feasible within the context of current programmes to identify individuals at continued risk of infection with relatively low resource and time input.
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Affiliation(s)
- Georgina Angel
- Department of Screening and Immunisation, Public Health England, Bristol, UK
| | - Paddy J Horner
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Norah O'Brien
- South West Office of Sexual Health, Public Health England, Bristol, UK
| | - Matt Sharp
- Cornwall Chlamydia Screening Office, Royal Cornwall Hospitals Trust, Truro, UK
| | - Karl Pye
- Young People Public Health Team, Public Health England, Bristol, UK
| | | | - John Macleod
- Department of Social Medicine, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Katharine J Looker
- Department of Screening and Immunisation, Public Health England, Bristol, UK
| | - Katherine M E Turner
- School of Social and Community Medicine/School of Veterinary Sciences, University of Bristol, Bath, UK
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10
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Dukers-Muijrers NHTM, Theunissen KATM, Wolffs PT, Kok G, Hoebe CJPA. Acceptance of Home-Based Chlamydia Genital and Anorectal Testing Using Short Message Service (SMS) in Previously Tested Young People and Their Social and Sexual Networks. PLoS One 2015; 10:e0133575. [PMID: 26230085 PMCID: PMC4539363 DOI: 10.1371/journal.pone.0133575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022] Open
Abstract
Background Control strategies for Chlamydia trachomatis (CT) are most effective when targeting people at highest risk. We assessed test acceptance of home-collection test kits offered by short messaging services (SMS) texts, in high-risk young people, i.e. those who had previously tested CT positive (positive indices), or negative reporting more than 3 sex partners (negative indices), and their sexual and social networks. Methods Young (16 to 25 years old) heterosexuals who previously tested positive (n=536) or negative (n=536) in our STI clinic received, 3 to 20 months after their initial screening, an SMS inviting them to re-test. They were offered a free home-collection test kit including a genital (men and women) and anorectal (women only) test, and a test kit to pass on to a friend or sex partner (peer). SMS reminders were sent in case of non-response. We assessed proportions of tests requested and returned, peers tested, and positivity. Associations with the individual’s initial screening result and other factors were explored using logistic regression. Results Of 1072 people invited to retest, 34.4% (n=369) requested a test. Of these, 55.8% (n=206) retested. Overall, retest participation was higher in positive (22%) than in negative indices (16%) (p<0.001); it was also higher in women and in those aged >22 years. Positivity was 13% and 7% in positive and negative indices, respectively. One in 3 retesters also had a peer tested. Of tested peers (n=87), 84% were friends, 31% were first-time testers, and 7% tested positive. Conclusion Acceptance of a relatively low-cost strategy for genital and anorectal testing, i.e. using SMS and home-collection test kits, was highest in individuals who previously tested CT positive suggesting that implementation for this group may be considered. By further including a peer-led testing component, undetected CT positives can be identified in the social networks surrounding a high-risk individual.
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Affiliation(s)
- Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands
- * E-mail:
| | - Kevin A. T. M. Theunissen
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands
| | - Petra T. Wolffs
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands
| | - Gerjo Kok
- Department of Work & Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Geleen, the Netherlands
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands
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Smith KS, Hocking JS, Chen MY, Fairley CK, McNulty AM, Read P, Bradshaw CS, Tabrizi SN, Wand H, Saville M, Rawlinson W, Garland SM, Donovan B, Kaldor JM, Guy RJ. Dual Intervention to Increase Chlamydia Retesting: A Randomized Controlled Trial in Three Populations. Am J Prev Med 2015; 49:1-11. [PMID: 26094224 DOI: 10.1016/j.amepre.2015.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/10/2015] [Accepted: 01/22/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Chlamydia retesting 3 months after treatment is recommended to detect reinfections, but retesting rates are typically low. The purpose of this study is to determine if the addition of a postal home collection kit to a short message service (SMS) reminder at 3 months increases the percentage of patients retested for chlamydia at 1-4 months, compared to SMS alone. DESIGN In this unblinded randomized controlled trial, participants were randomized 1:1 to intervention (home arm) or control (clinic arm) status. SETTING/PARTICIPANTS Participants included 200 each of women, heterosexual men, and men who have sex with men diagnosed and treated for chlamydia at sexual health services. INTERVENTION Three months after chlamydia diagnosis, home arm participants received an SMS reminder and postal home collection kit (women, vaginal swab; heterosexual men, Copan UriSwab; men who have sex with men, UriSwab and rectal swab). MAIN OUTCOME MEASURES The main outcome measures were the percentage of participants retested at 1-4 months after chlamydia diagnosis and the percentage in each arm with repeat positive tests, by risk group and overall, analyzed by intention to treat. Data were collected from 2011 to 2013 and analyzed in 2014. RESULTS The percentage retested within 1-4 months of chlamydia diagnosis was significantly higher in home versus clinic arm participants among women (64% [66/103] vs 39% [38/97], p<0.001); heterosexual men (56% [57/101] vs 34% [34/99], p=0.002); men who have sex with men (62% [61/98] vs 44% [45/102], p=0.010); and overall (61% [184/302] vs 39% [117/298], p<0.001). The percentage in the home versus clinic arm with repeat positive tests was significantly higher among men who have sex with men (16% [16/98] vs 5% [5/102], p=0.021) and overall (10% [31/302] vs 4% [12/298], p=0.006). CONCLUSIONS The addition of a postal home collection kit to routine SMS reminders resulted in substantial improvements in chlamydia retesting rates in all three risk groups and detection of more repeat positive tests, compared with SMS alone. Extending the intervention to other primary care settings with low retesting rates should be considered.
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Affiliation(s)
- Kirsty S Smith
- Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Marcus Y Chen
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Melbourne Sexual Health Centre, Carlton, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Carlton, Australia; Central Clinical School, Monash University, Australia
| | - Anna M McNulty
- School of Public Health and Community Medicine, University of New South Wales, Sydney; Sydney Sexual Health Centre, Sydney, Australia
| | - Phillip Read
- Kirby Institute, University of New South Wales, Sydney, Australia; Kirketon Road Centre, Kings Cross, Australia
| | - Catriona S Bradshaw
- Melbourne School of Population and Global Health, University of Melbourne, Australia; Melbourne Sexual Health Centre, Carlton, Australia; Central Clinical School, Monash University, Australia
| | - Sepehr N Tabrizi
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Department of Microbiology, Royal Women's Hospital, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - William Rawlinson
- Virology Division, SEALS Microbiology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia; Department of Microbiology, Royal Women's Hospital, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Basil Donovan
- Kirby Institute, University of New South Wales, Sydney, Australia; Sydney Sexual Health Centre, Sydney, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rebecca J Guy
- Kirby Institute, University of New South Wales, Sydney, Australia
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Ali H, Cameron E, Drovandi CC, McCaw JM, Guy RJ, Middleton M, El-Hayek C, Hocking JS, Kaldor JM, Donovan B, Wilson DP. A new approach to estimating trends in chlamydia incidence. Sex Transm Infect 2015; 91:513-9. [PMID: 25564675 DOI: 10.1136/sextrans-2014-051631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 12/14/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Directly measuring disease incidence in a population is difficult and not feasible to do routinely. We describe the development and application of a new method for estimating at a population level the number of incident genital chlamydia infections, and the corresponding incidence rates, by age and sex using routine surveillance data. METHODS A Bayesian statistical approach was developed to calibrate the parameters of a decision-pathway tree against national data on numbers of notifications and tests conducted (2001-2013). Independent beta probability density functions were adopted for priors on the time-independent parameters; the shapes of these beta parameters were chosen to match prior estimates sourced from peer-reviewed literature or expert opinion. To best facilitate the calibration, multivariate Gaussian priors on (the logistic transforms of) the time-dependent parameters were adopted, using the Matérn covariance function to favour small changes over consecutive years and across adjacent age cohorts. The model outcomes were validated by comparing them with other independent empirical epidemiological measures, that is, prevalence and incidence as reported by other studies. RESULTS Model-based estimates suggest that the total number of people acquiring chlamydia per year in Australia has increased by ∼120% over 12 years. Nationally, an estimated 356 000 people acquired chlamydia in 2013, which is 4.3 times the number of reported diagnoses. This corresponded to a chlamydia annual incidence estimate of 1.54% in 2013, increased from 0.81% in 2001 (∼90% increase). CONCLUSIONS We developed a statistical method which uses routine surveillance (notifications and testing) data to produce estimates of the extent and trends in chlamydia incidence.
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Affiliation(s)
- Hammad Ali
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Ewan Cameron
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia Spatial Ecology & Epidemiology Group, University of Oxford, Oxford, United Kingdom
| | - Christopher C Drovandi
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - James M McCaw
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Rebecca J Guy
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Melanie Middleton
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Carol El-Hayek
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - John M Kaldor
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Basil Donovan
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia
| | - David P Wilson
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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Fernando KA, Fowler T, Harding J, Flew S, Caley M, Phattey J, Ross J. Detecting re-infection in patients after an initial diagnosis of gonorrhoea: is routine recall for re-screening useful? Int J STD AIDS 2014; 26:640-7. [PMID: 25161175 DOI: 10.1177/0956462414548905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 07/24/2014] [Indexed: 11/15/2022]
Abstract
To assess the outcome of routine sexually transmitted infection re-screening after a three-month interval in unselected patients diagnosed with gonorrhoea, we sought to assess whether this active approach would result in an increase in the number of people attending clinic and subsequently diagnosed with gonorrhoea re-infection, compared with normal re-presentation rates. A recall group of patients were invited for re-screening three months after their initial diagnosis of gonorrhoea. Permission was sought to send a reminder two weeks prior to their scheduled recall appointment. Comparisons were made with a historical control group of patients with gonorrhoea in the absence of any formal recall. Of the 242 patients in the intervention arm, 96 (40%) re-attended within six months, and 15 (6%) tested gonorrhoea positive. Two hundred and two patients were assessed in the control group, of whom 45 (22%) re-attended within six months, and 13 (6%) tested gonorrhoea positive. Women were more likely than men to re-attend following active recall, but they were not at higher risk of re-attending while re-infected with gonorrhoea. Active recall following a gonorrhoea diagnosis significantly increases re-attendance rates for repeat screening but did not result in an increased number of subsequent gonorrhoea diagnoses.
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Affiliation(s)
- K A Fernando
- Department of Genitourinary Medicine, Staffordshire and Stoke-on-Trent Partnership NHS Trust, Cobridge Community Health Centre, Stoke-on-Trent, UK
| | - T Fowler
- Field Epidemiology Services - West Midlands, Public Health England, Birmingham, UK Public Health, Epidemiology & Biostatistics Home, University of Birmingham, Birmingham, UK
| | - J Harding
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - S Flew
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - M Caley
- Department of Public Health, NHS Warwickshire/Warwickshire County Council, Warwick, UK
| | - J Phattey
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Jdc Ross
- Department of Genitourinary Medicine, Whittall Street Clinic, University Hospitals Birmingham NHS Trust, Birmingham, UK
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Smith KS, Hocking JS, Chen M, Fairley CK, McNulty A, Read P, Bradshaw CS, Tabrizi SN, Wand H, Saville M, Rawlinson W, Garland SM, Donovan B, Kaldor JM, Guy R. Rationale and design of REACT: a randomised controlled trial assessing the effectiveness of home-collection to increase chlamydia retesting and detect repeat positive tests. BMC Infect Dis 2014; 14:223. [PMID: 24758169 PMCID: PMC4002559 DOI: 10.1186/1471-2334-14-223] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Repeat infection with Chlamydia trachomatis is common and increases the risk of sequelae in women and HIV seroconversion in men who have sex with men (MSM). Despite guidelines recommending chlamydia retesting three months after treatment, retesting rates are low. We are conducting the first randomised controlled trial to assess the effectiveness of home collection combined with short message service (SMS) reminders on chlamydia retesting and reinfection rates in three risk groups. METHODS/DESIGN The REACT (retest after Chlamydia trachomatis) trial involves 600 patients diagnosed with chlamydia: 200 MSM, 200 women and 200 heterosexual men recruited from two Australian sexual health clinics where SMS reminders for retesting are routine practice. Participants will be randomised to the home group (3-month SMS reminder and home-collection) or the clinic group (3-month SMS reminder to return to the clinic). Participants in the home group will be given the choice of attending the clinic if they prefer. The mailed home-collection kit includes a self-collected vaginal swab (women), UriSWAB (Copan) for urine collection (heterosexual men), and UriSWAB plus rectal swab (MSM). The primary outcome is the retest rate at 1-4 months after a chlamydia diagnosis, and the secondary outcomes are: the repeat positive test rate; the reinfection rate; the acceptability of home testing with SMS reminders; and the cost effectiveness of home testing. Sexual behaviour data collected via an online survey at 4-5 months, and genotyping of repeat infections, will be used to discriminate reinfections from treatment failures. The trial will be conducted over two years. An intention to treat analysis will be conducted. DISCUSSION This study will provide evidence about the effectiveness of home-collection combined with SMS reminders on chlamydia retesting, repeat infection and reinfection rates in three risk groups. The trial will determine client acceptability and cost effectiveness of this strategy. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12611000968976.
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Affiliation(s)
- Kirsty S Smith
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
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15
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Guy RJ, Natoli L, Ward J, Causer L, Hengel B, Whiley D, Tabrizi SN, Donovan B, Fairley CK, Badman SB, Tangey A, Wand H, Shephard M, Regan DG, Wilson D, Anderson D, Kaldor JM. A randomised trial of point-of-care tests for chlamydia and gonorrhoea infections in remote Aboriginal communities: Test, Treat ANd GO- the "TTANGO" trial protocol. BMC Infect Dis 2013; 13:485. [PMID: 24138699 PMCID: PMC4231474 DOI: 10.1186/1471-2334-13-485] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/14/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND High prevalence rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been reported in Aboriginal people in remote and regional areas of Australia for well over two decades, and repeat positivity rates are high. To interrupt disease transmission and reduce the risk of complications, early diagnosis and treatment is important. However in many remote and regional areas there are long delays between testing for these curable sexually transmissible infections and providing treatment, due to both physical distance from laboratories and difficulties when recalling patients for subsequent management once results are available. Point-of-care (POC) tests have the potential to provide more timely diagnosis, to increase treatment and contact tracing, and in turn reduce CT and NG infection rates. METHODS/DESIGN TTANGO (Test, Treat, ANd GO) is a cross-over cluster randomised controlled trial in 12 regional or remote Australian health services, which predominantly provide clinical services to Aboriginal people. The overall aim of TTANGO is to measure the clinical effectiveness, cost-effectiveness and cultural and operational acceptability of molecular POC testing for CT and NG infection. The primary outcome is repeat positivity at three months after treatment of an initial CT or NG infection. Participating health services will undertake the clinical management of CT and NG under two different modalities for one year each. In the first year, six health services will be randomly assigned to manage these infections under current diagnostic guidelines. The other six will supplement current diagnostic guidelines with POC testing, whereby diagnosis is made and subsequent treatment for those with positive POC tests is offered at the initial consultation. In the second year, the health services will cross over to the opposite management modality. TTANGO will be conducted over four years; 1.5 years of trial initiation and community consultation, 2 years of trial conditions and evaluation, and 6 months of data analysis and feedback. DISCUSSION TTANGO is the first cluster randomised trial of POC testing for CT and NG internationally. The results of this trial will provide crucial information to guide sexual health clinical practice in remote Aboriginal communities and other high prevalence settings. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12613000808741.
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Affiliation(s)
- Rebecca J Guy
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Lisa Natoli
- The Kirby Institute, University of New South Wales, Sydney, Australia
- The Burnet Institute, Melbourne, Australia
| | - James Ward
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Baker IDI, Alice Springs, Northern Territory, Alice Springs, Northern Territory, Australia
| | - Louise Causer
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Belinda Hengel
- Apunipima Cape York Health Council, Cairns, Queensland, Australia
| | - David Whiley
- Queensland Paediatric Infectious Diseases (QPID) Laboratory, Queensland Children’s Medical Research Institute, The University of Queensland, Queensland, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital and Murdoch Childrens Research Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Christopher K Fairley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Steven B Badman
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Annie Tangey
- Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Shephard
- Flinders University International Centre for Point of-Care Testing, Flinders University, Adelaide, South Australia, Australia
| | - David G Regan
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - David Wilson
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
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16
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Gaydos CA, Barnes M, Jett-Goheen M, Quinn N, Whittle P, Hogan T, Hsieh YH. Characteristics and predictors of women who obtain rescreening for sexually transmitted infections using the www.iwantthekit.org screening programme. Int J STD AIDS 2013; 24:736-44. [PMID: 23970594 PMCID: PMC3777605 DOI: 10.1177/0956462413483252] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Professional organizations recommend rescreening chlamydia-infected women. The iwantthekit Internet-screening programme offered rescreening opportunities by using iwantthekit. Mailed, home-collected vaginal swabs were tested for chlamydia, gonorrhoea, and trichomoniasis by nucleic acid amplification tests. Demographics and risk behaviours of repeat users were determined from questionnaires. Predictors of repeat users were measured in a matched case-control study. Of 1747 women, 304 (17%), who used iwantthekit, indicated they had used the kit previously. Mean age was 24.7 ± 5.7 years and 69% were African-American. Repeat iwantthekit users were more likely to be aged ≥ 20 years (OR=2.10); were more likely to have been treated for a sexually transmitted infection (OR=2.32); less likely to drink alcohol before sex (OR=0.63); and to never use condoms (OR=0.43). Of repeat users, 84.2% had a negative prior test and 15.8% had a positive. At current test, 13.2% were infected. Previous trichomoniasis was associated with current trichomoniasis (p<0.05). The iwantthekit may offer rescreening opportunities for previously infected women.
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Affiliation(s)
| | | | | | | | | | - Terry Hogan
- Johns Hopkins University, Baltimore, MD, USA
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Hocking JS, Guy R, Walker J, Tabrizi SN. Advances in sampling and screening for chlamydia. Future Microbiol 2013; 8:367-86. [PMID: 23464373 DOI: 10.2217/fmb.13.3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chlamydia is the most commonly diagnosed bacterial sexually transmitted infection in the developed world, with diagnosis rates continuing to increase each year. As chlamydia is largely asymptomatic, screening and treatment is the main way to detect cases and reduce transmission. Recent advances in self-collected specimens and laboratory tests has made chlamydia screening easier to implement as well as possible in nonclinical settings. This review will discuss new approaches to specimen collection and how these have expanded opportunities for reaching target populations for chlamydia screening. Furthermore, it will discuss how advanced molecular microbiological methods can be used with self-collected specimens to further our knowledge of the epidemiology of chlamydia and the dynamics of transmission.
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Affiliation(s)
- Jane S Hocking
- Centre for Women's Health, Gender & Society, University of Melbourne, Victoria, Australia
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Satterwhite CL, Chow JM, Bernstein KT, Guerry SL, Nakatsukasa-Ono W, Bauer HM. Opportunities for chlamydia control in the era of healthcare reform: lessons from two decades of innovative family planning care. ACTA ACUST UNITED AC 2013; 9:25-38. [PMID: 23241153 DOI: 10.2217/whe.12.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the USA, family planning clinics are primary providers of reproductive healthcare to young women and their male partners and have long provided quality sexually transmitted infection (STI) care and prevention. Chlamydia, an easily treatable STI that can lead to serious adverse outcomes if untreated, is the most common bacterial STI in the USA, and annual chlamydia screening is recommended for sexually active women aged ≤25 years. As early adopters of routine screening, family planning clinics screen >50% of all care-seeking eligible women for chlamydia, performing better than private sector healthcare plans. To achieve high levels of quality care, family planning clinics have been leaders in implementing evidence-based care delivery and developing prevention innovations. As national healthcare reform is implemented in the USA and categorical STI clinics close, public-sector demand on family planning clinics will increase.
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Affiliation(s)
- Catherine L Satterwhite
- Department of Preventive Medicine & Public Health, University of Kansas School of Medicine, 3901 Rainbow Boulevard, MS 1008, Kansas City, KS 66160, USA.
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Shi L, Xie Y, Liu J, Kissinger P, Khan M. Is out-of-pocket cost a barrier to receiving repeat tests for chlamydia and gonorrhoea? Int J STD AIDS 2013; 24:301-6. [PMID: 23970662 DOI: 10.1177/0956462412472821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to examine whether out-of-pocket (OOP) costs associated with chlamydia (CT) and gonorrhoea (GC) screening tests is a barrier to receiving CT/GC re-screening and follow-up annual screening. A major health insurance claims database 2006-2010 was used for analysis. The date of first CT/GC diagnosis was used as the index date, and OOP costs at index date for screening tests were retrieved. A re-screening test and an annual screening were defined as tests that occurred within 90-180 days and 181-395 days of the index date, respectively. Re-screening rates were 11.7% and 10.9% and annual screening rates were 24.7% and 23.7% for CT and GC cases, respectively. Compared with the CT patients without OOP expenses, those with OOP expenses of $30 or higher had significantly reduced likelihood of receiving re-screening and annual screening. Similar results were found for GC patients. We concluded that OOP costs serve as a significant barrier to re-screening and annual screening.
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Affiliation(s)
- L Shi
- Department of Global Health Systems and Development, School of Public Health and Tropical Medicine,Tulane University, New Orleans, LA, USA.
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20
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Götz HM, Wolfers MEG, Luijendijk A, van den Broek IVF. Retesting for genital Chlamydia trachomatis among visitors of a sexually transmitted infections clinic: randomized intervention trial of home- versus clinic-based recall. BMC Infect Dis 2013; 13:239. [PMID: 23705624 PMCID: PMC3666896 DOI: 10.1186/1471-2334-13-239] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 05/20/2013] [Indexed: 11/10/2022] Open
Abstract
Background Reinfections of Chlamydia trachomatis (Ct) are common. In a two-armed intervention study at an urban STI clinic in the Netherlands, heterosexual Ct-positive visitors received an invitation for retesting after 4–5 months. Interventions were either home-based sampling by mailed test-kit, or clinic-based testing without appointment. Methods Data collection included socio-demographic and sexual behavioural variables at first (T0) and repeat test (T1). Participation in retesting, prevalence and determinants of repeat infection among study participants are described and compared with findings from non-participants. Results Of the 216 visitors enrolled in the study, 75 accepted retesting (35%). The retest participation was 46% (50/109) in the home group versus 23% (25/107) in the clinic group (p = 0.001). Men were less often retested than women (15% versus 43%, p < 0.001). The overall chlamydia positivity rate at retest was 17.3% (13/75) compared to 12.4% seen at all visits at the STI clinic in 2011. Repeated infections were more frequent among non-Dutch than Dutch participants (27.0% versus 7.9%; p = 0.04) and in persons reporting symptoms (31.0% versus 7.0%; p = 0.01). Both untreated infections of current partners as well as unprotected sex with new partners contribute to repeated infections. Conclusion The high rate of repeated infections indicates the need for interventions to increase retesting; improvement of partner-management and risk reduction counselling remain necessary. Home- based testing was more effective than clinic-based testing. However other strategies, including self-triage of patients, may also increase repeat testing rates and personal preferences should be taken into account.
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Walker J, Tabrizi SN, Fairley CK, Chen MY, Bradshaw CS, Twin J, Taylor N, Donovan B, Kaldor JM, McNamee K, Urban E, Walker S, Currie M, Birden H, Bowden F, Gunn J, Pirotta M, Gurrin L, Harindra V, Garland SM, Hocking JS. Chlamydia trachomatis incidence and re-infection among young women--behavioural and microbiological characteristics. PLoS One 2012; 7:e37778. [PMID: 22662220 PMCID: PMC3360595 DOI: 10.1371/journal.pone.0037778] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 04/24/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study aimed to estimate rates of chlamydia incidence and re-infection and to investigate the dynamics of chlamydia organism load in prevalent, incident and re-infections among young Australian women. METHODS 1,116 women aged 16 to 25 years were recruited from primary care clinics in Australia. Vaginal swabs were collected at 3 to 6 month intervals for chlamydia testing. Chlamydia organism load was measured by quantitative PCR. RESULTS There were 47 incident cases of chlamydia diagnosed and 1,056.34 person years of follow up with a rate of 4.4 per 100 person years (95% CI: 3.3, 5.9). Incident infection was associated with being aged 16 to 20 years [RR = 3.7 (95%CI: 1.9, 7.1)], being employed [RR = 2.4 (95%CI: 1.1, 4.9)] and having two or more new sex partners [RR = 5.5 (95%CI: 2.6, 11.7)]. Recent antibiotic use was associated with a reduced incidence [RR:0.1 (95%CI: 0.0, 0.5)]. There were 14 re-infections with a rate of 22.3 per 100 person years (95%CI: 13.2, 37.6). The median time to re-infection was 4.6 months. Organism load was higher for prevalent than incident infections (p<0.01) and for prevalent than re-infections (p<0.01). CONCLUSIONS Chlamydia is common among young women and a high proportion of women are re-infected within a short period of time, highlighting the need for effective partner treatment and repeat testing. The difference in organism load between prevalent and incident infections suggests prevalent infection may be more important for ongoing transmission of chlamydia.
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Affiliation(s)
- Jennifer Walker
- CERSH Melbourne Medical School, University of Melbourne, Victoria, Australia.
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