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Re-Screening of CT Positive Clients in Region X IPP, 2003-2008

Re-Screening of CT Positive Clients in Region X IPP, 2003-2008. Goldenkranz S., 1 Fine D. 1 1 Center for Health Training 2010 CDC STD Prevention Meeting, Atlanta, GA March 8-11. Background: Re-Infection and Re-Screening. Women with a history of CT are at elevated risk for:

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Re-Screening of CT Positive Clients in Region X IPP, 2003-2008

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  1. Re-Screening of CT Positive Clients in Region X IPP, 2003-2008 Goldenkranz S.,1 Fine D.1 1Center for Health Training 2010 CDC STD Prevention Meeting, Atlanta, GA March 8-11

  2. Background: Re-Infection and Re-Screening • Women with a history of CT are atelevated risk for: • Repeat CT infection • PID and other complications

  3. Most post-treatment infections result from re-infection1 • Initial infection cleared • Infected again by untreated or new partner • Recommendations: • CDC: re-screen women at next visit 3-12 months after CT treatment1 • AAP: re-screen adolescents in 3-6 months2 1Sexually Transmitted Diseases Treatment Guidelines, 2006 CDC DSTDP 2American Association of Pediatrics Treatment Guidelines, 2006

  4. Background: Infertility Prevention Project Region X • Funds chlamydia screening for low-income women • Family Planning (FP) & STD clinics, primarily • Universal screening for women <age 25 • Region X (WA, OR, ID, AK) has re-screening visit data for 2003-present

  5. X X IPP Lab Slip Lab slip completed for each CT test • Visit Type • Lab slip includes reason for visit • Patient-reported • Can mark multiple reasons for visit • CT+ • Lab slip includes CT test result

  6. Objectives For Family Planning and STD programs: • Estimate ‘rate’ of re-screening • Characterize re-screening clients & compare to other clients • Demographic & reproductive health characteristics • Compare CT positivity at re-screening & other visits

  7. Methods I • Compiled FP and STD visit records from 2003-2008 for female clients < age 25 • Estimated annual re-screening prevalence ( ) • #re-screen visits • # positive test results from other visits

  8. Methods II • Compared frequencies of demographic & reproductive health characteristics for: • All Visits • Re-screening visits • Subset of visits with positive CT results (non-re-screening) • Computed % CT+ at re-screen visits and other visits

  9. (Assumption)

  10. Results • Number of visits by females under age 25: • FP: 437,177 total 6601 re-screening (1.5%) • STD: 23,100 total 940 re-screening (4.1%)

  11. Estimated % Re-ScreenedFamily Planning Clinics • FP clinics: • # CT+ at “other” visits* = 26127 (5.7%) • # re-screen visits = 6601 (1.5%) Estimated % re-screened (ratio) = 26% • STD clinics • # CT+ at “other” visits* = 2837 (11.0%) • # re-screen visits = 940 (4.1%) Estimated % re-screened (ratio) = 34% *all visits except re-screening

  12. FP ≈ 26% STD ≈ 34%

  13. Demographic ProfileFamily Planning Clinics

  14. Reproductive Health ProfileFamily Planning Clinics

  15. Demographic ProfileSTD Clinics

  16. Reproductive Health ProfileSTD Clinics

  17. Elevated positivity at re-screening visits to FP Clinics

  18. Increased positivity, without reported symptoms or exposure?

  19. Increased positivity, without increased risk behaviors? Behavioral Risk Factors (past 60 days): + Sex Partners; New Sex Partner; Symptomatic Partner

  20. Summary of Findings • Re-screening “rate” for CT+ females age <25: • FP ~ 26% • STD ~ 34%

  21. Summary of Findings • In FP clinics, re-screening visits yield 2X higher positivity than other visits • Positivity of FP re-screening clients as high as average STD clients • Similar trend not found in STD clinics

  22. Summary of Findings • Re-screening clients NOT more likely to report risk behaviors, symptoms, or exposure to STDs • STD clients less likely to report risk at re-screening visits than other visits

  23. Implications • Suggested Intervention: Scale up re-screening efforts targeting young women in FP clinics • Expected Impact: • IncreaseCT case detection by targeting group with high CT positivity • Target women at elevated risk for adverse health outcomes (PID, ectopic pregnancy)

  24. Steps to increase re-screening: Positive CT result Asked to return for re-screening Returns for re-screening Re-tested Ensure providers accurately mark ‘re-screening’ box!

  25. Limitations • Analyzed visit-level data • Demographic data “weighted” towards clients who visited more than once • Estimated re-screening “rate” assumes re-screening clients are subset of CT+ clients • No unique identifier for STD clinic clients to link records

  26. Some Parting Thoughts…on measuring re-screening

  27. FP Clients Tested in April 2008 (Aggregated client data, n= 5568 Females age<25) “Re-Screened”

  28. All clients with initial CT+ April 2008 % Re-screened N = 316 females < age 25 Re-screened ? Not re-screened *Not Re-Tested includes clients that came to clinic but were not re-screened

  29. Thank You Contact Information: Sarah Goldenkranz Center for Health Training (206) 447-9538 Sarah@jba-cht.com

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