Chlamydia Screening Rates among Pregnancy Test Only Visits in Region I, Andee Krasner, MPH Region I IPP Infrastructure

Background National Objective of IPP Infrastructure Epidemiologic profile of pregnancy-test only clients seen in prevalence monitoring clinics

Objectives 1.Explore provider PTO screening practices among IPP supported clinics and partners 2.Provide baseline CT screening rates among women presenting for pregnancy-test only visits from by age and by race/ethnicity

METHODS

I. Provider Survey 2009 electronic survey N=295 from all six states Respondents from FP clinics, CHCs, STD clinics and Other 59 (20%) of providers did not answer PTO questions

II. PTO Screening Rates Data from Region I Family Planning Data System Data from Title X Family Planning sites are largely representative of IPP – Both have family planning clinics, school-based clinics, and Department of Youth Services (DYS) sites – The Title X data will not be representative of state-funded STD clinics and adult correctional facilities

Definition of PTO? General Definition Primary reason for visit= Pregnancy Test Variable Definition A clinic visit by a woman coming into family planning clinics for pregnancy testing who did not receive a physical examination, injection, or STD screening (other than CT, GC, or HIV) at the time of the visit. Includes: Visits with pregnancy test (PT) and zero or more of the following tests during the same visit: CT test, GC test, HIV test, emergency contraception, or blood pressure measurement. Note: No existing national definition for PTO

Age Categories for Analysis Used 24 and younger for age cut off in all states to reflect highest screening rates

Limitations Constructed PTO variable based on visit type response options – dont know primary intention of visit No national CT screening rates among PTO visit to compare to – used pelvic exam screening rates as bench mark No CT positivity rates in Title X Family Planning dataset – rely on published literature to suggest that positivity in PTO visits supports screening (4.7%-13.7%)

RESULTS

I. Provider Knowledge, Attitudes, and Behavior Around CT Screening During PTO Visits PTO visit feasible at clinic level 6 states use NAAT testing; capacity to do urine-based or self-collected vaginal swab Used urine based screening already: – 99% for men – 93% for women

Provider Practice The majority (86%) responded that PTO visits were fewer than 20% of their visits Variability in clinical practice from state to state ̶Our clinic policy is to only do CT testing during scheduled visits and annual exams (not walk in PTO visit) ̶Range of agreement in Region I states from 2.3% - 46%

Provider Attitude Interest in and commitment to increasing screening at PTO visits in the region – Providers indicate that they have time to CT screen on PTO visit – Providers were most strongly influenced to change their screening practices by evidence of higher positivity

II. CT Screening Rates Among PTO Visits by Age Year % Women with CT Screen at PTO Visit

CT Screening Rates Among PTO Visits by Race ( combined)

CT Screening Rates Among PTO Visits by State

Comparison of CT screening in PTO and Pelvic Exam Visits In all states, chlamydia screening among pelvic exams was much more common than the CT screening among PTO visits Chlamydia screening rates among PTO visits were never higher than 30%, while screening rates among pelvic exams hovered around %

What do the data mean?

CT Screening Rates among PTO Visits PTO screening in Region I – Increasing over 5 years (without national screening guidance) PTO Screenings according to National and state CT screening recommendations – Teens most often screened during PTO visits – women should also be emphasized – Women 25 and older least likely to receive screening at PTO visit

Positivity Rates Support CT Screening in PTO Visits Positivity in PTO visits has been shown to be 4-13% in the literature Region I: 5.1% PTO Positivity of Q1/Q2 Region I: 5.1% As high as 8.2% in ME (small numbers <50 visits)

% PTO Visits, Family Planning Clinics Q1/Q2 2011

Percent Positive Among PTO/Non-PTO Visits in FP Clinics, Q1/Q Women < 25/26

How to increase CT screening in future PTO visits? Clinicians say they have time to do a CT screening during PTO visit Clinicians are influenced by data showing higher positivity PTO variable on lab slips allow us to provide data on positivity

Ideas to Increase CT screening in PTO visits Provider and staff education about state IPP CT screening guidelines and CT positivity among PTO visits Establish standing orders, written policies and protocols that assume CT screening among PTO visits Monitor CT positivity among PTO visits and share data

CONCLUSIONS

Widespread commitment to evidence-based practice in Region I CT positivity supports increased screening in PTO visits Although not widely practices in 2009, evidence suggests CT screening among PTO visits is steadily increasing Commitment from Region I AB to monitor PTO visits (lab slip changes)