ECDC Guidance Chlamydia control in Europe Marita van de Laar, programme coordinator STI/HIV/hepatitis European Centre for Disease Prevention and Control London, 30 June 2009

A young EU agency dedicated to the control of communicable diseases  ECDC became operational in May 2005  Located in Stockholm, Sweden  Director Zsuzanna Jakab  27 EU Member States & 3 EFTA  Founding regulation EC/851/2004

Disease Specific Programme STI, HIV/AIDS and hepatitis  Coordinate the enhanced surveillance of HIV/AIDS (2008) and STI (2009), prepare hepatitis B/C surveillance  Develop standardised behavioural surveillance and to promote second generation surveillance in Europe  Produce guidance documents on key prevention strategies including Chlamydia control, HIV testing, migrants, partner notification  Establish a Monitoring and Evaluation programme to review national HIV/STI prevention and control programmes  Support Member States to monitor the commitments in HIV Dublin Declaration and EU Action Plan against HIV

Chlamydia is the most prevalent bacterial STI in Europe, affecting young people the most Review of Chlamydia control programmes:  10/24 countries had no national organisation of Chlamydia control  5 had patient management guidelines and additional 3 had active case finding;  In countries with patient management guidelines, these are not always available in the chlamydia testing settings  In most countries with guidelines, partner notification is part of the guideline but implementation is not always clear Source: Review of Chlamydia control programmes in EU countries. ECDC Technical Report, May 2008 ECDC Guidance Background and Rationale

ECDC Guidance Chlamydia control in Europe Purpose  Provide guidance about national Chlamydia control strategy  Facilitate the development of local evidence-based guidelines within the context of national Chlamydia strategies Target audiences  National programme managers on sexual health and STI  Policy makers at EU and national level  Experts involved in sexual health areas (public health, dermato-venerologists, gynaecologists, general practitioners, microbiologists, etc.)

ECDC Guidance Chlamydia control in Europe Developing a Chlamydia control strategy  Step-by-step approach  Ensure that patient management infrastructures and quality controls are in place before other community-based interventions are introduced  National Chlamydia control strategy to ensure the sustainability of a comprehensive and effective control

ECDC Guidance Chlamydia control in Europe Video on Chlamydia control

ECDC Guidance Chlamydia control in Europe Step wise approach  A: Primary prevention  health promotion/education, school programmes, condom distribution  B: Case management  diagnostics, patient and partner management, surveillance  C: Opportunistic testing  testing routinely offered to specified sub-populations attending clinical services  D: Screening programme  organised provision of Chlamydia testing to a defined population

LevelEssential activitiesEssential policiesEvaluation APrimary prevention Sexual health/education, awareness campaigns, promotion of condoms Health promotion policiesPeriodic surveys including knowledge and behaviour. BCase management Routine surveillance of casescase reporting policyTrends in case reports Chlamydia diagnostic servicesGuidelines for diagnosisQuality control of diagnosis Clinical servicesGuidelines for patient management Periodic clinical audit Partner notification servicesGuidelines for partner notification Periodic audit COpportunistic testing Chlamydia testing routinely offered to sub-populations (asymptomatic people) Policy on Chlamydia testing (who, which settings_) Coverage of target group(s) DScreening programme Organised provision of regular Chlamydia testing for defined sub-population(s) Policy on Chlamydia screening Monitoring of coverage, positivity, quality Evaluation of trends in complications (PID, ectopic pregnancy, neonatal infections); periodic survey of prevalence ECDC Guidance Chlamydia control in Europe

ECDC guidance Chlamydia control in Europe The costs and potential benefits of screening will depend on:  the prevalence in a population or country  the ability to reach high risk populations  sexual behaviour  sensitivity and specificity of testing methods  uptake of screening in target populations  uptake of/compliance with treatment Evaluation efforts includes:  Enhanced surveillance of Chlamydia  Repeated surveys on Chlamydia control across Europe

ECDC guidance Chlamydia control in Europe Thanks to the Technical Expert Group:  Helen Ward, United Kingdom (chair)  Hans Fredlund, Sweden  Hannelore Gotz, Netherlands  Véronique Goulet, France  Angela Robinson, United Kingdom  Anneli Uusküla, Estonia