1. 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

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

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

6. Objectives For Family Planning and STD programs: 1. Estimate ‘rate’ of re-screening 2. Characterize re-screening clients & compare to other clients Demographic & reproductive health characteristics 3. 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 All Visits Re-screening visits Re-screening visits Subset of visits with positive CT results (non-re-screening) 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-Screened Family Planning Clinics FP clinics: # CT+ at “other” visits* = 26127 (5.7%) # re-screen visits = 6601 (1.5%) 26%  Estimated % re-screened (ratio) = 26% STD clinics # CT+ at “other” visits* = 2837 (11.0%) # re-screen visits = 940 (4.1%) 34%  Estimated % re-screened (ratio) = 34% *all visits except re-screening

12. FP ≈ 26% STD ≈ 34%

13. Demographic Profile Family Planning Clinics

14. Reproductive Health Profile Family Planning Clinics

15. Demographic Profile STD Clinics

16. Reproductive Health Profile STD 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 : Behavioral Risk Factors (past 60 days): + Sex Partners; New Sex Partner; Symptomatic Partner

20. Summary of Findings 1. Re-screening “rate” for CT+ females age <25: FP ~ 26% FP ~ 26% STD ~ 34%

21. Summary of Findings 2. 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 Positivity of FP re-screening clients as high as average STD clients Similar trend not found in STD clinics Similar trend not found in STD clinics

22. Summary of Findings 3. 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 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 Increase CT case detection by targeting group with high CT positivity Target women at elevated risk (P 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 “Re-Screened” (Aggregated client data, n= 5568 Females age<25)

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

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