Region II IPP Screening Among Females Age 30 Years and Older

1. Region II IPPScreening Among FemalesAge 30 Years and Older Region II IPP Advisory Meeting November 1, 2006 Kelly Opdyke, MPH Cicatelli Associates Inc.

2. Why Worry About Targeting Screening for Chlamydia Infection? “Screening is the testing of apparently well people to find those at increased risk of having a disease or disorder” “Inappropriate screening harms healthy individuals and squanders precious resources” Source: Grimes, Schulz: Uses and Abuses of Screening Tests, Lancet 2002

3. Region II IPPStrategic Plan 2005-2009 • PRIORITY 1: Target/Expand Chlamydia Screening to Young Sexually Active Women and Men at Risk for Infection in Public and Private Settings. • GOAL: All at risk men and women under the age of 25 will be screened at least annually. • OBJECTIVE 1C: By December 2007, decrease routine CT and GC screening by 50% in women >30 years of age in FP clinics where the prevalence of CT is less than 2%.

4. Screening Trends inFP Clinics, Region II IPP N (2003) = 46,077 22,691 41,609 4,684 2,030 117,091 N (2004) = 36,825 21,995 26,050 6,503 2,019 93,392 N (2005) = 47,542 20,871 95,957 7,054 966 172,390

5. Chlamydia Positivity in Females by Age, FP Clinics, Region II IPP, CY2005 (N = 172,390) 82% of cases identified 94% of cases identified Positivity N=917 N=41,818 N=64,801 N=32,373 N=32,481 Age (Years) Data Source: CY2005 Region II IPP Prevalence Monitoring Database

6. Screening Trends inSTD Clinics, Region II IPP N (2003) = 6,513 20,470 8,518 1,360 339 37,200 N (2004) = 4,693 21,173 10,077 714 392 37,049 N (2005) = 6,367 20,791 10,319 3,420 245 41,142

7. Chlamydia Positivity in Females by Age, STD Clinics, Region II IPP, CY2005 (N = 41,142) 78% of cases identified 91% of cases identified Positivity N=138 N=7,376 N=13,227 N=7,867 N=12,534 Age (Years) Data Source: CY2005 Region II IPP Prevalence Monitoring Database

8. Screening Trends in ClinicsOther than FP/STD, Region II IPP N (2003) = 11,656 1,481 4,457 14,736 691 33,021 N (2004) = 7,591 4,074 4,826 9,219 1,447 27,157 N (2005) = 8,716 5,237 4,399 12,464 1,529 32,345

9. Chlamydia Positivity in Females by Age, †Other Sites, Region II IPP, CY2005 (N = 32,345) 81% of cases identified 93% of cases identified Positivity N=529 N=8,820 N=9,135 N=5,270 N=8,591 †All sites other than FP/STD clinics Age (Years) Data Source: CY2005 Region II IPP Prevalence Monitoring Database

10. Chlamydia Positivity Among Females Age 30+ YrsRegion II IPP, CY2005 (N = 53,606)

11. Ct Positivity by Reason for Test Among Females Age 30+ YrsRegion II IPP, CY2005

12. Ct Positivity by Patient Risk Hx Among Females Age 30+ YrsRegion II IPP, CY2005

13. Process for Changing Ct Screening Practices in Selected Sites Sample strategies employed nationally: • Test allotment system – provider receives a pre-determined # test kits/mo. based on anticipated need for target pop. (Region Ill) • Charge providers for tests conducted outside of screening criteria (PA) • Laboratory rejects tests conducted on clients who do not meet screening criteria (WV)

14. Defining TheNext Set of Questions

15. Region II IPPStrategic Plan 2005-2009 • PRIORITY 1: Target/Expand Chlamydia Screening to Young Sexually Active Women and Men at Risk for Infection in Public and Private Settings. • GOAL: All at risk men and women under the age of 25 will be screened at least annually. • OBJECTIVE 1A: Revise regional screening criteria for females so that screening is targeted to the most at-risk populations by Oct 2006.

16. Region II IPPMinimum Screening Criteria Title X Family Planning Clinics • All women ≤ 24 years of age attending the clinic for an initial or annual visit will be screened for chlamydia. STD Clinics • All women ≤ 29 years of age attending the STD clinic will be screened for chlamydia.

17. Region II IPPMinimum Screening Criteria Regional minimum criteria do not address: • Screening among in FP with no pelvic exam • Screening in other clinic types • Male screening • Screening for gonorrhea • Screening among pregnant females • Screening for reinfection • Testing among symptomatic individuals • Screening thresholds based on local prevalence

18. Region II IPPMinimum Screening Criteria • Region II IPP minimum screening criteria for FP include only those women who have an initial or annual (i.e. pelvic) exam • In the past, chlamydia testing required the collection of a cervical specimen. • Highly-sensitive urine-based NAATs (nucleic acid amplification tests) provide an opportunity for expanded screening to additional high-risk clients.

19. Current Use of Urine Specimen forCt Testing Among FemalesRegion II IPP, CY2005

20. Is Providing a Chlamydia Test During a Pelvic Exam Enough? • Nebraska IPP Program implemented urine-based chlamydia screening among women seeking pregnancy testing only in FP clinics: • Screening from October 2002 – March 2005 • 1200 females age 15-24 yrs seeking pregnancy testing only services were screened for chlamydia with a 13% (average) positivity rate. • Overall positivity rate in women age 15-24 yrs receiving speculum exam was 4.9%. • Pilot projects in Arizona, Pennsylvania, and New Mexico yielded similar results. SOURCE: Chlamydia Positivity among Women coming into Title X Family Planning Clinics for Pregnancy Testing Only: A summary of demonstration projects conducted in the Regional IPP, 1997-2005. L Dicker, D Middleton, A James, K Johnson, P. Blackburn et al. February 2006.