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Renee Gindi 1 , Heidi Bauer 2 , Joan Chow 2 , Melanie Deal 1

Evaluating Efforts to Increase Testing for Repeat Chlamydia Infection Among Women in California Family Planning Clinics. Renee Gindi 1 , Heidi Bauer 2 , Joan Chow 2 , Melanie Deal 1

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Renee Gindi 1 , Heidi Bauer 2 , Joan Chow 2 , Melanie Deal 1

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  1. Evaluating Efforts to Increase Testing for Repeat Chlamydia Infection Among Women in California Family Planning Clinics Renee Gindi1, Heidi Bauer2, Joan Chow2, Melanie Deal1 1California Family Health Council, Berkeley, CA 2 California Sexually Transmitted Disease Control Branch, Berkeley, CA

  2. Background • Repeat chlamydial infection can lead to increased risk of sequelae • Studies estimate that >10% of women with chlamydia are re-infected within 4 months • Most repeat infections are due to re-infection from untreated partner • CDC Guidelines • Clinicians should consider advising all [non-pregnant] women with chlamydial infection to be re-screened 3-4 months after treatment.

  3. Study Objectives • Estimate the baseline re-screening rate in selected California family planning clinics • Promote the CDC guidelines and re-screening recommendations to family planning clinic staff • Evaluate re-screening rates before and after the release of the CDC guidelines

  4. Methods: Data • Line-listed chlamydia test data from 1999-2003 at 13 family planning clinics • Defining “re-screening” • Second test between 3-4 months • Second test between 1-6 months • Excludes: • Males • Initial positive tests after July 1, 2003 • Cases re-screened within 30 days • Statistical analysis • Trends • Grouped by pre/post-guidelines release

  5. Methods: Guideline Promotion • May 2002: CDC STD Treatment Guidelines released • May 2002: CFHC e-mail to 250 clinics • June 2002: CIPP memo to 250 clinics • Nov 2002: guidance document distribution to 19 agencies at conference • Apr 2003: guidance document distribution to 31 agencies at conference

  6. Results: Study Population 64,652 tests between Jan 1999-Jun 2003 3,149 positive tests (4.8%) 2,953 (unique) women with a positive test 1,282 women with a second test (50%) 651 women with a second test between 1-6 mo (22%) 134 women with a second test between 3-4 mo (4.5%)

  7. Rates of re-screening within 3-4 months 3.48% 5.97% GUIDELINES 6.19% 3.65%

  8. Rates of re-screening within 1-6 months 22.8% 19.8% GUIDELINES

  9. Distribution of time to re-screen among those re-screened within 6 months

  10. Distribution of time to re-screen among those re-screened within 6 months 14% 25%

  11. Median time to re-screen among those re-screened within 6 months Median=90 days Median=76 days

  12. Discussion • Overall rates of re-screening remain low • 4.5% within 3-4 months • 22% within 1-6 months • Increase in re-screening between 3-4 months • Statistical significance varied based on mode of analysis • Guideline promotion may have lengthened the time to re-screening

  13. Limitations: Data • Secondary data • Did not collect “chlamydia re-test” as reason for visit • Test date used as approximation for treatment date • Short observational period • 12 months after CDC guidelines released • Data from LA and SF not included

  14. Limitations: Intervention • Distributed entire CDC STD Treatment Guidelines document • Targeted guidance documents highlighted other chlamydia screening practices in addition to re-screening

  15. Next Steps • Performance measures for providers and clinics • Give feedback to providers and clinics • Eliminate financial barriers to re-screening • Educate clients about risks of re-infection • Make re-screening more convenient for clients • Increase emphasis on partner management

  16. Q&A

  17. Additional Materials

  18. Repeat infection rates

  19. Rates of select contraceptive method use

  20. Rates of re-screening within 1-6 monthsby half-year

  21. Rates of Test of Cure

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