Chlamydia Screening Rates among “Pregnancy Test Only” Visits in Region I, 2005-2009

1. Chlamydia Screening Rates among “Pregnancy Test Only” Visits in Region I, 2005-2009 Andee Krasner, MPH Region I IPP Infrastructure

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

3. Objectives • Explore provider PTO screening practices among IPP supported clinics and partners • Provide baseline CT screening rates among women presenting for “pregnancy-test only” visits from 2005-2009 by age and by race/ethnicity

4. METHODS

5. 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

6. 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

7. 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

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

9. Limitations • Constructed PTO variable based on “visit type” response options – don’t 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%)

10. RESULTS

11. I. Provider Knowledge, Attitudes, and Behavior Around CT Screening During PTO Visits -2009 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

12. 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%

13. 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

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

15. CT Screening Rates Among PTO Visits by Race(2005-2009 combined)

16. CT Screening Rates Among PTO Visits by State

17. 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 50 -70%

18. What do the data mean?

19. 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 20-24 should also be emphasized • Women 25 and older least likely to receive screening at PTO visit

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

21. % PTO Visits, Family Planning Clinics Q1/Q2 2011

22. Percent Positive Among PTO/Non-PTO Visits in FP Clinics, Q1/Q2 2011 Women < 25/26

23. 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

24. 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

25. CONCLUSIONS

26. 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)