Chlamydia Screening Rates among “Pregnancy Test Only” Visits in

Region I, 2005-2009

Andee Krasner, MPHRegion I IPP Infrastructure

Background

National Objective of IPP Infrastructure

•Epidemiologic profile of pregnancy-test only clients seen in prevalence monitoring clinics

Objectives

1. Explore provider PTO screening practices among IPP supported clinics and partners

2. Provide baseline CT screening rates among women presenting for “pregnancy-test only” visits from 2005-2009 by age and by race/ethnicity

METHODS

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

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

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

Age Categories for Analysis

Used 24 and younger for age cut off in all states to reflect highest screening rates

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%)

RESULTS

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

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%

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

II. CT Screening Rates Among PTO Visits by Age

Year

% W

omen

with

CT

Scre

en a

t PTO

Vis

it

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

2005 2006 2007 2008 2009

<15-19

20-24

25+

CT Screening Rates Among PTO Visits by Race

(2005-2009 combined)

CT Screening Rates Among PTO Visits by State

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%

What do the data mean?What do the data mean?

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

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%Region I: 5.1%• As high as 8.2% in ME (small numbers

<50 visits)

% PTO Visits, Family Planning ClinicsQ1/Q2 2011

Percent Positive Among PTO/Non-PTO Visits in FP Clinics, Q1/Q2 2011

Women < 25/26

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

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

CONCLUSIONS

• 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)