renee gindi 1 , heidi bauer 2 , joan chow 2 , melanie deal 1
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
Evaluating Efforts to Increase Testing for Repeat Chlamydia
Infection Among Women in California Family Planning
ClinicsRenee Gindi1, Heidi Bauer2, Joan
Chow2, Melanie Deal1
1 California Family Health Council, Berkeley, CA 2 California Sexually
Transmitted Disease Control Branch, Berkeley, CA
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.
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
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
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
Results: Study Population64,652 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%)
Rates of re-screening within 3-4 months
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Jan-Jun1999
Jul-Dec1999
Jan-Jun2000
Jul-Dec2000
Jan-Jun2001
Jul-Dec2001
Jan-Jun2002
Jul-Dec2002
Jan-Jun2003
GUIDELINES
3.65% 6.19%
3.48% 5.97%
Rates of re-screening within 1-6 months
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
May 1999-2000 May 2000-2001 May 2001-2002 May 2002-2003
GUIDELINES
19.8%
22.8%
Distribution of time to re-screen among those
re-screened within 6 months
0%
20%
40%
60%
80%
100%
Jan-Jun1999
Jul-Dec1999
Jan-Jun2000
Jul-Dec2000
Jan-Jun2001
Jul-Dec2001
Jan-Jun2002
Jul-Dec2002
Jan-Jun2003
5-6 mo
3-4 mo
1-2 mo
<1 mo
Distribution of time to re-screen among those
re-screened within 6 months
0%
20%
40%
60%
80%
100%
Jan-Jun1999
Jul-Dec1999
Jan-Jun2000
Jul-Dec2000
Jan-Jun2001
Jul-Dec2001
Jan-Jun2002
Jul-Dec2002
Jan-Jun2003
5-6 mo
3-4 mo
1-2 mo
<1 mo
14%
25%
Median time to re-screen among those re-screened
within 6 months
0102030405060708090
100
Jan-Jun1999
Jul-Dec1999
Jan-Jun2000
Jul-Dec2000
Jan-Jun2001
Jul-Dec2001
Jan-Jun2002
Jul-Dec2002
Jan-Jun2003
Med
ian
day
s to
re-
scre
en
Median=76 days
Median=90 days
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
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
Limitations: Intervention• Distributed entire CDC STD
Treatment Guidelines document
• Targeted guidance documents highlighted other chlamydia screening practices in addition to re-screening
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
Q&A
Additional Materials
Repeat infection rates
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
1999 2000 2001 2002 2003
Rates of select contraceptive method use
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Jul-Dec 2001 Jan-Jun2002
Jul-Dec 2002 Jan-Jun2003
Jun-Dec2003
OCPs
Depo Provera
Rates of re-screening within 1-6 months
by half-year
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Jan-Jun1999
Jul-Dec1999
Jan-Jun2000
Jul-Dec2000
Jan-Jun2001
Jul-Dec2001
Jan-Jun2002
Jul-Dec2002
Jan-Jun2003
Rates of Test of Cure
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
Jan-Jun1999
Jul-Dec1999
Jan-Jun2000
Jul-Dec2000
Jan-Jun2001
Jul-Dec2001
Jan-Jun2002
Jul-Dec2002
Jan-Jun2003