Australian general practitioner chlamydia testing rates among young people

Abstract

Objective: To describe the proportion of 16-29-year-olds tested for chlamydia by Australian general practitioners in a 12-month period. Design and setting: Between October 2007 and September 2008, the national chlamydia testing rate in 16-29-year-olds was calculated by dividing the number of Medicare-reimbursed chlamydia tests by two denominators: (i) Medicare-reimbursed GP consultations; and (ii) estimated resident populations adjusted for the proportion who were sexually active. Main outcome measures: GP chlamydia testing rates in 16-29-year-olds per 100 patients attending a GP consultation and per 100 sexually active population, by patient age and sex, state/territory of residence, and remoteness area. Results: Among the estimated Australian population of 16-29-year-olds, 85.6% of females and 64.4% of males had at least one GP consultation in the 12-month period. The national GP chlamydia testing rate per 100 patients was 8.9% (95% CI, 8.88%-8.94%). The national GP chlamydia testing rate per 100 sexually active population was 8.0% (95% CI, 7.92%-7.98%). The rate per 100 sexually active population was higher in females (12.5%) compared with males (3.7%) (P < 0.01); higher in 20-24-year-olds (9.0%) compared with 16-19-year-olds (8.7%) and 25-29-year-olds (6.6%) (P < 0.01); higher in those living in non-metropolitan areas (11.0%) compared with metropolitan areas (8.4%) (P < 0.01); and highest in those living in the Northern Territory (21.4%) compared with other jurisdictions (P < 0.01). Conclusions: Despite clinical guidelines recommending annual chlamydia testing for sexually active 15-29-year-olds, our analysis showed that a high proportion of young people aged 16-29 years attend a GP each year, but few of the sexually active population in this age group were tested for chlamydia in general practice. Strategies MJA 2011; 194: 249-252 are needed to support GPs to enhance chlamydia testing in young people.

Chlamydia and gonorrhoea infections and the risk of adverse obstetric outcomes: a retrospective cohort study

“…Throughout the study period antenatal screening for syphilis and hepatitis B was routine19 21 and so we can presume that women who did not link to a notification did not have these infections. Annual screening for chlamydia was only recommended for young women aged <25 years after 200519 and data suggests that despite this recommendation, testing in this population is still relatively low at <15% 22. Our study found that 1.0% of women having their first birth had a prior chlamydia notification record but when confined to those aged <25 years giving birth after 2005 this increased to 4.6%.…”

Understanding trends in genitalChlamydia trachomatiscan benefit from enhanced surveillance: findings from Australia

“…This is quite different from the ratio seen in the national notification numbers of 1:1.6 (22 703 notifications in young men compared with 37 112 in women in 2010) 14. This imbalance in the notification numbers is most likely attributable to less testing of men and more frequent testing of women (because of the risk of long-term complications) outside sexual health services 7 30…”

“…In addition, it provides limited information on patient risk behaviours, an important determinant of infection. Studies have previously demonstrated that notifications are highly correlated with testing,4–6 so when chlamydia testing rates are low, which is the case in many countries including Australia,7 notifications will grossly underestimate the true burden of disease. Conversely, any successful testing initiative has the potential to cause an increase in notifications.…”

“…However, if these clinical sites themselves have relatively low levels of testing (eg, general practices in Australia7) and testing in these sites is increasing, as is occurring in Australia, then even using the proportion of tests that are positive can provide misleading data because over time more low-risk individuals are likely to be tested. To overcome this, we have analysed data from a sexual health network that has consistently high levels of testing, and thus, the positivity rate can be used as a proxy for chlamydia prevalence among those attending the clinic 8 9.…”

Genital warts and chlamydia in Australian women: comparison of national population-based surveys in 2001 and 2011

“…There are no routine national surveillance data available to estimate chlamydia testing coverage. However, a recent population-wide Australian study of chlamydia testing based on national health insurance (Medicare) reimbursements for chlamydia tests estimated that in 2007/2008, among 16–29-year-old sexually active women, the proportion who had a test each year was 12.5% 18. Higher testing reported among those participating the 2011 survey and the estimate from the study using 2007/2008 data may be because only Medicare reimbursement data was used, and this does not include chlamydia testing occurring in sexual health clinics or hospitals.…”