Community-Based Assessment to Inform a Chlamydia Screening Program for Women in a Rural American Indian Community

Abstract

Background Rates of chlamydial infection in American Indian/Alaska Native women in the United States are approximately 4-fold those in non-Hispanic white women. We conducted a community-based survey of self-identified American Indian/Alaska Native women 14 to 25 years of age on a reservation in the Northwestern United States to inform a chlamydia screening strategy. Methods The anonymous survey assessed respondents’ knowledge, perceptions, and preferences related to chlamydia screening, results receipt, and partner notification. We recruited women using respondent-driven sampling, school-based sampling, and direct recruitment through social media and fliers. Participants in schools completed the survey as a paper-based, self-administered survey. Other participants could complete the survey in person, by phone as an interviewer-administered survey, or online. Results We recruited 162 participants, most in schools (n = 83; 51%) or by peer referral (n = 55; 34%). Only 1 woman completed the survey online. Thirty-one respondents (19%) reported a history of an unplanned first pregnancy, and 19 (12%) reported a history of a diagnosed sexually transmitted disease. Most women (n = 98; 63%) recognized the potential impact of Chlamydia trachomatis on fertility. The preferred site for chlamydia screening was the Indian Health Service Clinic (n = 114; 70%), but 79 women (41%) would accept a C. trachomatis test at a nonclinical testing site. Of the 56 women (35%) who would accept home testing, most preferred to get the test kit from a clinic. Conclusions Our results suggest that Indian Health Service efforts to increase chlamydia screening in the clinic and through outreach may be more successful than promotion of home testing in this population.

Protecting our future generation: study protocol for a randomized controlled trial evaluating a sexual health self-care intervention with Native American youth and young adults

“…Second, this study draws on an unconventional and nuanced approach to sexual health self-care through the use of self-assessments combined with personalized messaging, and self-administered non-clinic based STI screening. These approaches have the potential for widespread uptake within communities served by Indian Health Service, and provide complementary alternatives to provider-driven, clinic-based care [4, 11, 13, 16]. Third, the self-assessment will include a risk prediction/clinical prediction rule to assist with identifying those at greatest risk for STIs, which is urgently needed in this and other settings where STI rates are climbing.…”

“…Research attempting to explain this gap in STIs indicates a higher prevalence of STIs among Native youth and young adults is not fully explained by different sexual or substance use behaviors [3]. These disparities in sexual health by ethnicity may be better attributed to social environments and structural determinants such as a shortage of sexual healthcare providers, socioeconomic status, and access barriers to healthcare including confidentiality concerns, and geographic isolation [4–10]. Further, because many STIs can be treated free of charge within the Indian Health Service (IHS), differential access to screening and treatment may explain these disparities [3].…”

“…Further, because many STIs can be treated free of charge within the Indian Health Service (IHS), differential access to screening and treatment may explain these disparities [3]. Data from IHS corroborate inequalities in access to care, namely underutilization of services by higher risk groups and a lack of universal promotion of sexual health care by providers [4, 11].…”

“…Innovative, non-clinic based alternatives to traditional sexual health screening and treatment are essential for alleviating these sexual health disparities. Promotion of self-care, or the care taken by individuals towards their own health and well-being may be such a strategy; it is endorsed for improving sexual health outcomes by increasing access to care and individual satisfaction with care through client-driven, confidential options [4, 12–16]. Improving sexual health though the promotion of self-care is increasingly a focus of preventing sexual health disparities due to: 1) increased availability of new technologies, 2) the ease of STI screening using non-invasive samples, and 3) the lack of capacity for routine sexual health care service provision common in many reservation-based and other rural communities [13].…”

“…Approaches that focus on self-care may also address budgetary limitations at IHS by maximizing case finding through selective screening of individuals at highest risk, aiding in risk communication with providers, and stimulating health-seeking behavior [4, 12–16]. Self-care approaches can also include strategies for identifying those at increased risk for STIs, and have potential for reducing onward transmission and preventing new cases of disease [15, 16].…”