P1-S6.08 A multifaceted intervention to increase chlamydia testing in Australian general practice

Abstract

HIV prevalence is more (less) likely to decline after effective interventions introduced in mature (early) epidemics. R2 was conducted too early after R1 to expect large decline in HIV. Without control group, mathematical modelling is required to simulate counterfactuals and estimate intervention impact.

Screening for Chlamydial and Gonococcal Infections

“…Of 2356 unique citations and 490 full-text articles reviewed, 20 studies (N = 179 515) met inclusion criteria, including 13 new studies [19][20][21][22][23][24][25][26][27][28][29][30][31] and 7 [32][33][34][35][36][37][38] from the previous USPSTF report (Figure 2).…”

“…In sexually active, asymptomatic adolescents and adults, including those who are pregnant, what is the effectiveness of screening for chlamydial or gonococcal infections in reducing complications of infection and transmission or acquisition of disease, including gonorrhea, chlamydia, and HIV? Four randomized trials evaluated the effects of screening for chlamydial infection vs no screening on risk of complications of infection (Table 1), 25,32,33,36 including 3 trials 32,33,36 from the prior review. 17 As in the previous reviews, no study evaluated the effectiveness of screening for gonorrhea.…”

“…Three trials enrolled exclusively women, 32,33,36 1 trial enrolled both women and men, 25 1 trial enrolled exclusively adolescents, 33 and 3 enrolled a mix of adolescents and adults (16 to 34 years) from a rural primary care setting, 25 a university setting, 32 and a population of higher-risk women. 36 Trials were conducted in the US, 36 Europe, 32,33 and Australia 25 and compared screening vs usual care, 25 home sampling, 33 or clinic-based testing. 36 One trial compared immediate vs deferred screening.…”

“…36 One trial compared immediate vs deferred screening. 32 Three trials used selfcollected vaginal 25,32,33 or male urine testing. 25 Two trials were rated good-quality 25,32 and 2 fair-quality (eTable 1 in the Supplement), 33,36 because of unclear randomization methods and high loss to follow-up.…”

“…The Australian Chlamydia Control Effectiveness Pilot trial (ACCEPt), was a new, good-quality cluster randomized trial that evaluated the effectiveness of screening for chlamydia compared with usual care in 180 355 men and women aged 16 to 29 years in 130 rural Australian primary care clinics. 25 While screening was significantly associated with reduced risk of hospital-diagnosed primary PID (relative risk [RR], 0.6 [95% CI, 0.4-1.0]), the absolute difference was small (0.24% [57/ 23 527] Three trials included in the prior USPSTF review indicated an association between screening and decreased risk of PID, although results were statistically significant in only 1 trial. 32 Chlamydia screening was significantly associated with reduced risk for PID in a fair-quality RCT of 2607 women aged 18 to 34 years at increased risk for chlamydia who were recruited from a health maintenance organization in the US (RR, 0.44 [95% CI, 0.20-0.90]).…”