Screening for Chlamydia trachomatis in Asymptomatic Women Attending Family Planning Clinics: A Cost-Effectiveness Analysis of Three Strategies

Howell, M. René; Quinn, Thomas C.; Gaydos, Charlotte A.

doi:10.7326/0003-4819-128-4-199802150-00005

Cited by 134 publications

(77 citation statements)

References 30 publications

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“…Previous studies have demonstrated that screening programs for STDs are cost-effective in direct proportion to the number of infections that are detected and treated before infection is transmitted or sequelae develop (10,21,22,24). The higher the predictive value of the test, both positive and negative, the greater the value of testing.…”

Section: Discussionmentioning

confidence: 99%

“…With the more sensitive tests, the return on the public health investment in screening programs is higher. A study of the cost-effectiveness of screening for C. trachomatis using culture, direct tests, and amplification tests suggested that the amplification tests provided the greatest cost benefit by permitting noninvasive specimen collection and preventing the greatest number of PID cases (20,23,24).…”

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confidence: 99%

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Performance of the APTIMA Combo 2 Assay for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Female Urine and Endocervical Swab Specimens

et al. 2003

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The greater sensitivity of nucleic acid amplification tests (NAATs) for Chlamydia trachomatis and Neisseria gonorrhoeae permits the use of urine and other noninvasive specimens, which can increase the reach and decrease the costs of public health screening programs aimed at controlling these infections. This study evaluated the performance of the APTIMA Combo 2 assay, a multiplex assay based on the transcriptionmediated amplification reaction, for the simultaneous detection of both pathogens in endocervical swab and urine specimens from females. Combo 2 assay results were compared with patient infected status, which were available by using other commercial NAATs. Sensitivity and specificity for C. trachomatis were 94.2 and 97.6%, respectively, in swabs and 94.7 and 98.9%, respectively, in first-catch urine (FCU). Sensitivity and specificity for N. gonorrhoeae were 99.2 and 98.7%, respectively, in swabs and 91.3 and 99.3%, respectively, in FCU. The assay reliably detected both infections in coinfected patients. The Combo 2 assay can be recommended for use with endocervical swab and urine specimens from females, especially for screening tests for asymptomatic women in sexually transmitted disease surveillance programs. This Food and Drug Administration-cleared assay can be a useful tool in efforts to reduce the prevalence and incidence of C. trachomatis and N. gonorrhoeae infections in sexually active women and to prevent their costly and serious sequelae.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Performance of the APTIMA Combo 2 Assay for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Female Urine and Endocervical Swab Specimens

et al. 2003

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“…Maryland Medicaid reimburses $28 per cervical chlamydia PCR test, but reimbursement may differ by state and insurance scheme. 54 Chlamydia screening of sexually active adolescent females in both primary care and nontraditional health care settings detects a large burden of asymptomatic infection in a variety of demographically defined populations. 33,37,49,50 We demonstrated that the median time to diagnosis of incident infection is approximately 6 months, regardless of prior infection status, and that selective screening criteria are unable to identify a group in which to target screening efforts among adolescent females.…”

Section: -41mentioning

confidence: 99%

Incident <EMPH TYPE="ITAL">Chlamydia trachomatis</EMPH> Infections Among Inner-city Adolescent Females

Burstein

Gaydos²,

Diener‐West

et al. 1998

JAMA

248

129

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Context.-Adolescents are at highest risk for infection with Chlamydia trachomatis, an important preventable cause of pelvic inflammatory disease and subsequent tubal factor infertility in US women. Current guidelines for delivery of adolescent primary care services recommend yearly chlamydia screening for those adolescent females considered to be at risk.Objectives.-To describe the epidemiology of prevalent and incident chlamydia infection among adolescent females to assess the appropriate interval for chlamydia screening and to define risk factors that would identify adolescent females to target for screening.Design.-Prospective longitudinal study.Patients.-A consecutive sample of 3202 sexually active females 12 through 19 years old making 5360 patient visits over a 33-month period, January 1994 through September 1996.Setting.-Baltimore, Md, family planning, sexually transmitted disease, and school-based clinics.Intervention.-Testing for C trachomatis by polymerase chain reaction. Main Outcome Measures.-Prevalence and incidence of C trachomatis infections; predictors of positive test result for C trachomatis.Results.-Chlamydia infection was found in 771 first visits (24.1%) and 299 repeat visits (13.9%); 933 adolescent females (29.1%) had at least 1 positive test result. Females who were 14 years old had the highest age-specific chlamydia prevalence rate (63 [27.5%] of 229 cases; P=.01). The chlamydia incidence rate was 28.0 cases per 1000 person-months (95% confidence interval, 24.9-31.5 cases). The median time was 7.2 months to a first positive chlamydia test result and 6.3 months to a repeat positive test result among those with repeat visits. Independent predictors of chlamydia infection-reason for clinic visit, clinic type, prior sexually transmitted diseases, multiple or new partners, or inconsistent condom use-failed to identify a subset of adolescent females with the majority of infections.Conclusions.-A high prevalence and incidence of C trachomatis infection were found among adolescent females. We, therefore, recommend screening all sexually active adolescent females for chlamydia infection every 6 months, regardless of symptoms, prior infections, condom use, or multiple partner risks.

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“…Because most infected individuals are either asymptomatic or have mild, nonspecific symptoms, C. trachomatis infection poses a problem for health control programs. National screening and prevention programs for C. trachomatis infection have been implemented, usually among young adults, in industrialized countries (11,14,16). With the exception of sporadic testing of commercial sex workers, Chlamydia screening is rare in developing countries, which have the highest incidence of new chlamydial infections (7,9,17,25).…”

mentioning

confidence: 99%

Prevalence of Chlamydia trachomatis Infection among Low- and High-Risk Filipino Women and Performance of Chlamydia Rapid Tests in Resource-Limited Settings

et al. 2007

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The prevalence of urogenital Chlamydia trachomatis infection was determined with a PCR-based test of women from low-and high-risk populations in Iloilo City, Philippines, between August 2002 and March 2006. Two rapid tests for C. trachomatis, Clearview Chlamydia MF and the Chlamydia Rapid Test (CRT), were also evaluated in these resource-limited settings. Specimens were obtained from female sex workers (FSWs; n ‫؍‬ 1,484) attending a social hygiene clinic (SHC) and from women (n ‫؍‬ 838) attending an obstetrics-gynecology (OB-GYN) clinic. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the rapid tests were determined, with PCR as the gold standard. The PCR positivity rate for SHC participants (72% asymptomatic) ranged from 17.9 to 32.0% during the study period. Compared with those of PCR, the sensitivities and specificities of the Clearview test were 53.5 and 99.1%, respectively, with endocervical swab specimens (CS; n ‫؍‬ 822) from the FSWs and 31.1 and 95.2%, respectively, with vaginal swab specimens (VS; n ‫؍‬ 333) from these women. The sensitivity, specificity, PPV, and NPV of the CRT with VS from the FSWs were 71.0, 99.0, 97.1, and 87.9%, respectively. At the OB-GYN site, the PCR positivity rate with VS was 6.3%. The sensitivity, specificity, PPV, and NPV of the CRT with these specimens were 86.8, 99.6, 93.9, and 99.1%, respectively. The performance of the Clearview test at the SHC was thus markedly lower with VS than with CS, whereas the CRT performed well with VS from both populations.Chlamydia trachomatis is responsible for the most common sexually transmitted bacterial infection and the leading cause of pelvic inflammatory disease in women (34,38). In 1999, the World Health Organization (WHO) estimated that 92 million new chlamydial infections occur worldwide annually, with the largest proportion (43 million) of these infections being contracted in south and Southeast Asia (38), a region that is mostly resource limited with respect to infectious disease diagnosis and management.Although up to 94% of women with urogenital chlamydial infections do not manifest obvious symptoms (20, 28), the consequences of such untreated infections, including pelvic inflammatory disease, ectopic pregnancy, and infertility (27), generate a global financial burden of billions of dollars annually. Because most infected individuals are either asymptomatic or have mild, nonspecific symptoms, C. trachomatis infection poses a problem for health control programs. National screening and prevention programs for C. trachomatis infection have been implemented, usually among young adults, in industrialized countries (11,14,16). With the exception of sporadic testing of commercial sex workers, Chlamydia screening is rare in developing countries, which have the highest incidence of new chlamydial infections (7,9,17,25). The major barriers to screening programs in the developing world include the high cost of testing and the lack of appropriate staff and diagnostic tools. Such countri...

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Screening for Chlamydia trachomatis in Asymptomatic Women Attending Family Planning Clinics: A Cost-Effectiveness Analysis of Three Strategies

Cited by 134 publications

References 30 publications

Performance of the APTIMA Combo 2 Assay for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Female Urine and Endocervical Swab Specimens

Performance of the APTIMA Combo 2 Assay for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Female Urine and Endocervical Swab Specimens

Incident <EMPH TYPE="ITAL">Chlamydia trachomatis</EMPH> Infections Among Inner-city Adolescent Females

Prevalence of Chlamydia trachomatis Infection among Low- and High-Risk Filipino Women and Performance of Chlamydia Rapid Tests in Resource-Limited Settings

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