How can we minimise inequalities in access to Chlamydia screening: a cross-sectional study in the South East of England

Overview & Synopsis

Background: England's National Chlamydia Screening Programme (NCSP) provides opportunistic testing for 15-24 year olds in healthcare and non-healthcare settings. We aimed to explore relationships between coverage and positivity in relation to demographic characteristics or setting, in order to inform efficient and sustainable implementation of the NCSP. Methods: We analysed mapped NCSP testing data from the South East region of England between April 2006 and March 2007 inclusive to population characteristics. Coverage was estimated by sex, demographic characteristics and service characteristics, and variation in positivity by setting and population group. Results: Coverage in females was lower in the least deprived areas compared to the most deprived areas (Odds Ratio (OR)-0.48; 95%CI: 0.45-0.50). Testing rates were lower in 20-24 year olds compared to 15-19 year olds (OR 0.69 95%CI: 0.67-0.72 for females and OR-0.67; 95%CI: 0.64-0.71 for males), but positivity was higher in older males. Females were tested most often in healthcare services which also identified the most positives. The greatest proportions male tests were in university (27%) and military (19%) settings which only identified a total of 11% and 13% of total male positives respectively. More chlamydia positive males were identified through healthcare services despite fewer numbers of tests. Conclusions: Testing of males focussed on institutional settings where there is a low yield of positives, and limited capacity for expansion. By contrast, the testing of females, especially in urban environments, was mainly through established healthcare services. Future strategies should prioritise increasing male testing in healthcare settings.