Provision of chlamydia testing in a nationwide service offering termination of pregnancy: with data capture to monitor prevalence of infection.
OBJECTIVE
To establish a methodology by which all women attending for termination of pregnancy (TOP) at British Pregnancy Advisory Service (BPAS) branches may be approached to participate in Chlamydia trachomatis screening. To examine the feasibility of monitoring C trachomatis prevalence and the impact of charging for screening on the uptake rate in this population.


METHODS
Patients attending for TOP at participating BPAS branches were offered a test for chlamydia infection and asked to complete a questionnaire. Urine samples from participants were tested using a nucleic acid amplification test (NAAT).


RESULTS
1001 women provided a urine sample, a 77% response rate among those participating in the study. Factors significantly associated with taking up chlamydia screening included symptoms, previous TOP, parity, and no previous chlamydial test. Overall prevalence of genital chlamydial infection was 7.5%, with highest age specific prevalences occurring among attendees aged 20-24 years (11.5%) and under 20 years (10.8%). In univariate analysis, chlamydia positivity was significantly associated with respondent age and previous diagnosis with chlamydia. Only 35% of women who had the screening test would have done so had they been asked to pay the pound 20 clinical, administrative, and laboratory costs of the examination.


CONCLUSIONS
We have demonstrated the feasibility of routine chlamydia screening and the potential for prospective prevalence monitoring across the nationwide BPAS service. In most cases the chlamydia result was available within the clinical contact period for the TOP. Charging patients directly for the test could reduce uptake of chlamydia screening to levels unsatisfactory for both the public health and prevalence monitoring purposes.
Mallinson
H
H
PHLS Laboratory, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK. hmallinson@nw.phls.nhs.uk
Hopwood
J
J
Skidmore
S
S
Fenton
K
K
Phillips
C
C
Jones
I
I
D000028:Abortion, Induced; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000191:economics; D002692:Chlamydia trachomatis; D003625:Data Collection; D005240:Feasibility Studies; D005249:Fees and Charges; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D018579:Patient Selection; D015995:Prevalence; D013048:Specimen Handling