title: Coverage and uptake of systematic postal screening for genital Chlamydia trachomatis and prevalence of infection in the United Kingdom general population: cross sectional study.
abstract: OBJECTIVE
  To measure the coverage and uptake of systematic postal screening for genital Chlamydia trachomatis and the prevalence of infection in the general population in the United Kingdom. To investigate factors associated with these measures.
  
  
  METHODS
  Cross sectional survey of people randomly selected from general practice registers. Invitation to provide a specimen collected at home.
  
  
  METHODS
  England.
  
  
  METHODS
  19,773 men and women aged 16-39 years invited to participate in screening.
  
  
  METHODS
  Coverage and uptake of screening; prevalence of chlamydia.
  
  
  RESULTS
  Coverage of chlamydia screening was 73% and was lower in areas with a higher proportion of non-white residents. Uptake in 16-24 year olds was 31.5% and was lower in men, younger adults, and practices in disadvantaged areas. Overall prevalence of chlamydia was 2.8% (95%confidence interval 2.2% to 3.4%) in men and 3.6% (3.1% to 4.9%) in women, but it was higher in people younger than 25 years (men 5.1%; 4.0% to 6.3%; women 6.2%; 5.2% to 7.8%). Prevalence was higher in the subgroup of younger women who were harder to engage in screening. The strongest determinant of chlamydial infection was having one or more new sexual partners in the past year.
  
  
  CONCLUSIONS
  Postal chlamydia screening was feasible, but coverage was incomplete and uptake was modest. Lower coverage of postal screening in areas with more non-white residents along with poorer uptake in more deprived areas and among women at higher risk of infection could mean that screening leads to wider inequalities in sexual health.
authors.affiliation: Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT. j.a.macleod@bham.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: Macleod
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
authors.forename: Nicola
authors.initials: N
authors.lastname: Low
authors.forename: Anne
authors.initials: A
authors.lastname: McCarthy
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
authors.forename: Aisha
authors.initials: A
authors.lastname: Holloway
authors.forename: Rita
authors.initials: R
authors.lastname: Patel
authors.forename: Emma
authors.initials: E
authors.lastname: Sanford
authors.forename: Andrea
authors.initials: A
authors.lastname: Morcom
authors.forename: Paddy
authors.initials: P
authors.lastname: Horner
authors.forename: George
authors.initials: G
authors.lastname: Davey Smith
authors.forename: Susan
authors.initials: S
authors.lastname: Skidmore
authors.forename: Alan
authors.initials: A
authors.lastname: Herring
authors.forename: Owen
authors.initials: O
authors.lastname: Caul
authors.forename: F D Richard
authors.initials: FD
authors.lastname: Hobbs
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D002692:Chlamydia trachomatis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D013689:Telephone / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology