Risk selection and targeted interventions in community-based control of chlamydia.
OBJECTIVE
To describe recent developments in the community-based approach of high-risk groups for Chlamydia trachomatis infection, and to discuss the assessment of impact of selective systematic screening on the transmission of C. trachomatis in the community.


RESULTS
Two large home-based screening programs in Europe have recently shown that systematic postal screening for C. trachomatis infection is feasible, but certain high-risk groups are poor participators. This underscores the need for risk selection and targeted approaches. A prediction rule has been developed which can assist in identifying high-risk groups and can be used as a tool for (self) selection for screening. The Internet has been shown to be a promising medium to promote chlamydia testing. School-based programs also succeed in including high-risk groups in screening programs. Recently developed dynamic simulation models, which take into account transmission of C. trachomatis, can assist in the development and evaluation of targeted screening strategies.


CONCLUSIONS
Chlamydia will not likely be controlled by one standard approach. Risk selection strategies need further development and different systematic approaches at the community level, including postal screening, school-based screening, and the Internet may produce the desired public health effect of decreasing morbidity and reducing the transmission of C. trachomatis in the community.
Richardus
Jan Hendrik
JH
Division of Infectious Disease Control, Municipal Public Health Service Rotterdam Area, Rotterdam, The Netherlands. richardush@ggd.rotterdam.nl
Götz
Hannelore M
HM
D002690:Chlamydia Infections / Q000150:complications / Q000175:diagnosis*; D002692:Chlamydia trachomatis; D006284:Health Plan Implementation; D006801:Humans; D008403:Mass Screening; D011634:Public Health; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000175:diagnosis