title: Retesting for repeat chlamydial infection: family planning provider knowledge, attitudes, and practices.
abstract: BACKGROUND
  Repeated genital infections with Chlamydia trachomatis are common and associated with serious adverse reproductive sequelae in women such as infertility, ectopic pregnancy, and chronic pelvic pain. Retesting for repeat chlamydial infection is recommended 3 months after treatment for an initial infection; however, retesting rates in various settings are low. In order to design interventions to increase retesting rates, understanding provider barriers and practices around retesting is crucial. Therefore, in this survey of family planning providers we sought to describe: (1) knowledge about retesting for chlamydia; (2) attitudes and barriers toward retesting; (3) practices currently utilized to ensure retesting, and predictors associated with their use.
  
  
  METHODS
  We conducted a cross-sectional, self-administered, Internet-based survey of a convenience sample of family planning providers in California inquiring about strategies utilized to ensure retesting in their practice setting. High-intensity strategies included chart flagging, tickler (reminder) systems, follow-up appointments, and phone/mail reminders.
  
  
  RESULTS
  Of 268 respondents, 82% of providers reported at least 1 barrier to retesting, and only 44% utilized high-intensity interventions to ensure that patients returned. Predictors associated with use of high-intensity interventions included existence of clinic-level retesting policies (OR 3.95, 95% CI 1.98-7.88), and perception of a high/moderate level of clinic priority toward retesting (OR 3.75, 95% CI 2.12-.6.63).
  
  
  CONCLUSIONS
  Emphasizing the importance of retesting to providers through adoption of clinic policies will likely be an important component of a multimodal strategy to ensure that patients are retested and that provider/clinic staff take advantage of opportunities to retest patients. Innovative approaches such as home-based retesting with self-collected vaginal swabs and use of cost-effective technologies to generate patient reminders should also be considered.
authors.affiliation: Program Development and Evaluation Section, California Department of Public Health STD Control Branch, Richmond, California 94804, USA. ina.park@cdph.ca.gov
authors.forename: Ina U
authors.initials: IU
authors.lastname: Park
authors.forename: Annette
authors.initials: A
authors.lastname: Amey
authors.forename: Linda
authors.initials: L
authors.lastname: Creegan
authors.forename: Aileen
authors.initials: A
authors.lastname: Barandas
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Bauer
mesh_terms: D001291:Attitude of Health Personnel; D002140:California; D002690:Chlamydia Infections / Q000175:diagnosis*; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003625:Data Collection; D005193:Family Planning Services; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis*; D006282:Health Personnel; D006801:Humans; D010820:Physicians; D012008:Recurrence