title: Does a clinical guideline change chlamydia testing? Report from the Waikato Chlamydia Project.
abstract: BACKGROUND
  Waikato District Health Board was one of three districts chosen to implement a national chlamydia management guideline, with the aim of optimising testing and treatment. Previous New Zealand studies suggest any test increases associated with such an intervention may be short-lived.
  
  
  METHODS
  District-wide chlamydia test volumes were compared for three periods, before (June-Nov 2008), during (June-Nov 2009) and after (June-Nov 2010) guideline implementation by age, gender and ethnicity. Crude estimates of population test uptake were calculated. Azithromycin pharmacy claim volumes were assessed as a measure of treatment.
  
  
  RESULTS
  Chlamydia test uptake for women was already high, with 23% of 15- to 24-year-old women tested during the period from June to November 2008. Although tests from under-25-year-olds increased during implementation in 2009, the change was not significant and was not sustained in 2010, p=0.06. Similarly, there were no significant sustained changes by gender or ethnicity following implementation.
  
  
  METHODS
  This includes a continued emphasis on optimal chlamydia case finding and treatment by focusing on those at greater risk of infection. Efforts to improve partner notification should be instigated which may in turn better engage men around sexual health.
  
  
  CONCLUSIONS
  Local data should be used to identify local issues. There is a need to determine whether <25 years is the optimal age threshold for targeted chlamydia testing in New Zealand and to ensure appropriate resources, training and support are in place for primary care nurses who play a pivotal role in sexual health care delivery.
authors.affiliation: Waikato Hospital, PB3200, Hamilton, New Zealand. jane.morgan@waikatodhb.health.nz
authors.forename: Jane
authors.initials: J
authors.lastname: Morgan
authors.forename: Andre
authors.initials: A
authors.lastname: Donnell
authors.forename: Anita
authors.initials: A
authors.lastname: Bell
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002690:Chlamydia Infections / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D009520:New Zealand; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin