title: Effects of population based screening for Chlamydia infections in the Netherlands limited by declining participation rates.
abstract: BACKGROUND
  A large trial to investigate the effectiveness of population based screening for chlamydia infections was conducted in the Netherlands in 2008-2012. The trial was register based and consisted of four rounds of screening of women and men in the age groups 16-29 years in three regions in the Netherlands. Data were collected on participation rates and positivity rates per round. A modeling study was conducted to project screening effects for various screening strategies into the future.
  
  
  RESULTS
  We used a stochastic network simulation model incorporating partnership formation and dissolution, aging and a sexual life course perspective. Trends in baseline rates of chlamydia testing and treatment were used to describe the epidemiological situation before the start of the screening program. Data on participation rates was used to describe screening uptake in rural and urban areas. Simulations were used to project the effectiveness of screening on chlamydia prevalence for a time period of 10 years. In addition, we tested alternative screening strategies, such as including only women, targeting different age groups, and biennial screening. Screening reduced prevalence by about 1% in the first two screening rounds and leveled off after that. Extrapolating observed participation rates into the future indicated very low participation in the long run. Alternative strategies only marginally changed the effectiveness of screening. Higher participation rates as originally foreseen in the program would have succeeded in reducing chlamydia prevalence to very low levels in the long run.
  
  
  CONCLUSIONS
  Decreasing participation rates over time profoundly impact the effectiveness of population based screening for chlamydia infections. Using data from several consecutive rounds of screening in a simulation model enabled us to assess the future effectiveness of screening on prevalence. If participation rates cannot be kept at a sufficient level, the effectiveness of screening on prevalence will remain limited.
authors.affiliation: Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands.
authors.forename: Boris V
authors.initials: BV
authors.lastname: Schmid
authors.forename: Eelco A B
authors.initials: EA
authors.lastname: Over
authors.forename: Ingrid V F
authors.initials: IV
authors.lastname: van den Broek
authors.forename: Eline L M
authors.initials: EL
authors.lastname: Op de Coul
authors.forename: Jan E A M
authors.initials: JE
authors.lastname: van Bergen
authors.forename: Johan S A
authors.initials: JS
authors.lastname: Fennema
authors.forename: Hannelore M
authors.initials: HM
authors.lastname: Götz
authors.forename: Christian J P A
authors.initials: CJ
authors.lastname: Hoebe
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.forename: Mirjam E E
authors.initials: ME
authors.lastname: Kretzschmar
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015233:Models, Statistical; D009426:Netherlands / Q000453:epidemiology; D010358:Patient Participation / Q000706:statistics & numerical data; D015995:Prevalence; D012725:Sexual Behavior; D013269:Stochastic Processes; D055815:Young Adult