title: Modest rise in chlamydia and gonorrhoea testing did not increase case detection in a clinical HIV cohort in Ontario, Canada.
abstract: OBJECTIVE
  We described patterns of testing for chlamydia and gonorrhoea infection among persons in specialty HIV care in Ontario, Canada, from 2008 to 2011.
  
  
  METHODS
  We analysed data from 3165 participants in the OHTN Cohort Study attending one of seven specialty HIV care clinics. We obtained chlamydia and gonorrhoea test results via record linkage with the provincial public health laboratory. We estimated the proportion of participants who underwent testing annually, the positivity rate among those tested and the proportion diagnosed with chlamydia or gonorrhoea among all under observation. We explored risk factors for testing and diagnosis using multiple logistic regression analysis.
  
  
  RESULTS
  The proportion tested annually rose from 15.2% (95% CI 13.6% to 16.7%) in 2008 to 27.0% (95% CI 25.3% to 28.6%) in 2011 (p<0.0001). Virtually all were urine-based nucleic acid amplification tests. Testing was more common among men who have sex with men (MSM), younger adults, Toronto residents, persons attending primary care clinics and persons who had tested in the previous year or who had more clinic visits in the current year. We observed a decrease in test positivity rates over time. However, the annual proportion diagnosed remained stable and in 2011 this was 0.97% (95% CI 0.61% to 1.3%) and 0.79% (95% CI 0.46% to 1.1%) for chlamydia and gonorrhoea, respectively. Virtually all cases were among MSM.
  
  
  CONCLUSIONS
  Chlamydia and gonorrhoea testing increased over time while test positivity rates declined and the overall proportion diagnosed remained stable, suggesting that the modest increase in testing did not improve case detection.
authors.affiliation: Ontario HIV Treatment Network, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ann N
authors.initials: AN
authors.lastname: Burchell
authors.affiliation: Ontario HIV Treatment Network, Toronto, Ontario, Canada.
authors.forename: Ramandip
authors.initials: R
authors.lastname: Grewal
authors.affiliation: Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vanessa G
authors.initials: VG
authors.lastname: Allen
authors.affiliation: Ontario HIV Treatment Network, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Gardner
authors.affiliation: Ontario HIV Treatment Network, Toronto, Ontario, Canada.
authors.forename: Veronika
authors.initials: V
authors.lastname: Moravan
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Centre for Research on Inner City Health, The Keenan Research Centre in the Li KaShing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rupert
authors.initials: R
authors.lastname: Kaul
authors.affiliation: AIDS Bureau, Ontario Ministry of Health and Long Term Care, Toronto, Ontario, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: McGee
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Margaret Peggy E
authors.initials: MP
authors.lastname: Millson
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Remis
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.affiliation: Public Health Laboratories, Public Health Ontario, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada Mount Sinai Hospital/University Health Network, Toronto, Ontario, Canada.
authors.forename: Tony
authors.initials: T
authors.lastname: Mazzulli
authors.affiliation: Ontario HIV Treatment Network, Toronto, Ontario, Canada Centre for Research on Inner City Health, The Keenan Research Centre in the Li KaShing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sean B
authors.initials: SB
authors.lastname: Rourke
mesh_terms: D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence
keywords: CHLAMYDIA INFECTION; GAY MEN; GONORRHOEA; HIV; SCREENING