ORIGINAL ARTICLE

Opportunistic screening for genital chlamydial infection. I: Acceptability of urine testing in primary and secondary healthcare settings

J M Pimenta¹, M Catchpole¹, P A Rogers², E Perkins³, N Jackson⁴, C Carlisle⁵, S Randall⁶, J Hopwood⁷, G Hewitt⁸, G Underhill⁸, H Mallinson⁹, L McLean¹⁰, T Gleave⁷, J Tobin¹¹, V Harindra¹¹ and A Ghosh¹²

¹ PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK
² PHLS Statistics Unit
³ Health and Community Care Research Unit, University of Liverpool, Thompson Yates Building, The Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK
⁴ Conway Smith Rose, 60 Charlotte Street, London W1P 2AX, UK
⁵ School of Nursing and Midwifery, The University of Glasgow, 59 Oakfield Avenue, Glasgow G12 8LW, UK
⁶ Ella Gordon Unit, St Mary’s Hospital, Milton Road, Portsmouth PO3 6AD, UK
⁷ Chlamydia Pilot Office, Evidence-based Practice Unit, St Catherine’s Hospital, Church Road, Birkenhead, Wirral, L42 0LQ, UK
⁸ Portsmouth Public Health Laboratory, St Mary’s Hospital (East Wing), Milton Road, Portsmouth PO3 6AQ, UK
⁹ Liverpool Public Health Laboratory, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
¹⁰ Chlamydia Pilot Office, Ella Gordon Unit, St Mary’s Hospital, Milton Road, Portsmouth PO3 6AD, UK
¹¹ Department of GU Medicine, St Mary’s Hospital, Milton Road, Portsmouth PO3 6AD, UK
¹² Department of GU Medicine, Arrowe Park Hospital, Upton, Wirral, CH49 5PE, UK

Correspondence to:
Correspondence to:
Dr Mike Catchpole, PHLS Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK;
mcatchpole{at}phls.org.uk

Objectives: To determine the acceptability of opportunistic screening for Chlamydia trachomatis in young people in a range of healthcare settings.

Design: An opportunistic screening programme (1 September 1999 to 31 August 2000) using urine samples tested by ligase chain reaction (LCR). Data on uptake and testing were collected and in-depth interviews were used for programme evaluation.

Setting: General practice, family planning, genitourinary medicine clinics, adolescent sexual health clinics, termination of pregnancy clinics, and women’s services in hospitals (antenatal, colposcopy, gynaecology and infertility clinics) in two health authorities (Wirral and Portsmouth and South East Hampshire).

Main participants: Sexually active women aged between 16 and 24 years attending healthcare settings for any reason.

Main outcome measures: Uptake data: proportion of women accepting a test by area, healthcare setting, and age; overall population coverage achieved in 1 year. Evaluation data: participants’ attitudes and views towards opportunistic screening and urine testing.

Results: Acceptance of testing by women (16–24 years) was 76% in Portsmouth and 84% in Wirral. Acceptance was lower in younger women (Portsmouth only) and varied by healthcare setting within each site. 50% of the target female population were screened in Portsmouth and 39% in Wirral. Both the opportunistic offer of screening and the method of screening were universally acceptable. Major factors influencing a decision to accept screening were the non-invasive nature of testing and treatment, desire to protect future fertility, and the experimental nature of the screening programme.

Conclusions: An opportunistic model of urine screening for chlamydial infection is a practical, universally acceptable method of screening.

Keywords: screening; chlamydial infection; urine testing; healthcare settings

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