Background While opportunistic chlamydia screening is conducted in several countries, debate remains about the effectiveness of population-based screening programs for reducing chlamydia transmission and its morbidity. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) aims to assess the feasibility, acceptability, efficacy and cost-effectiveness of annual chlamydia testing in general practice.
Methods ACCEPt is a cluster randomised controlled trial targeting sexually active 16–29-year old women and men for annual chlamydia testing. 54 postcodes (towns) are being randomised and all GP clinics within each area invited to participate. A multifaceted intervention to maximise testing includes: a computer alert prompting GPs to test; incentive payments for GPs and payments for employing practice nurses; a recall system to encourage annual testing; partner notification, and; information/support with regular feedback on testing performance. Clinics in the control group are encouraged to continue their usual practice. The intervention will be in place for up to 4 years. The primary outcome is change in chlamydia prevalence among a consecutive sample of 80–100 patients attending participating clinics in each postcode (total sample size about 4500) measured at the beginning and end of the trial. Secondary outcomes include pelvic inflammatory disease and chlamydia testing rates.
Results Recruitment began in July 2010 and 282 GPs in 69 clinics in 24 postcodes have been recruited to date in the States of Victoria, New South Wales and Queensland. Four clinics have refused so far and these postcodes have been excluded. To date, 615 16 to 29 year olds have been tested during the baseline prevalence survey with a participation rate of 70%. Overall chlamydia prevalence is 4.0% (95% CI 2.5% to 6.0%). Prevalence is slightly higher among males (4.5%; 95% CI 2.0% to 8.7%) than females (3.7%; 95% CI 2.0% to 6.3%, p=0.7) and in rural (6.9%; 95% CI 3.8% to 11.2%) compared with metropolitan areas (2.2%; 95% CI 0.9%, 4.4%, p<0.01). Recruitment will be completed by December 2011 with the intervention period running till end of 2014.
Conclusions This study shows high participation rates by GP clinics and by individuals invited to take part in the prevalence survey. Results will determine whether annual chlamydia testing is effective at reducing transmission and morbidity and will inform the optimal design of a chlamydia testing program in Australia.
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