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Health services and policy poster session 7: screening
P5-S7.05 Chlamydia screening in an international resort community: an outreach program to expand access
  1. M Collins1,
  2. R Holehouse2,
  3. J Kaczorowski1
  1. 1University of British Columbia, Whistler, Canada
  2. 2Options for Sexual Health BC, Canada

Abstract

Objective To evaluate an event-based outreach Chlamydia (CT) screening program pilot developed to address barriers to access in a resort community with an international, transient and disproportionally large young adult population. A local sexual health clinic operates at capacity. There is no provincial or national outreach CT screening campaign.

Methods Series of 15 outreach CT screening sessions, each 2–3 h duration, held in Whistler, BC, Canada in 2009 & 2010. Sessions were held at resort staff-housing dinners, staff-housing lounge, entertainment, educational and sport events. Men and women <30 years were offered free CT nucleic acid amplification tests on urine. Positive cases were notified, with treatment and partner notification per standard of care. Primary outcome measures were age, gender and infection rates of outreach participants compared to <30 age cohort tested for CT at the sexual health clinic during same calendar years. Anonymous, post-test survey queried interval since last CT test, intention to test, health insurance, and satisfaction with the outreach experience. Unpaired t test & χ2 analysis.

Results 112 tests for CT were obtained through outreach; 87.5% response rate to post-test survey. Mean outreach age of 23.3 years was 14.4 months younger than comparison age cohort tested at clinic (p=0.0001). Males were tested at outreach in greater proportion than at clinic (57.1% vs 46.5%, p=0.04). Proportion of asymptomatic cases was greater at outreach than clinic (90% vs 46.6%, p=0.01), yet positive test rates at outreach (8.9%, 10/112) and clinic (8.5%, 58/686) were comparable (p=0.87). On survey, 43.9% had never previously tested for CT, 53.7% were not already considering a test, 61.7% would not have gone for a test within the next 2 months. Only 27.6% had Canadian health insurance. 93.9% were satisfied or very satisfied with CT screening in an outreach setting.

Conclusions Intermittent, free, event-based outreach CT screening was operationally feasible, effective at increasing case detection, and highly acceptable to participants. Outreach attracted a younger age and more men than clinic. A large proportion of participants were first-time testers, over half were without prior intent to test or likelihood to test in near future, and most would have had to pay up-front for CT testing in a clinic setting. This study demonstrates both need and benefit of expanded CT screening efforts in the international resort setting.

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