Background Racial and ethnic minorities are often disproportionately affected by health disparities. In 2009, American Indian and Alaska Natives (AI/AN) had the 2nd highest rates of chlamydia in the USA. In an effort to eliminate health inequities and reduce the burden of disease, the US Centers for Disease Control and Prevention (CDC) recommends annual chlamydia screening for all sexually active women <25 while reducing screening among older less at-risk individuals. We sought to assess and describe geographic regional differences in how recommendations have been adopted across Indian Country to identify what opportunities exist for improving care within the Indian Health Service (IHS) National STD Program's Stop Chlamydia Project, a screening program that partners with IHS/Tribal/Urban Indian health centers (I/T/U) to enhance and expand chlamydia screening among AI/AN.
Methods We calculated chlamydia screening coverage rates and associated per cent positivity for women <25 and >26 years of age screened through sites participating in the Stop Chlamydia Project by geographic region. Screening coverage was calculated using the 2009 Indian Health Services facility-level user population estimates as denominator values.
Results Screening coverage among AI/AN women tested in Stop CT Project sites varied across geographic regions. Among women <25, rates ranged from 50.8% (Alaska) to 6.8% (California). Chlamydia positivity among this population also demonstrated variance across geographic regions ranging from 13.2% (Aberdeen) to 4.6% (California). Among >26-year-old women, similar levels of screening were seen ranging from 34.4% (Alaska) and 5.7% (Bemidji); however, significantly less positivity was identified (1.4%–5.6%) (Abstract P5-S7.10 table 1).
Conclusions This is the first time screening coverage for American Indian/Alaska Native women has been evaluated by geographic regions. These data can help inform program improvement activities to maximise screening outcomes by expanding testing among women <25 years old and limiting routine screening efforts in older women (>26 years old) in order to better utilise testing resources to expand coverage among those at greatest risk for chlamydia (<25 years old).