Background The US Centers for Disease Control and Prevention (CDC) recommends annual chlamydia screening for sexually active females aged <26 years. Community health centers (CHCs) have been a focal point for Health Care Reform in the US and have traditionally served as safety-net providers, however little is known about CT screening practices in CHCs or CT prevalence among CHC clients. The Region II Infertility Prevention Project (IPP) supports chlamydia and gonorrhoea (CT/GC) prevalence monitoring in participating facilities throughout New Jersey, New York, Puerto Rico and the US Virgin Islands, including a small number of CHCs.
Methods We reviewed Region II IPP CT/GC prevalence monitoring data for females aged 15–25 years tested in CY2009 attending CHCs for non-prenatal visits by age, test result, and laboratory test type, and compared with data for females attending family planning (FP) clinics for non-prenatal visits in the same counties. A total of 3103 CT and 2890 GC test records were associated with 18 CHCs in 12 counties in New Jersey, New York, and the US Virgin Islands; 35 FP clinics in the same counties reported 32 905 CT and 19 882 GC tests.
Results CT positivity among females aged 15–19 and 20–25 years in CHCs was 11.4% (n=640) and 5.7% (n=2463), respectively, compared with 8.5% (n=10 946) and 4.6% (n=21 959) in FP clinics in the same counties. GC positivity in CHCs was 1.3% (n=594) and 0.2% (n=2296) among females aged 15–19 and 20–25 years, respectively, compared with 1.0% (n=6548) and 0.3% (n=13 334) in FP clinics (Abstract P5-S7.11 table 1). Over 99% of tests in CHCs were performed using highly sensitive nucleic acid amplification tests (NAATs), vs 55% of tests performed in FP.
Conclusion The burden of chlamydia and gonorrhoea among females aged 15–25 years attending CHCs is comparable to that observed in FP clinics, and highest among teens. As state and local health departments face mounting budget deficits and impending cuts to public health infrastructure—including cuts to the delivery of direct clinical services, CHCs may play an increasingly integral role in providing screening to the most at risk populations. CHCs are required to report to HRSA (the federal agency that funds the CHC program) on their performance using the measures defined in the Uniform Data System (UDS); however, the UDS does not currently include a measure for the proportion of clients screened for CT/GC. State and local health departments should consider opportunities to partner with CHCs in high morbidity areas to ensure and expand access to CT/GC screening and treatment for at risk populations, and leverage existing infrastructure to incorporate CHCs into ongoing prevalence monitoring efforts.
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