Chlamydia infection is endemic among sexually active young adults. A recent systematic review of chlamydia prevalence in young adults in Europe and other high income countries estimated a pooled point prevalence of 3.6% (95% CI 2.4, 4.8) in women and 3.5% (95% CI 1.9, 5.2) in men. These levels of infection have remained stubbornly persistent in many countries despite major investments in sexual health programmes. This leaves policy makers with a challenge: what can we do to control chlamydia?
Existing evidence underpinning chlamydia control policy comes from (a) observational studies showing the incidence of sequelae, (b) a small number of trials showing a reduction in PID following a single offer of a chlamydia test to asymptomatic women, (c) ecological studies suggesting a decline in chlamydia following the introduction of widespread testing in some countries, (d) a small number of (inconclusive) studies the impact of testing interventions on population prevalence, (e) mathematical models estimating that screening programmes could have an impact on transmission and therefore prevalence if they achieve high coverage and repeated rounds of testing.
Overall there is a lack of a robust evidence base for the development of control policy.
The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) promises to add to the evidence base by explicitly testing the effectiveness of an intervention in terms of changes in chlamydia prevalence. The results of the pilot will be discussed in relation to the wider evidence briefly described above.