Sex Transm Infect doi:10.1136/sextrans-2011-050267
  • Health services research
  • Original article

Evaluation of a systematic postal screening and treatment service for genital Chlamydia trachomatis, with remote clinic access via the internet: a cross-sectional study, East of England

  1. Alison Woolnough3
  1. 1Health Protection Agency, London, UK
  2. 2School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
  3. 3Department of Public Health, NHS North East Essex, Colchester Primary Care Centre, Colchester, Essex, UK
  1. Correspondence to Dr Samantha Bracebridge, Consultant Epidemiologist/Field Epidemiology Training Programme Coordinator, Public Health Strategy Division, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK; sam.bracebridge{at}
  1. Contributors SB: seconded to North East Essex PCT to commission chlamydia screening service; devised the study; responsible for data collection, cleaning and anonymisation; responsible for ethics review; drafting manuscript; guarantor for study. MOB: statistical analysis of anonymised data; review of manuscript. KR: development of chlamydia screening service and resources manager; responsible for PCT approval of the study and oversight of data management; guarantor for study; review of manuscript. AW: monitoring of the chlamydia screening service; review of manuscript.

  • Accepted 27 January 2012
  • Published Online First 28 February 2012


Objective England's National Chlamydia Screening Programme provides opportunistic testing for all 15–24-year-olds in healthcare and non-healthcare settings. The authors undertook an evaluation of a population service-based postal chlamydia screening and treatment service, with registration and access to the service via the internet, in order to target screening interventions more effectively in future.

Methods Individuals aged between 18 and 24 years, within the North East Essex Primary Care Trust, were identified for chlamydia screening by the service between 1 December 2008 and 31 January 2009. Associations between test uptake and positivity, and individuals' personal characteristics, were examined. The efficacy of partner notification was estimated, and the costs of screening were compared with the national average.

Results Uptake of chlamydia screening was 11.5%, with lower response rates among men, individuals older than 20 years and those living in more deprived areas. The chlamydia positivity was 4.4% and higher in those reporting multiple sexual partners, individuals older than 20 years and those living in more deprived areas. The proportion of partners notified per index case was 0.17. The service contributed to 3431 of the overall 11 209 annual chlamydia screens of the Primary Care Trust in 2008–2009, at a cost of £78 per screening test completed and £1764 per case detected.

Conclusions Our evaluation shows that this service model can contribute substantially to the overall coverage of chlamydia screening tests. However, the costs of service provision per case detected and treated, using this model, were high compared to the National Chlamydia Screening Programme.


  • Competing interests None.

  • Ethics approval NRES advice: ethics approval not required as this was a service evaluation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Standard procedures for secure handling of data were followed in line with the Data Protection Act and Caldicott guidance. Data were cleaned and anonymised by PCT staff before transfer to University of East Anglia for statistical analysis.