Background The National Chlamydia Screening Programme (NCSP) seeks to increase rates of chlamydia diagnosis amongst young people aged 15–24 across the 326 English Local Authorities (LA). 68% of screens and 79% of diagnoses are made in the community sexual health, general practise, pharmacy, termination of pregnancy (TOP) and genitourinary medicine (GUM) services that take part in the NCSP. These ‘Core Services’ are central to the delivery of the programme but not all clinics screen for chlamydia. This study was undertaken as part of a project to inform optimum services configuration to increase diagnostic rates to improve chlamydia detection and infection control.
Methods Diagnoses of genital chlamydia recorded in data from sexually transmitted disease clinics and NCSP surveillance datasets for 2011 were aggregated to LA level. Overall diagnostic rates (outcome) were calculated using Office of National Statistics (ONS) population estimates for the 15–24 year age group. This information was analysed together with the total testing at each Core Service and ONS area classification. Data were analysed using multivariable negative binomial poisson regression and spatial mapping techniques.
Results Overall chlamydia diagnostic rates were associated with increased rates of testing in community health services (RR = 1.02; p < 0.0001), general practise (RR = 1.01; p = 0.0176) and GUM (RR = 1.03; p < 0.0001) but not pharmacy or TOP. Diagnostic rates varied by geographic location (p < 0.0001), lower rates being seen in ‘Central London’ (RR = 0.63; 95% CI = 0.50–0.80), ‘London Suburbs’ (RR = 0.77; 95% CI = 0.61–0.96) ‘Southern England’ (RR = 0.63; 95% CI = 0.51–0.78) and ‘Outer London’ (RR = 0.64; 95% CI = 0.50–081). Diagnostic rates also increased as the range of service types contributing to testing increased (p = 0.0427).
Conclusions The analysis highlights the importance of community based testing and the provision of a range of services to achieving high rates of chlamydia detection. The study is being extended to investigate patient flow and service attendances within and between LAs in relation to gender, age group, ethnicity and service type.
- Chlamydia trachomatis