Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted infection and its greatest burden is among young adults with community-based studies reporting prevalence estimates of 3 to 5% among 16 to 29 year olds in Australia. As over 80% of infections are asymptomatic, screening is the main way to detect cases. However, there is considerable debate about the effectiveness of chlamydia screening. In response to this concern, the Australian Government funded the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) to assess the feasibility, acceptability, efficacy and cost-effectiveness of annual chlamydia testing for sexually active 16 to 29 year old men and women attending general practice.
ACCEPt is being evaluated using a cluster randomised controlled trial design. A total of 143 general practice clinics in 52 geographical areas (clusters) are participating. An intervention to support increased chlamydia testing, including incentive payments for each test done, quarterly feedback on testing performance and computer prompts, has been allocated at the cluster level and all general practice clinics within each cluster are participating. The primary outcome of ACCEPt is change in chlamydia prevalence among 16 to 29-year-old men and women attending general practice. This will be assessed as the difference in chlamydia prevalence between a baseline prevalence survey conducted among a consecutive sample of 16- to 29-year-old men and women attending all participating clinics prior to randomisation and a follow-up survey conducted at the conclusion of the trial. The fundamental premise of this trial is that increased levels of testing can be achieved by providing support to clinics, and that once levels of chlamydia testing are sufficiently increased, the prevalence of chlamydia will fall. Preliminary results from ACCEPt will be presented.
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