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The implementation of chlamydia screening: a cross-sectional study in the South East of England
  1. Sandra A Johnson1,2,
  2. Ian Simms3,
  3. Jessica Sheringham4,
  4. Graham Bickler1,
  5. Catherine M Bennett2,
  6. Ruth Hall1,
  7. Jackie A Cassell1,5
  1. 1South East Region, Health Protection Agency, London, UK
  2. 2Melbourne School of Population Health, The University of Melbourne, Melbourne, Australia
  3. 3National Chlamydia Screening Programme, Health Protection Agency, London, UK
  4. 4Health Care Evaluation Group, Department of Epidemiology and Public Health, London, UK
  5. 5Brighton and Sussex Medical School, Brighton, UK
  1. Correspondence to Ms Sandra A Johnson, Health Protection Agency—South East Region, 7th Floor, Holborn Gate, 330 High Holborn, London WC1V 7PP, UK; sandra.johnson{at}


Background England's National Chlamydia Screening Programme (NCSP) provides opportunistic testing for under 25 year-olds in healthcare and non-healthcare settings. The authors aimed to explore relationships between coverage and positivity in relation to demographic characteristics or setting, in order to inform efficient and sustainable implementation of the NCSP.

Methods The authors analysed mapped NCSP testing data from the South East region of England between April 2006 and March 2007 inclusive to population characteristics. Coverage was estimated by sex, demographic characteristics and service characteristics, and variation in positivity by setting and population group.

Results Coverage in females was lower in the least deprived areas compared with the most deprived areas (OR 0.48; 95% CI 0.45 to 0.50). Testing rates were lower in 20–24-year-olds compared with 15–19-year-olds (OR 0.69; 95% CI 0.67 to 0.72 for females and OR 0.67; 95% CI 0.64 to 0.71 for males), but positivity was higher in older males.

Females were tested most often in healthcare services, which also identified the most positives. The greatest proportions of male tests were in university (27%) and military (19%) settings which only identified a total of 11% and 13% of total male positives respectively. More chlamydia-positive males were identified through healthcare services despite fewer numbers of tests.

Conclusions Testing of males focused on institutional settings where there is a low yield of positives, and limited capacity for expansion. By contrast, the testing of females, especially in urban environments, was mainly through established healthcare services. Future strategies should prioritise increasing male testing in healthcare settings.

  • Chlamydia
  • screening

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  • Competing interests None.

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

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