1. THE BIG SCREEN Ruth Hall Chlamydia Screening Programme Brighton & Hove City, Eastbourne Downs, Mid-Sussex, Sussex Downs & Weald PCTs

2. Chlamydia Trachomatis Commonest sexually transmitted infection in England & WalesCommonest sexually transmitted infection in England & Wales 90,000 new cases diagnosed in 200390,000 new cases diagnosed in 2003 < 70% of cases are asymptomatic – large numbers remain undiagnosed< 70% of cases are asymptomatic – large numbers remain undiagnosed Largest single factor in PID, ectopic pregnancy and infertilityLargest single factor in PID, ectopic pregnancy and infertility Bacterial infection - easily cured by antibioticsBacterial infection - easily cured by antibiotics

3. Diagnoses of genital chlamydial infection in GUM clinics by sex & age group, UK: 1995-2002 MalesFemales

4. Background CMO Expert Advisory Group 1998CMO Expert Advisory Group 1998 –acknowledged seriousness 1999/2000 screening pilots – Portsmouth / Wirral1999/2000 screening pilots – Portsmouth / Wirral –reported 2001/2 –high level acceptance –>95% positive cases treated Increased availability of non-invasive, more sensitive testsIncreased availability of non-invasive, more sensitive tests

5. Background Department of Health funding for National Roll-out of ProgrammeDepartment of Health funding for National Roll-out of Programme 2002 – Ten Phase 1 sites announced2002 – Ten Phase 1 sites announced 2004 – Sixteen Phase 2 sites announced2004 – Sixteen Phase 2 sites announced Brighton consortium won Phase 2 fundingBrighton consortium won Phase 2 funding

6. How many will we screen? Target population 92,800 (age 16-24 years)Target population 92,800 (age 16-24 years) Estimate 75,000 will be sexually active (NATSAL)Estimate 75,000 will be sexually active (NATSAL) Screen 30,000 per annumScreen 30,000 per annum

7. Opportunistic screening Continuous sites:Continuous sites: –Gynaecology –Termination pregnancy –Family planning –GU Medicine –Selected GP surgeries –University –Youth clinics Sporadic screening:Sporadic screening: –6th form colleges –Schools –Youth clubs –Freshers’ events –Sports events –Lewes prison –Clubs –Pubs –Beaches

8. How does it work? Any patients under 25 offered the testAny patients under 25 offered the test Posters and information bookletsPosters and information booklets Specific chlamydia request formsSpecific chlamydia request forms –largely self completed by patients –three data items to be completed by clinic staff No examination necessaryNo examination necessary –Urine sample for men –Self-taken lower vaginal swab for women Programme training and manual for site staffProgramme training and manual for site staff

10. Patient Management Estimate ~ 10% positive (14-17% in some sites)Estimate ~ 10% positive (14-17% in some sites) Contact via preferred method and invite to attendContact via preferred method and invite to attend –primary screening site –central chlamydia office –“chlamydia clinics” TreatmentTreatment –stat dose of azithromycin 1g direct observation –offer full screen at GU clinic if symptomatic –sexual abstinence for 7 days Trace contactsTrace contacts

11. Direct advantages Reduce the local prevalence of chlamydiaReduce the local prevalence of chlamydia Improve access to sexual health services (rural areas, disadvantaged groups, homeless)Improve access to sexual health services (rural areas, disadvantaged groups, homeless) Detailed epidemiological data for the Department of Health from outside GUM clinic settingsDetailed epidemiological data for the Department of Health from outside GUM clinic settings Decreased reproductive morbidity (ectopic pregnancy, infertility)Decreased reproductive morbidity (ectopic pregnancy, infertility) Reduced consultations relating to chronic pelvic painReduced consultations relating to chronic pelvic pain

12. Indirect advantages Improved awareness of sexual health & safer sex issuesImproved awareness of sexual health & safer sex issues Greater knowledge amongst health care professionalsGreater knowledge amongst health care professionals Increased opportunities to discuss sexual health promotion / condom useIncreased opportunities to discuss sexual health promotion / condom use Enhanced links between health, youth, education & non-NHS servicesEnhanced links between health, youth, education & non-NHS services

13. Local Programme Stages Stage 1Design & ImplementStage 1Design & Implement Stage 2Evaluate TrialStage 2Evaluate Trial Stage 3Monitor & ReportStage 3Monitor & Report Stage 4Secure Future FundingStage 4Secure Future Funding

14. Programme Plan

15. Scope Sexually active <25sSexually active <25s Brighton & Hove, Eastbourne Downs, Mid- Sussex and Sussex Downs & Weald PCTsBrighton & Hove, Eastbourne Downs, Mid- Sussex and Sussex Downs & Weald PCTs Phase II of Department of Health National Chlamydia Screening Programme Roll-outPhase II of Department of Health National Chlamydia Screening Programme Roll-out DH funding for 2 yearsDH funding for 2 years –£510k set-up and year 1 –£515k year 2

16. Sites to Date Brighton & Hove City-10Brighton & Hove City-10 Eastbourne Downs-3Eastbourne Downs-3 Sussex Downs & Weald-1Sussex Downs & Weald-1 Mid-Sussex-2Mid-Sussex-2 Presentations made to 8 further sitesPresentations made to 8 further sites

17. Sites to Date Hospital Clinics-3Hospital Clinics-3 GP Surgeries-7GP Surgeries-7 Family Planning-2Family Planning-2 Youth Centres-2Youth Centres-2 Student Advice Centres-2Student Advice Centres-2

18. Tests to Date August (from 17 th )-23August (from 17 th )-23 September-145September-145 October-168October-168 November (to 17 th )-90November (to 17 th )-90

19. Results to Date

20. Questions?