1. Assessment of Chlamydia Rescreening Practices Kelly Opdyke, MPH Region II IPP Advisory Committee Mtg May 16-17, 2007 Cicatelli Associates Inc.

2. Region II IPP Strategic Plan 2005-2009 PRIORITY 2: Incorporate Analysis of Regional Prevalence Monitoring Data for Regional and Local Data-Directed Planning and Quality Assurance. PRIORITY 2: Incorporate Analysis of Regional Prevalence Monitoring Data for Regional and Local Data-Directed Planning and Quality Assurance. –GOAL: IPP data will direct the most cost effective implementation of screening and treatment funds OBJECTIVE 2C: By June 30, 2007, evaluate/ assess chlamydia rescreening practices for clients testing positive for chlamydia 3-4 months post treatment. OBJECTIVE 2C: By June 30, 2007, evaluate/ assess chlamydia rescreening practices for clients testing positive for chlamydia 3-4 months post treatment.

3. CDC STD Tx Guidelines Retest all females approximately 3 months after treatment for chlamydia. Retest all females approximately 3 months after treatment for chlamydia. Retest all women treated for chlamydial infection whenever they next seek medical care within the following 3–12 months, regardless of whether the patient believes that her sex partners were treated. Retest all women treated for chlamydial infection whenever they next seek medical care within the following 3–12 months, regardless of whether the patient believes that her sex partners were treated. Test-of-Cure (repeat testing within 3-4 weeks, i.e. 21 to 28 days) is not recommended except in pregnant women. Test-of-Cure (repeat testing within 3-4 weeks, i.e. 21 to 28 days) is not recommended except in pregnant women.

4. Rationale for Rescreening High prevalence of chlamydia infection is observed in women treated for chlamydial infection in the preceding several months. High prevalence of chlamydia infection is observed in women treated for chlamydial infection in the preceding several months. –Niccolai et al. (Mar 2007) found that 52% of Ct infections in their study population of 14-19 year old females were recurrent infections Most posttreatment infections result from reinfection Most posttreatment infections result from reinfection Repeat infections confer an elevated risk for PID and other complications when compared with the initial infection. Repeat infections confer an elevated risk for PID and other complications when compared with the initial infection.

5. Rescreening Assessment Purpose and Aims Purpose: To assess current practices for chlamydia rescreening in Region II Purpose: To assess current practices for chlamydia rescreening in Region II Specific Aims: Specific Aims: –Develop and pilot methodology for Regional rescreening assessment –Establish a baseline measure of rescreening rates to inform future discussions related to regional rescreening practices Methods were developed in consultation with Screening Workgroup Methods were developed in consultation with Screening Workgroup

6. Rescreening Assessment Methodology Eligible clients were females (all ages) testing positive for chlamydia between January 1 and December 31, 2005 Eligible clients were females (all ages) testing positive for chlamydia between January 1 and December 31, 2005 Follow-up period through December 31, 2006 Follow-up period through December 31, 2006 Data requested from sites currently able to provide electronic data with the following variables: Data requested from sites currently able to provide electronic data with the following variables: –Client ID (to link initial and f/u tests) –Client age –Date of Initial Positive Ct Test –Date of Follow-Up Ct Test –Result of Follow-Up Ct Test

7. Rescreening Assessment Outcome Measures Elapsed time from initial positive Ct test to next Ct test, by age group Elapsed time from initial positive Ct test to next Ct test, by age group –Approx. 3 months (75-99 days) –Approx. 3-12 months (100-365 days) Repeat Ct positivity by age group Repeat Ct positivity by age group

8. Rescreening Assessment Study Sample Age Group AGENCYTotal NJ DHSS NYC DOHMH NYS DOH STD UPR TXFPP <15 yrs 87289 15-19 yrs 17591573481958 20-24 yrs 145023324321739 25+ yrs 6441362782 TOTAL394052858424568 Undup. Number of Females Testing Positive for Chlamydia from January 1 to December 31, 2005 (N=4568)

9. Rescreening Assessment Results Age Group Within Approx. 3 mos (75-99 days) Within Approx. 3-12 mos (100-365 days) Total (75-365 days) <15 yrs 1 (1.1%) 23 (25.8%) 24 (27.0%) 15-19 yrs 102 (5.2%) 439 (22.4%) 541 (27.6%) 20-24 yrs 90 (5.2%) 364 (20.9%) 454 (26.1%) 25+ yrs 40 (5.1%) 162 (20.7%) 202 (25.8%) TOTAL 233 (5.1%) 988 (21.6%) 1221 (26.7%) Undup. Number of Females Retested for Chlamydia Within 3-12 Months After Initial Positive Test (N=4568)

10. Rescreening Assessment Results (cont’d) Age Group Within Approx. 3 mos (75-99 days) Within Approx. 3-12 mos (100-365 days) Total (75-365 days) <15 yrs 0 (0.0%) 7 (30.4%) 7 (29.2%) 15-19 yrs 18 (17.6%) 82 (18.7%) 100 (18.5%) 20-24 yrs 12 (13.3%) 56 (15.4%) 68 (15.0%) 25+ yrs 3 (7.5%) 26 (16.0%) 29 (14.4%) TOTAL 33 (14.2%) 171 (17.3%) 204 (16.7%) Repeat Chlamydia Positivity Among Females Retested for Chlamydia 3-12 Months After Initial Positive Test (n=1221)

11. Rescreening Assessment Summary 1,221 (26.7% of) females who tested positive for Ct in CY2005 were rescreened within 3-12 months (75-365 days) per CDC guidelines 1,221 (26.7% of) females who tested positive for Ct in CY2005 were rescreened within 3-12 months (75-365 days) per CDC guidelines –16.7% positivity at follow-up An addt’l 414 (9.1% of) clients were retested within 22-74 days An addt’l 414 (9.1% of) clients were retested within 22-74 days –12.1% positivity at follow-up Overall, 1,635 (35.8% of) clients were retested within 22-365 days Overall, 1,635 (35.8% of) clients were retested within 22-365 days –15.5% positivity at follow-up Just 1.6% (71) of all clients were retested within less than 21 days Just 1.6% (71) of all clients were retested within less than 21 days –Could be prenatal test-of-cure (data not collected)

12. Rescreening Assessment Discussion What are project areas currently doing to assess rescreening practices? What are project areas currently doing to assess rescreening practices? –What have been the results so far? How can we expand rescreening assessment to include additional project areas and sites? How can we expand rescreening assessment to include additional project areas and sites? How do these data support retesting women for chlamydia? How do these data support retesting women for chlamydia?