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Interventions to Increase Rescreening for Repeat Chlamydial Infection

Guy, Rebecca BAppSc, MAppEpid, PhD*; Hocking, Jane MPH, MHlthSc, PhD†,‡; Low, Nicola MD, PhD; Ali, Hammad MBBS, MPH*; Bauer, Heidi M. MD, MPH§; Walker, Jenny MPH, PhD; Klausner, Jeffrey D. MD, MPH; Donovan, Basil MD*,‖; Kaldor, John M. PhD*

doi: 10.1097/OLQ.0b013e31823ed4ec
Review

Background: Repeat infection with Chlamydia trachomatis following treatment is common and increases the risk of sequelae. Despite clinical guidelines recommending rescreening within 3 months of treatment, rescreening rates remain low. We undertook a systematic review to identify studies that compared rates of rescreening for repeat chlamydial infection between patients receiving and not receiving an intervention.

Methods: We searched Medline, EMBASE, and conference Web sites from 2000 to September 2010 using variations of the terms “chlamydia” and “rescreening” and “intervention.” We used meta-analysis to calculate the overall relative risk (RR) effect on rescreening rates by study design and strategy type.

Results: We identified 8 randomized controlled trials (RCTs) and 4 controlled observational studies, all conducted in the United States. Four RCTs assessed mailed screening kits ± reminders, with an average effect estimate of 1.30 (95% confidence interval [CI]: 1.01–1.50); 2 RCTs assessed motivational interviewing ± reminders with a summary effect of 2.15 (95% CI: 0.92–3.37); one RCT evaluated the effect of reminders with a RR of 9.67 (95% CI: 1.31–71.31), and another RCT assessed the effect of a $20 patient incentive with a RR of 1.16 (95% CI: 0.62–2.17). Three controlled observational studies assessed reminder strategies with RRs of 1.97 (95% CI: 1.76–2.21), 1.01 (95% CI: 0.66–1.55), and 1.88 (95% CI: 1.58–2.24)—a summary effect was not calculated due to significant heterogeneity; and one controlled observational study assessed the promotion of clinical guidelines with a RR of 1.35 (95% CI: 0.96–1.90).

Conclusion: The review suggests that the use of mailed screening kits is an important strategy to increase rescreening, reminder systems are promising, and motivational interviewing is worth investigation.

From the *The Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia; Centre for Women's Health, Gender and Society, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia; Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Switzerland; §Program Development and Evaluation, STD Control Branch, California Department of Public Health, Richmond, CA; Department of Medicine, University of California, San Francisco, CA; and Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia

Correspondence: Rebecca Guy, BAppSc, MAppEpid, PhD, The Kirby Institute (formerly the National Centre in HIV Epidemiology & Clinical Research), Faculty of Medicine, University of New South Wales, Cliffbrook Campus, 45 Beach Street, Coogee, New South Wales, 2031, Australia. E-mail: Rguy@kirby.unsw.edu.au.

Received for publication April 21, 2011, and accepted September 20, 2011.

© Copyright 2012 American Sexually Transmitted Diseases Association