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Missed Opportunities for Chlamydia Screening in Title X Family Planning Clinics

Salomon, Sarah Goldenkranz MPH*; Torrone, Elizabeth PhD; Nakatsukasa-Ono, Wendy MPH; Fine, David N. PhD

doi: 10.1097/OLQ.0000000000000641
Original Studies

Background Annual chlamydia (CT) screening is recommended for women younger than 25 years, yet less than half of young women seeking health care are screened annually. We analyzed Title X family planning service data from the Northwest United States to assess factors associated with missed opportunities for CT screening. Our primary hypothesis was screening coverage is higher during annual preventive health visits compared to other visit types. Study objectives were: (1) identify gaps in screening coverage by patient demographics, visit characteristics, and clinic measures; and (2) examine the association between visit type and CT screening by controlling for other covariates and stratifying by state.

Methods Calendar year 2011 Title X visit records (n = 180,856) were aggregated to the patient level (n = 112,926) to assess CT screening coverage by all characteristics. Screening variation was explored by bivariate and multivariate Poisson regression. Adjusted models for each state estimated association between comprehensive examination and screening controlling for confounders.

Results Clinic and visit characteristics were associated with CT screening. Coverage ranged from 45% in Washington to 80% in Alaska. Only 34% of patients visited for a routine comprehensive examination. Visit type was associated with screening; 75% of patients who had a comprehensive examination were screened versus 34% of those without a comprehensive examination (unadjusted PR, 2.18; 95% confidence interval, 2.16–2.21). The association between comprehensive examination and CT screening varied significantly by state (interaction term, P < 0.001).

Conclusions Missed screening opportunities are common among women who access brief appointments for specific needs but do not seek routine preventive care, particularly in some states. Structural interventions may help address these systematically missed opportunities.

A study of family planning clinics in US Public Health Service Region X found state and visit type were stronger predictors of chlamydia screening than other visit and patient characteristics.

From the *Foundation for Healthy Generations, Seattle, WA; †Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA; and ‡Cardea Services, Seattle, WA

Acknowledgments: The authors greatly appreciate the commitment and effort by members of the Region X Infertility Prevention Project Regional Advisory Council who spearheaded region-wide CT control efforts and offered valuable input on the interpretation of our findings.

This study was supported by the Department of Health and Human Services, Office of Population Affairs as part of an interagency agreement with the Centers for Disease Control and Prevention, Division of STD Prevention. Grant number FPTPA100014 awarded to Cardea Services.

Conflicts of interest: none declared.

Correspondence: Sarah Goldenkranz Salomon, MPH, 419, 3rd Ave. W, Seattle, WA 98119. E-mail:;

Received for publication December 3, 2016, and accepted April 17, 2017.

© Copyright 2017 American Sexually Transmitted Diseases Association