BMJ, doi: 10.1136/bmj.38413.663137.8F, (Published 4 April 2005)

PRIMARY CARE

Coverage and uptake of systematic postal screening for genital Chlamydia trachomatis and prevalence of infection in the United Kingdom general population: cross sectional study

John Macleod 1, Chris Salisbury 2, Nicola Low 3, Anne McCarthy 3, Jonathan A C Sterne 3, Aisha Holloway 1, Rita Patel 2, Emma Sanford 3, Andrea Morcom 1, Paddy Horner 4, George Davey Smith 3, Susan Skidmore 5, Alan Herring 6, Owen Caul 6, F D Richard Hobbs 1, Matthias Egger 7

1 Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT
2 Department of Community Based Medicine, University of Bristol, Bristol BS6 6JL
3 Department of Social Medicine, University of Bristol, Bristol BS8 2PR
4 Milne Centre, United Bristol Healthcare Trust, Bristol BS21 7LR
5 Public Health Laboratory Service, Birmingham B9 5SS
6 Public Health Laboratory Service, Bristol BS2 8EL
7 Department of Social and Preventive Medicine, University of Berne, Finkenhubelweg 11, Berne, CH-3012, Switzerland

Objective To measure the coverage and uptake of systematic postal screening for genital Chlamydia trachomatis and the prevalence of infection in the general population in the United Kingdom. To investigate factors associated with these measures.

Design Cross sectional survey of people randomly selected from general practice registers. Invitation to provide a specimen collected at home.

Setting England.

Participants 19 773 men and women aged 16-39 years invited to participate in screening.

Main outcome measures Coverage and uptake of screening; prevalence of chlamydia.

Results Coverage of chlamydia screening was 73% and was lower in areas with a higher proportion of non-white residents. Uptake in 16-24 year olds was 31.5% and was lower in men, younger adults, and practices in disadvantaged areas. Overall prevalence of chlamydia was 2.8% (95%confidence interval 2.2% to 3.4%) in men and 3.6% (3.1% to 4.9%) in women, but it was higher in people younger than 25 years (men 5.1%; 4.0% to 6.3%; women 6.2%; 5.2% to 7.8%). Prevalence was higher in the subgroup of younger women who were harder to engage in screening. The strongest determinant of chlamydial infection was having one or more new sexual partners in the past year.

Conclusions Postal chlamydia screening was feasible, but coverage was incomplete and uptake was modest. Lower coverage of postal screening in areas with more non-white residents along with poorer uptake in more deprived areas and among women at higher risk of infection could mean that screening leads to wider inequalities in sexual health.

(Accepted 2 March 2005)
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