Thinking about chlamydia management at Australian family planning clinics

Very pleased to be able to share the Chlamydia testing and management – FINAL REPORT. This is the outcome of a project that assessed chlamydia testing, contact management and re-testing practices of clinicians at Australian family planning clinics. The project was funded by a National Health and Medical Research Council (NHMRC) Program Grant, and run by The Kirby Institute, UNSW. But the project could not have happened without the support of the management and senior staff of Family Planning organisations. We used a mixed methods approach – a survey of 168 clinicians (run by Joanne Micallef) and 11 focus groups with 70 clinicians (run by me).

Family planning organisations in Australia are state-based non-government organisations and clinics offering a variety of sexual and reproductive health services. There are 29 family planning clinics located across all Australian states and territories. These clinics have high case loads of young, sexually active women (primarily) and men at risk of chlamydia infection.

We’ve presented some findings at the Sexual Health conference in Darwin last year and we’re working on manuscripts. But here are the headlines:

TESTING

  • Screening for chlamydia was perceived by clinicians as routine and a priority.
  • Chlamydia screening facilitators:
    • high community awareness of chlamydia;
    • communicating to clients that chlamydia testing is normal;
    • good relationship between FPC/clinicians and client;
    • providing easy access to screening; and
    • the ability to offer screening without a physical examination.
  • Evaluating the success of chlamydia screening:
    • clinicians felt confident that chlamydia screening was going well at both the individual and FPC level;
    • clients widely accept the offer to be screened for chlamydia;
    • informal review of clinic notes by clinicians reassured them that screening was occurring; and
    • formal reviews through audits challenged the clinicians’ perception of chlamydia screening rates.
  • Challenges of chlamydia screening:
    • clients being considered low or no risk;
    • refusal by clients and dealing with decliners;
    • clinicians worrying that clients may be offended by screening offer so not offering.
  • Clinicians raised concerns about over-testing for chlamydia.

MANAGEMENT

  • Three quarters of clinicians suggested contact tracing the sexual partner(s) of clients in the 6 months prior to the chlamydia diagnosis.
  • Family planning clinicians were proactive in managing contacts of their clients:
    • almost all clinicians would encourage clients to tell partner(s)
    • three quarters would assist clients by providing a brochure containing information on chlamydia.
  • The Let Them Know website has become an important partner notification tool for family planning clinicians.
  • The Let Them Know website is a part of routine practice for many clinicians.
  • Use of the website varied between jurisdictions.
  • For clinicians not using the website, there is a desire to have access to this resource.
  • Contact managementfacilitators:
    • preparing clients for a positive test result;
    • low level of stigma associated with chlamydia; and
    • easy access to chlamydia screening for partners of clients.
  • Evaluating the success of contact management:
    • it is difficult to determine if clients notified their partner(s) and if partner(s) are tested and treated; and
    • there are few indicators for determining the success of contact management.
  • Challenges of contact management:
    • uncertainty around what is expected from clinicians; and
    • clinicians’ doubt around the importance of contact management for chlamydia.
  • The majority of clinicians acknowledged the benefits of patient delivered partner therapy although only 35% of clinicians ever used it. Most clinicians had concerns about using PDPT and its legal status was a major impediment to the uptake of the strategy.

RETESTING

  • Only 22% of clinicians recommend annual testing to all clients.
  • The majority (88%) of clinicians recommend clients return for retesting three months after a diagnosis of chlamydia.
  • The most common strategies for chlamydia retesting included recommending retesting at the time of initial treatment, explaining the importance of retesting after treatment and explaining the risk of repeat infection.
  • Most retesting was opportunistic; that is, a clinician noticed a recent positive chlamydia test recorded in a file and suggested a retest.
  • Evaluating the success of retesting:
    • it is difficult to determine the number of clients who return for retesting; and
    • clinicians were confident that new reminder systems were successful in getting clients to return for retesting.
  • Challenges to retesting:
    • clients often don’t return for retesting;
    • clinicians rely on opportunistic screening as retesting when clients return to the clinic;
    • uncertainty around the value of retesting for chlamydia; and
    • clinicians’ view that proactive retesting reminders undermine client responsibility.
  • ‘Proactive’ client reminder systems had mixed support from clinicians
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