200755 Restricting Chlamydia Screening Among Women Aged >25 Years During Budget Constraints, Infertility Prevention Program Iowa, 20052007

Monday, November 9, 2009

Mary E. Fournier, MD, MPH , Centers for Disease Control and Prevention, Epidemic Intelligence Service Officer, LCDR, US Public Health Service, Des Moines, IA
Patricia Quinlisk, MD, MPH , State Epidemiologist/Medical Director, Iowa Department of Public Health, Des Moines, IA
Colleen Bornmueller , Family Planning Council of Iowa, Des Moines, IA
Karen Thompson , Iowa Department of Public Health, STD Program, Des Moines, IA
Sheryl Lyss, MD, MPH , Supervisor, EIS Field Assignments Branch, CDR, US Public Health Service, Atlanta, GA
Background: Chlamydia, the most common bacterial sexually transmitted infection (STI), is a substantial cause of preventable infertility. The Infertility Prevention Program (IPP), CDC's national chlamydia testing and treatment program, includes sexually active women aged ≤25 years and their partners. Iowa IPP also tests selected women aged >25 years; in family planning clinics, selection criteria include women with a new partner, multiple partners, a partner with a STI, or signs or symptoms of disease. Faced with decreased funding and limited testing, Iowa IPP requires further information to focus services to those at highest risk. Methods: Iowa IPP behavioral, clinical and laboratory data for 20052007 were analyzed. Chlamydia diagnosis required a positive nucleic acid amplification test. Analyses were restricted to women attending family planning clinics and stratified by age. Results: Overall, 6,309/119,357 (5.3%) chlamydia tests were positive: 5,539/98,580 (5.6%) tests among women aged ≤25 years; 443/9,512 (4.7%) among women aged 2629 years; and 327/11,253 (2.9%) among women aged ≥30 years. By restricting testing to women aged <30 years, IPP would have identified 5,982 (94.8%) infections by conducting 108,092 (90.6%) tests. Among women aged 2629 years, 1,489/9,512 (15.7%) tests did not meet selection criteria. By restricting testing to women aged ≤25 years and only those women aged 2629 years who meet selection criteria, IPP would have identified 5,942 (94.2%) infections by conducting 106,603 (89.3%) tests. Conclusions: Iowa IPP can limit chlamydia testing among women aged >25 years, yet identify most infections, by enforcing selection criteria and limiting participants' ages.

Learning Objectives:
1) List the current selection criteria for the Iowa Infertility Prevention Program (IPP). 2) Explain the funding constraints facings state public health programs such as Iowa IPP. 3) Identify at least two steps the program can take to decrease testing and still diagnose most infections.

Keywords: Chlamydia, Funding

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As an adolescent medicine physician, I have had a lot of clinical experience working with grant-funded programs for STD testing and treatment. Since obtaining my MPH, I have been an EIS officer with the CDC and am assigned to the Iowa Department of Public Health. I have worked with the STD program at IDPH and the Family Planning Council of Iowa to evaluate chlamydia surveillance in Iowa and have worked with the past three years of data from IPP.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.