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Randomized Controlled Trial
. 2012 Jul 5:345:e4316.
doi: 10.1136/bmj.e4316.

Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation

Ingrid V F van den Broek  1 , Jan E A M van Bergen, Elfi E H G Brouwers, Johannes S A Fennema, Hannelore M Götz, Christian J P A Hoebe, Rik H Koekenbier, Mirjam Kretzschmar, Eelco A B Over, Boris V Schmid, Lydia L Pars, Sander M van Ravesteijn, Marianne A B van der Sande, G Ardine de Wit, Nicola Low, Eline L M Op de Coul
Affiliations
Randomized Controlled Trial

Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation

Ingrid V F van den Broek et al. BMJ. .

Abstract

Objective: To evaluate the effectiveness of register based, yearly chlamydia screening.

Design: Controlled trial with randomised stepped wedge implementation in three blocks.

Setting: Three regions of the Netherlands: Amsterdam, Rotterdam, and South Limburg.

Participants: 317 304 women and men aged 16-29 years listed on municipal registers at start of trial.

Intervention: From March 2008 to February 2011, the Chlamydia Screening Implementation programme offered yearly chlamydia screening tests. Postal invitations asked people to use an internet site to request a kit for self collection of samples, which would then be sent to regional laboratories for testing. Treatment and partner notification were done by the general practitioner or at a sexually transmitted infection clinic.

Main outcome measures: Primary outcomes were the percentage of chlamydia tests positive (positivity), percentage of invitees returning a specimen (uptake), and estimated chlamydia prevalence. Secondary outcomes were positivity according to sex, age, region, and sociodemographic factors; adherence to screening invitations; and incidence of self reported pelvic inflammatory disease.

Results: The participation rate was 16.1% (43 358/269 273) after the first invitation, 10.8% after the second, and 9.5% after the third, compared with 13.0% (6223/48 031) in the control block invited at the end of round two of the intervention. Chlamydia positivity in the intervention blocks at the first invitation was the same as in the control block (4.3%) and 0.2% lower at the third invitation (odds ratio 0.96 (95% confidence interval 0.83 to 1.10)). No substantial decreases in positivity were seen after three screening rounds in any region or sociodemographic group. Among the people who participated three times (2.8% of all invitees), positivity fell from 5.9% to 2.9% (odds ratio 0.49 (0.47 to 0.50)).

Conclusions: There was no statistical evidence of an impact on chlamydia positivity rates or estimated population prevalence from the Chlamydia Screening Implementation programme after three years at the participation levels obtained. The current evidence does not support a national roll out of this register based chlamydia screening programme.

Trial registration: NTR 3071 (Netherlands Trial Register, www.trialregister.nl).

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig Flow chart of the Chlamydia Screening Implementation programme
See this image and copyright information in PMC

Comment in

References

    1. Centers for Disease Control and Prevention. Sexually transmitted diseases guidelines, 2010. MMWR 2010;59:1-114.
    1. Health Protection Agency. National chlamydia screening programme. Core requirements. 5th ed, update 2. Health Protection Agency, 2010.
    1. Dutch Health Council. Screenen op Chlamydia. [Screening for Chlamydia.] Gezondheidsraad rapport. [Health Council Report.] Dutch Health Council, 2004.
    1. UK National Screening Committee. UK screening portal. Programme appraisal criteria. 2011. www.screening.nhs.uk/cms.php?folder=2431.
    1. National Chlamydia Screening Programme. The bigger picture. The national chlamydia screening programme 2008/09 annual report. 2011. www.chlamydiascreening.nhs.uk/ps/publications/reports.html.

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