[Promoting primary care screening for Chlamydia trachomatis infection]

Abstract

Background: Lower urogenital tract Chlamydia trachomatis (Ct) infection is the most common bacterial sexually transmitted infection in Europe, especially among young people with multiple partners. Often asymptomatic, its spread and severity are due to delayed diagnosis, highlighting the need for early detection.Objective: Implementation and evaluation of a complex intervention targeting GPs in the Alpes-Maritimes (06) promoting opportunistic screening of Ct infection in young patients.Method: Academic detailing visits provided 105 randomized GPs with tools and patient self-testing kits to include 10 patients over a 6-month period followed by a quantitative (prescribed screenings / reimbursed screenings among visited GPs and all GPs in the Alpes-Maritimes compared to the previous year) and a qualitative assessment (post-interventional interviews with GPs and trainers).Results: In the context of a global increase in screening between the 2013 and 2014 seasons (+15%), the intervention resulted in a significantly higher rate (73%), p = 0.02. Screening was performed in 73 (48%) patients and 12 were PCR-positive. Qualitative analysis of post-interventional interviews with GPs and a focus group of AD visitors highlighted facilitating factors and obstacles to screening. Conclusion: Our intervention, appreciated by the visited GPs, demonstrates its potential impact and feasibility in primary care. GPs used facilitating factors to overcome the identified obstacles. To sustain this intervention, evaluated tools will be available on line to help GPs promote Ct screening as well as for sexual health training targeting GPs.

Keywords: Chlamydia trachomatis; screening; ambulatory care; training; youth.