Evaluation of the leukocyte esterase test (LET) as pre-screening test to reduce costs for national population-based Chlamydia trachomatis screening programs.
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Biological Assay↗
Biomedical subjects
D T van Schaik
Publications and source records attributed to D T van Schaik.
Lessons learned from a population-based chlamydia screening pilot.
We evaluated process organization and response optimization in a home-based Chlamydia trachomatis (Ct) screening project in the Netherlands among 15- to 29-year-old women and men. The method used was computer-supported data flow, from population sampling to informing participants of the result. A new test kit or a letter reminded non-respondents after six weeks. Fifteen-year olds required parental consent. Urine arrived at the laboratory within 29 days from invitation, and four (1-11) days after collection, indicating good specimen quality. Test kits had a higher response than letters (15 versus 10%). Response in 15-year olds was 33%; with 2% Ct infected sexually active 15 year olds. In Conclusion, purpose made computer software is essential for an efficient screening programme. Sending urine by mail does not impair diagnostics. Reminders are necessary and effective after four weeks. Necessary parental consent for under 16-year olds should not be a deterrent to offer Ct screening to this age group.
Adolescent↗
Acceptability and consequences of screening for chlamydia trachomatis by home-based urine testing.
OBJECTIVE: The objective of this study was to study the acceptability and consequences of home-based chlamydia (CT) screening by Municipal Health Services (MHS) among 15- to 29-year-old participants. STUDY: This study consisted of a cross-section of 156 CT-positives and 600 random sampled CT-negatives after receiving the result of their CT test. RESULTS: Thirty-eight percent of the men and 59% of the women responded. The screening method was well-accepted. Seventy percent (52) of the CT-positives were surprised about their result. Infected women more often than men reported a feeling of being dirty and of anxiety about infertility. Curiosity for the CT result was decisive for participation in 68% and perception of personal risk was poor. The willingness to be tested regularly was determined by present chlamydial infection, young age, multiple lifetime partners, short relationship, and earlier test for chlamydia. CONCLUSIONS: Chlamydia screening organised by MHS is acceptable for future screening. Participants with an elevated risk are interested in screening as long as test kits are easily available. Counseling with focus on effects of CT, especially on women, is essential. Alternative approaches are needed to motivate men and non-Dutch high-risk groups.
Adolescent↗
A prediction rule for selective screening of Chlamydia trachomatis infection.
BACKGROUND: Screening for Chlamydia trachomatis infections is aimed at the reduction of these infections and subsequent complications. Selective screening may increase the cost effectiveness of a screening programme. Few population based systematic screening programmes have been carried out and attempts to validate selective screening criteria have shown poor performance. This study describes the development of a prediction rule for estimating the risk of chlamydial infection as a basis for selective screening. METHODS: A population based chlamydia screening study was performed in the Netherlands by inviting 21,000 15-29 year old women and men in urban and rural areas for home based urine testing. Multivariable logistic regression was used to identify risk factors for chlamydial infection among 6303 sexually active participants, and the discriminative ability was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with bootstrap resampling techniques. RESULTS: The prevalence of C trachomatis (CT) infection was 2.6% (95% CI 2.2 to 3.2) in women and 2.0% (95% CI 1.4 to 2.7) in men. Chlamydial infection was associated with high level of urbanisation, young age, Surinam/Antillian ethnicity, low/intermediate education, multiple lifetime partners, a new contact in the previous two months, no condom use at last sexual contact, and complaints of (post)coital bleeding in women and frequent urination in men. A prediction model with these risk factors showed adequate discriminative ability at internal validation (AUC 0.78). CONCLUSION: The prediction rule has the potential to guide individuals in their choice of participation when offered chlamydia screening and is a promising tool for selective CT screening at population level.
Adolescent↗