Original research article

Get Yourself Tested 2011–2012: Findings and prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae at an urban public health system

International Journal of STD & AIDS 2015, Vol. 26(5) 322–328 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0956462414536541 std.sagepub.com

Alicia Roston1, Katie Suleta1,2, Kelly Stempinski1, Louis Keith1,3 and Ashlesha Patel1,3

Abstract During April 2011 and April 2012 the Get Yourself Tested campaign was launched throughout the Cook County Health and Hospitals System to promote testing of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) among 15–25year-olds in a high-prevalence urban community. Retrospective data were collected and analysed. Demographic differences by CT and GC positivity were evaluated along with factors associated with CT and GC status. A total of 2853 tests were conducted among individuals aged 15–25 years. A total of 2060 (72%) females and 793 (28%) males were tested. Of those tested, 488 (17%) individuals tested positive for either CT or GC or both; 400 (14%) were positive for CT, 139 (5%) were positive for GC. The prevalence for GC was 8.8% (n ¼ 70) in males compared to 3.3% (n ¼ 69) in females (p < 0.001) and the prevalence of CT was 16% (n ¼ 127) for males compared to 13.3% (n ¼ 273) for females (p ¼ 0.057). Women in a high-risk population are more likely to get tested for sexually transmitted infections; however, men are more likely to test positive for CT and GC. Get Yourself Tested is an important campaign to encourage wider spread testing among populations at risk in Cook County.

Keywords Sexually transmitted infections, STIs, Chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae), North America, epidemiology, screening, young people Date received: 6 January 2014; accepted: 21 April 2014

Introduction Approximately 20 million new cases of sexually transmitted infections (STIs) are diagnosed annually in the United States. Most occur among young people aged 15–24 years.1 The annual cost of diagnosis and treatment of STIs is estimated at $16 billion.1,2 Chlamydia trachomatis (CT) is the most commonly reported STI with over 1.4 million cases recorded nationally in 2012 (456.7 per 100,000).3 The second most commonly reported STI is Neisseria gonorrhoeae (GC) with 334,826 cases (107.5 per 100,000) reported in the United States in 2012.3 In Illinois in 2012, 67,701 cases (526.1 per 100,000) of CT and 18,149 cases (141.0 per 100,000) of GC were reported and are well above the national averages.3 Cook County had the second highest number of CT cases with 37,946 (727.3

per 100,000) and the highest number of GC cases with 12,042 (230.8 per 100,000) in 2012.3 The US Centers for Disease Control and Prevention (CDC) recommends that all sexually active women younger than the age of 26 receive annual CT and 1 Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA 2 School of Public Health, University of Illinois at Chicago, Chicago, IL, USA 3 Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

Corresponding author: Ashlesha Patel, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, 1900 W Polk, 5th Floor, Chicago, IL 60612, USA. Email: [email protected]

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GC testing in an attempt to prevent sequelae from infection such as pelvic inflammatory disease (PID) which may contribute to additional reproductive complications, including tubal scarring, ectopic pregnancy or infertility.3 Routine screening for males is not currently recommended, although both the CDC and the US Preventative Services Task Force acknowledge that screening adolescent males should be considered in high-prevalence settings (STI clinics, detention centres and adolescent clinics).4 Despite these recommendations, nationally, only 49.2% of sexually active women aged 16–24 with insurance were screened for chlamydia in 2012.5 In Illinois, 41.4% of sexually active women 16–24 were screened for chlamydia in 2012, up from 19.4% in 2002.5 These statistics do not include uninsured women who may be less likely to access care. In 2009, the Get Yourself Tested (GYT) campaign was created as a collaboration between Planned Parenthood Federation of America, CDC, MTV, Kaiser Family Foundation and other partners in an attempt to improve these low screening rates.6 The programme’s goal is to improve screening for STIs among young adults (25 and under) by increasing public awareness and decreasing stigma associated with screening in this high-risk population.6 The Cook County Health and Hospitals System (CCHHS) and the Division of Family Planning implemented a system-wide GYT programme in April of 2011 and again in April of 2012. The objective of this study was to describe the findings from the GYT campaigns in 2011 and 2012.

Methods In response to the disproportionately high prevalence of STIs in adolescents and young adults the GYT campaign was developed. Campaign messages were developed through research conducted by national collaborating partners using key constructs of the Health Belief Model and the Theory of Planned Behavior.7–9 The national campaign was publicised by MTV, Planned Parenthood Federation of America and throughout 5000 health centres across the nation.10 CCHHS implemented the GYT campaign in April 2011 and April 2012. GYT banners and posters were hung throughout CCHHS hospitals and clinics to increase patient awareness surrounding CT and GC testing and remind providers to test for STIs. The campaign was also publicised on WGCI, Chicago’s Hip Hop and R&B radio station. CCHHS is an urban public healthcare system comprising hospitals, community health clinics, STI clinics, correctional facilities and the Cook County Department of Public Health. The mission of

CCHHS is to promote physical and mental health to residents of Cook County and to provide healthcare services regardless of an individual’s ability to pay.11 Facilities are located throughout suburban Cook County and the city of Chicago. CT and GC status was determined using the BD ProbeTecTM CT/GC Qx Amplified DNA Assay (Becton, Dickinson & Company, Sparks, MD, USA). Urine specimens were collected for 77.5% of tests in males, while the remaining 22.5% were urethral swabs. In females, half of all specimens were urine and half were cervical swabs. Patients were contacted via each clinic’s standard of care and asked to return for treatment. Information on whether the patient was able to be contacted and if they returned for treatment was not available for this study. Hospital information systems queried age, race, gender, test date, type of specimen tested and test result for all patients who received a CT and GC test in April 2011 and April 2012. Information was limited to individuals aged 15–25. This study is a retrospective analysis assessing the prevalence of CT and GC among 15–25-year-olds tested during the GYT programmes in April 2011 and April 2012. Additionally, the prevalence of CT and GC diagnosed during GYT were compared with data collected during the same month in 2010. During the months of April 2011 and April 2012 a public relations campaign was launched throughout the CCHHS system to promote testing for all STIs. This study was approved by the CCHHS Institutional Review Board. Statistical analysis was performed in SAS 9.2 (SAS Institute, Inc. Cary, NC, USA). Chi square tests were used to evaluate demographic (age, race and gender) differences by CT and GC positivity. Univariate and multivariate prevalence rate ratios were used to determine factors associated with CT and GC positivity. Multivariate analysis included all demographic variables and test year. All p value calculations were two-tailed, and an alpha level of 0.05 was considered statistically significant.

Results A total of 2853 tests were conducted among individuals of 15–25 years in April of 2011 (1385) and 2012 (1468). This represents a 36% and 44% increase, respectively, from April 2010 when 1019 tests were performed. Of the tests performed in 2011 and 2012, 2060 (72%) were performed on females and 793 (28%) were performed on males. Seventy-six percent of the young adults tested self-identified as black, followed by 14% white, and 10% Hispanic or other. Mean age was 21.2 years (standard deviation 2.5 years), and individuals younger than 20 accounted for less than 25% (726/2853) of all individuals tested. In total, 488 individuals tested

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International Journal of STD & AIDS 26(5)

positive for either CT or GC or both, with 400 (14%) positive for CT, 139 (5%) positive for GC. Approximately one quarter of all individuals tested were males. The majority of individuals were Black/ African American (75.9%) and between the ages of 20–25. Demographics did not significantly differ by year (Table 1). Table 2 shows the distribution of demographic factors by CT status. Although more women were tested than men, the prevalence of CT and GC were higher for males than females. The prevalence of CT among males in 2011 and 2012 was 15.7 and 16.3 per 100 population, respectively, compared to 11.7 and 14.7 per 100 population in females (2011 p ¼ 0.051; 2012 p ¼ 0.446). In 2011, the prevalence of CT was significantly higher among individuals aged 15–19

(18.2 per 100 population) compared to those 20–25 (10.9 per 100 population) (p < 0.001). In 2012 there was a similar trend in the prevalence of CT; however, this was not statistically significant (17.1 vs. 14.5 per 100 population, p ¼ 0.230). In 2011, CT status differed significantly by race. The prevalence of CT was 14.6 per 100 population among those who identified as Black compared to 8.3 per 100 population in White individuals and 6.2 per 100 population in individuals who indicated other as their race (p ¼ 0.002). In 2012, the prevalence of CT was again highest among Blacks (16.3 per 100 population); however, this was not statistically significant as the prevalence was 9.9 per 100 population in Whites and 13.8 per 100 population in those in the other race category (p ¼ 0.067).

Table 1. Distribution of demographics by year. 2011

2012

n Gender Male Female Age (years) 15–19 20–25 Ethnicity White Black Other

%

Total

n

%

n

%

p value 0.211

370 1015

26.7 73.3

423 1045

28.8 71.2

793 2060

27.8 72.2

352 1033

25.4 74.6

374 1094

25.5 74.5

726 2127

25.5 74.6

206 1034 145

14.9 74.7 10.5

192 1131 145

13.1 77.0 9.9

398 2165 290

14.0 75.9 10.2

0.970

0.297

Table 2. Demographic factors by CT status by year. 2011 (n ¼ 1385)

2012 (n ¼ 1468)

CT positive

Gender Male Female Age 15–19 20–25 Ethnicity White Black Other

CT negative a

n

Prevalence

15.7 11.7

312 896

84.3 88.3

18.2 10.9

288 920

81.8 89.1

n

Prevalence

58 119 64 113

CT positive a

p value

CT negative n

Prevalencea

16.3 14.7

354 891

83.7 85.3

17.1 14.5

310 935

82.9 85.5

n

Prevalence

69 154 64 159

a

0.051

0.446

Get Yourself Tested 2011-2012: findings and prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae at an urban public health system.

During April 2011 and April 2012 the Get Yourself Tested campaign was launched throughout the Cook County Health and Hospitals System to promote testi...
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