School-Based Screening Strategies for Chlamydia

This project extends our previously developed model of heterosexual transmission of chlamydia to evaluate the impact and cost-effectiveness of school-based screening for chlamydia in a community setting.

Chlamydia diagnosis rates are highest among people under the age of 25. A significant percentage of this population is school-aged children currently enrolled in educational facilities. These schools offer a structured setting for targeted interventions intended to reduce chlamydia prevalence. Screening is provided as part of these interventions, targeting communities with a high burden of infection. Research into the success of such school-based screening programs found variation in their potential impact (Jamil et al., 2014). Several pilot programs have failed to demonstrate a stable reduction in chlamydia prevalence in the intervention schools (Nsuami et al. 2013) (Salmon 2012). Factors limiting the potential impact are thought to include the mixing of students between intervention and non-intervention schools as well as yearly variation in school participation and parental consent (Nsuami et al. 2013).

Our analysis will explore the potential impact further by modeling a range of intervention strategies in urban settings characterized by varying profiles and pre-existing levels of chlamydia screening in public high schools.

Our major research questions include:

  • How should the school-based screening be targeted (frequency of testing, repeat testing, required coverage, targeting one or both sexes, impact of intervention alone whilst removing community-wide testing for the age group) to maximize impact?
  • What coverage is required at school-based screening programs before substantial impact is observed at community level?
  • What are the trade-offs between existing community-wide screening policies and school-based screening programs in terms of achieving reduction in chlamydia prevalence, resource allocation and targeting at risk groups?
  • What are the defining characteristics of the urban settings included in the analyses that affect the effectiveness of school-based screening program?
  • What are the areas of greatest uncertainty in implementing school-based screening program in practice as indicated by the model analyses and by published literature?
  • What are the associated costs of such programs?

References:

  1. Jamil, M.S. et al., 2014. Chlamydia Screening Strategies and Outcomes in Educational Settings : A Systematic Review. Sexually Transmitted Diseses, 41(3), pp.180–187.
  2. Nsuami, M.J. et al., 2013. Chlamydia positivity in New Orleans public high schools, 1996-2005: implications for clinical and public health practices. Academic pediatrics, 13(4), pp.308–15.
  3. Salmon, M., 2012. The More You Look, the More You Find – Results From the Philadelphia High School STD Screening Program, 2002-2011. In 2012 National STD Prevention Conference. CDC