Chlamydia Screening in Ireland: a pilot study of opportunistic screening for genital Chlamydia trachomatis infection in Ireland (2007-2009). Pre-screening Report
A series of background studies in 18 to 29 year olds were conducted in a range of primary care settings in Dublin and Galway, 2007-09, to assess the acceptability and feasibility of opportunistic screening for chlamydia:
- semi-structured interviews with 35 women who had never been tested for a sexually transmitted infection (STI)
- similar interviews with 30 men and women who had had a STI test
- a questionnaire survey of 5685 students and 400 primary care patients
- four focus group discussions with university students
- semi-structured interviews with eight doctors and 10 practice nurses.
The most important barrier to seeking or taking a STI test was the stigma young Irish men and women associated with chlamydia and other STIs, and the fear of being seen doing this. This fear was greater among young women.
Young people, especially women, were aware that chlamydia infection was often asymptomatic and were conscious of the danger of complications such as infertility and the consequences of transmitting chlamydia to other women.
Factors that would encourage acceptance of a chlamydia screening test, which were common to women and men, were:
- normalising STI testing, by portraying it as a responsible practice that adults should engage in
- not being asked questions by staff about their sexual history
- being offered screening by younger non-judgmental female healthcare professionals
- being offered screening in private or general health care settings, where others would not be aware that they were getting an STI test
There was a high level of acceptance of chlamydia screening among young people: 95% said it would be acceptable to be offered a test, and 90% of health facility attendees and 75% of students said they would accept a test if offered.
The most acceptable setting for chlamydia screening was a General Practice where respondents were most comfortable with being offered screening by a doctor or nurse. Other primary care settings were also acceptable, whereas pharmacies were not because they were seen as public settings.
80% said they would inform their current partner if they tested positive for chlamydia, though this fell to 55-60% in the case of previous partners.
Health care providers (doctors and nurses) viewed chlamydia screening as a priority, because young people are sexually active and are at high risk because of alcohol. Providers anticipated high chlamydia test offers and uptake rates.
Providers viewed chlamydia testing as a core activity to undertake in primary care, but they would need support for partner notification and easy access to laboratory tests, especially urine-based ones.
Most 18-29 year old men and women would respond positively if offered a test for chlamydia, when attending a health care facility for other reasons. They recognise the risks and the importance of their sexual contacts being tested, if they themselves test positive for chlamydia. However, sexual health services in Ireland need to minimise stigma and ensure the confidentiality and acceptability of STI testing of young people.