ROYAL PERTH HOSPITAL EMERGENCY DEPARTMENT SCREENING PROJECT FOR CHLAMYDIA TRACHOMATIS

Background Western Australian (WA) rates of Chlamydia are consistently higher than the national average and continue to rise. Chlamydia screening programs often miss hard-to-reach populations, including young men, indigenous peoples, and the homeless. The objective of this pilot study was to determine if screening patients for genital Chlamydia in the Emergency Department (ED) of a large metropolitan hospital is: feasible, able to access the hard-to-reach populations, and follow-up for treatment is possible Methodology Urinary screening for Chlamydia was offered to asymptomatic people aged 18–25 years who attended the Royal Perth Hospital (RPH) including visitors. Recruitment via a nurse-led strategy was compared to a patient self-initiated strategy. A resource package (including brochure and DVD) was designed to facilitate recruitment and screening, as well as to provide information on Chlamydia to those choosing not to participate. Options for notifying patients of their results have been evaluated (including text messaging and e-mail). Statistical analysis was performed using SAS. Results 823 people (male 532, female 291, aboriginal 58) were recruited. Of these 10% were homeless and 35% had moved residences in the last 3 months. The indigenous population of 7.1% was greater than that of the State (1.9% 2006 Census). The recruited asymptomatic population had a Chlamydia prevalence of 5.4%. When the nurse-led vs patient self-initiated strategies were compared there was a 23.8 to 1 ratio of recruitment. Conclusions This study was able to access the hard-to-reach population. The nurse-led recruitment was the most successful strategy to gain access to this group. This cohort engaged in many risk taking behaviours including higher than expected rates of current smoking (45.7%), binge drinking (72.1% male and 42.8% female), never using condoms (26.3%) and recreational drug use (62.4% ever). Most people preferred to get their results by mobile phone (54.1%). This was a feasible ED screening method with respect to notification success. Less than 7% of this hard-to-reach population with Chlamydia could not be informed of their infection. A quarter of the cases of Chlamydia required augmented efforts to notify them of their infection. The analysis of the data indicates that for every day there is a delay in attempting contact there is a 7.7 times increased chance of not having a successful contact.