Chlamydia screening interventions from community pharmacies: a systematic review
Sajni Gudka A C , Folasade E. Afuwape A , Bessie Wong A , Xuan Li Yow A , Claire Anderson B and Rhonda M. Clifford A
+ Author Affiliations
- Author Affiliations
A School of Medicine and Pharmacology, University of Western Australia, Crawley, WA 6009, Australia.
B Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, UK.
C Corresponding author. Email: sajni.gudka@uwa.edu.au
Sexual Health 10(3) 229-239 https://doi.org/10.1071/SH12069
Submitted: 10 May 2012 Accepted: 13 January 2013 Published: 8 May 2013
Abstract
Background: Chlamydia (Chlamydia trachomatis) is the most commonly notified sexually transmissible infection in Australia. Increasing the number of people aged 16–25 years being tested for chlamydia has become a key objective. The strategy recommends that chlamydia screening sites should be easy to access. Community pharmacies are conveniently located and easily accessible. This review aimed to determine the different types of pharmacy-based chlamydia screening interventions, describe their uptake rates, and understand issues around the acceptability of and barriers to testing. Methods: Seven electronic databases were searched for peer-reviewed articles published up to 30 October 2011 for studies that reported chlamydia screening interventions from community pharmacies, or had qualitative evidence on acceptability or barriers linked with interventions. Results: Of the 163 publications identified, 12 met the inclusion criteria. Nine reported chlamydia screening interventions in a pharmacy setting, whereas three focussed on perspectives on chlamydia screening. Pharmacists could offer a chlamydia test to consumers attending the pharmacy for a sexual health-related consultation, or consumers could request a chlamydia test as part of a population-based intervention. Participating consumers said pharmacies were accessible and convenient, and pharmacists were competent when offering a chlamydia test. Pharmacists reported selectively offering tests to women they thought would be most at risk, undermining the principles of opportunistic interventions. Conclusion: Chlamydia screening from community pharmacies is feasible, and can provide an accessible, convenient venue to get a test. Professional implementation support, alongside resources, education and training programs, and incentives may overcome the issue of pharmacists selectively offering the test.
Additional keywords: acceptability, access, barriers, opportunistic screening, testing.
References
[1] European Centre for Disease Prevention and Control (ECDPC). Chlamydia control in Europe. Stockholm: ECDP; 2009. Available online at: http://ecdc.europa.eu/en/publications/Publications/0906_GUI_Chlamydia_Control_in_Europe.pdf [verified March 2013].[2] Department of Health and Ageing(DoHA). Australia’s notifiable disease status. 2010: annual report of the National Notifiable Disease Surveillance System. Canberra: DoHA; 2010.
[3] Peipert JF. Genital chlamydial infections. N Engl J Med 2003; 349 2424–30.
| Genital chlamydial infections.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3sXpvFGqur0%3D&md5=a429341a35f0b00a73f10d0afabaeb2aCAS | 14681509PubMed |
[4] Haggerty CL, Gottlieb SL, Taylor BD, Low N, Xu F, Ness RB. Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis 2010; 201 S134–55.
| Risk of sequelae after Chlamydia trachomatis genital infection in women.Crossref | GoogleScholarGoogle Scholar | 20470050PubMed |
[5] Land JA, Van Bergen JE, Morre SA, Postma MJ. Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening. Hum Reprod Update 2010; 16 189–204.
| Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3c%2FotFOksQ%3D%3D&md5=6e9d7c82f7c120b25e50122208a699f8CAS | 19828674PubMed |
[6] Risser WL, Risser JM. The incidence of pelvic inflammatory disease in untreated women infected with Chlamydia trachomatis: a structured review. Int J STD AIDS 2007; 18 727–31.
| The incidence of pelvic inflammatory disease in untreated women infected with Chlamydia trachomatis: a structured review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2snotVajtQ%3D%3D&md5=233b5c87f0040b25897a2c5fb02b0b69CAS | 18005504PubMed |
[7] Egger M, Low N, Smith GD, Lindblom B, Herrmann B. Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis. BMJ 1998; 316 1776–80.
| Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3ovVajtg%3D%3D&md5=1b4c15aec8cdfc5f31677f038414344dCAS | 9624063PubMed |
[8] Herrmann B, Egger M. Genital Chlamydia trachomatis infections in Uppsala County, Sweden, 1985–1993: declining rates for how much longer? Sex Transm Dis 1995; 22 253–60.
| Genital Chlamydia trachomatis infections in Uppsala County, Sweden, 1985–1993: declining rates for how much longer?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28%2FlvFKiug%3D%3D&md5=8e8846e93c1c4081d9c6c558fc230749CAS | 7482109PubMed |
[9] Kamwendo F, Forslin L, Bodin L, Danielsson D. Decreasing incidences of gonorrhea- and chlamydia-associated acute pelvic inflammatory disease. A 25-year study from an urban area of central Sweden. Sex Transm Dis 1996; 23 384–91.
| Decreasing incidences of gonorrhea- and chlamydia-associated acute pelvic inflammatory disease. A 25-year study from an urban area of central Sweden.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s%2FjvFGitQ%3D%3D&md5=29fa9dc1759b57a68a359a39846c4a25CAS | 8885069PubMed |
[10] LaMontagne DS, Fenton KA, Randall S, Anderson S, Carter P. Establishing the National Chlamydia Screening Programme in England: results from the first full year of screening. Sex Transm Infect 2004; 80 335–41.
| Establishing the National Chlamydia Screening Programme in England: results from the first full year of screening.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2cvptFansw%3D%3D&md5=189bce959b5d2e4942946e5553dacc07CAS | 15459399PubMed |
[11] van den Broek IV, van Bergen JE, Brouwers EE, Fennema JS, Götz HM, Hoebe CJ, et al Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation. BMJ 2012; 345 e4316
| Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation.Crossref | GoogleScholarGoogle Scholar | 22767614PubMed |
[12] Ostergaard L, Andersen B, Olesen F, Moller J. Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study. BMJ 1998; 317 26–7.
| Efficacy of home sampling for screening of Chlamydia trachomatis: randomised study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1czhs1Wqsg%3D%3D&md5=c6e5c7a758703f787bc6f0b555f4e6c4CAS | 9651263PubMed |
[13] Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 1996; 334 1362–6.
| Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK283gsVGhsA%3D%3D&md5=a4cd8f21437cca5af8eaa302d317c74bCAS | 8614421PubMed |
[14] National Chlamydia Screening Steering Group. Looking back, moving forward: Annual report of the National Chlamydia Screening Programme in England 2004/05. London: Department of Health; 2005. Available online at:http://www.chlamydiascreening.nhs.uk/ps/resources/annual-reports/NCSPa-rprt-04_05.pdf [19 April 2013].
[15] Hocking JS, Walker J, Regan D, Chen MY, Fairley CK. Chlamydia screening – Australia should strive to achieve what others have not. Med J Aust 2008; 188 106–8.
| 18205585PubMed |
[16] Harris M, Bennett J, Del Mar C, Fasher M, Foreman L, Furler J, et al. Guidelines for preventive activities in general practice. Melbourne: The Royal Australian College of General Practitioners; 2009.
[17] Australian Government Department of Health and Ageing (DoHA). Second national sexually transmissible infections strategy 2010–2013. Canberra: DoHA; 2010.
[18] Kong F, Guy R, Hocking J, Merritt T, Pirotta M, Heal C, et al Australian general practitioner chlamydia testing rates among young people. Med J Aust 2011; 194 249–52.
| 21381999PubMed |
[19] Tilson EC, Sanchez V, Ford CL, Smurzynski M, Leone PA, Fox KK, et al Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions. BMC Public Health 2004; 4 21–31.
| Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions.Crossref | GoogleScholarGoogle Scholar | 15189565PubMed |
[20] Pavlin NL, Gunn JM, Parker R, Fairley CK, Hocking J. Implementing chlamydia screening: what do women think? A systematic review of the literature. BMC Public Health 2006; 6 221–31.
| Implementing chlamydia screening: what do women think? A systematic review of the literature.Crossref | GoogleScholarGoogle Scholar | 16948838PubMed |
[21] Rose SB, Smith MC, Lawton BA. “If everyone does it, it’s not a big deal.” Young people talk about chlamydia testing. N Z Med J 2008; 121 33–42.
| 18392060PubMed |
[22] Anderson C, Blenkinsopp A. Community pharmacy supply of emergency hormonal contraception: a structured literature review of international evidence. Hum Reprod 2005; 21 272–84.
| Community pharmacy supply of emergency hormonal contraception: a structured literature review of international evidence.Crossref | GoogleScholarGoogle Scholar | 16143639PubMed |
[23] Sunderland V, Burrows S, Joyce A. A comparative evaluation of pharmacy services in single and no pharmacy towns. Aust New Zealand Health Policy 2006; 3 8–18.
| A comparative evaluation of pharmacy services in single and no pharmacy towns.Crossref | GoogleScholarGoogle Scholar | 16800871PubMed |
[24] Gudka S, Bourdin A, Watkins K, Eshgabadi A, Everrett ARC. Self-reported sexual risk factors for chlamydia: a survey of pharmacy-based emergency contraception consumers in Australia. International Pharmaceutical Federation World Centennial Congress of Pharmacy and Pharmaceutical Sciences; Oct 3–8 2012; Amsterdam, Netherlands.
[25] Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, et al The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339 b2700
| The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.Crossref | GoogleScholarGoogle Scholar | 19622552PubMed |
[26] Low N, Bender N, Nartey L, Redmond S, Shang A, Stephenson J. Revised rapid review of effectiveness – chlamydia screening. London: National Institute for Health and Clinical Excellence; 2006. Available online at: http://www.nice.org.uk/nicemedia/pdf/Chlamydia_Screening_Revised_Review_of_Effectiveness.pdf [verified August 2012].
[27] Anderson C, Thornley T. A pharmacy-based private chlamydia screening programme: results from the first 2 years of screening and treatment. Int J Clin Pharm 2011; 33 88–91.
| A pharmacy-based private chlamydia screening programme: results from the first 2 years of screening and treatment.Crossref | GoogleScholarGoogle Scholar | 21365400PubMed |
[28] Baraitser P, Pearce V, Holmes J, Horne N, Boynton PM. Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London. Qual Saf Health Care 2007; 16 303–7.
| Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2svnsFSgsQ%3D%3D&md5=bb15a51f759b32ba66c8196d3fa9ebefCAS | 17693680PubMed |
[29] Bloomfield PJ, Kent C, Campbell D, Hanbrook L, Klausner JD. Community-based chlamydia and gonorrhea screening through the United States mail, San Francisco. Sex Transm Dis 2002; 29 294–7.
| Community-based chlamydia and gonorrhea screening through the United States mail, San Francisco.Crossref | GoogleScholarGoogle Scholar | 11984447PubMed |
[30] Taylor Nelson Sofres Healthcare. Pharmacy chlamydia screening pathfinder evaluation (PCSPf). Final. London: Department of Health; 2007.
[31] Watson M. Final report: chlamydia testing in community and primary care settings. Grampian: NHS Grampian Chlamydia Study Working Group; 2008.
[32] Brabin L, Thomas G, Hopkins M, O’Brien K, Roberts SA. Delivery of chlamydia screening to young women requesting emergency hormonal contraception at pharmacies in Manchester, UK: a prospective study. BMC Womens Health 2009; 9 7
| Delivery of chlamydia screening to young women requesting emergency hormonal contraception at pharmacies in Manchester, UK: a prospective study.Crossref | GoogleScholarGoogle Scholar | 19323804PubMed |
[33] Emmerton L, Buhrer Skinner M, Gardiner E, Nissen L, Debattista J. A trial of the distribution of chlamydia self-collection postal specimen kits from Australian community pharmacies. Sex Health 2011; 8 130–2.
| A trial of the distribution of chlamydia self-collection postal specimen kits from Australian community pharmacies.Crossref | GoogleScholarGoogle Scholar | 21371398PubMed |
[34] Gudka S, Creagh A, Marshall L, Clifford R. To develop and pilot a best practice community pharmacy chlamydia screening model. Contract no. IIG-003. Canberra: Pharmacy Guild of Australia; 2009.
[35] van Bergen JEAM, Postma MJ, Peerbooms PGH, Spangenberg AC, Tjen-A-Tak J, Bindels PJE. Effectiveness and cost-effectiveness of a pharmacy-based screening programme for Chlamydia trachomatis in a high-risk health centre population in Amsterdam using mailed home-collected urine samples. Int J STD AIDS 2004; 15 797–802.
| Effectiveness and cost-effectiveness of a pharmacy-based screening programme for Chlamydia trachomatis in a high-risk health centre population in Amsterdam using mailed home-collected urine samples.Crossref | GoogleScholarGoogle Scholar |
[36] Taylor KL, Clifford RM, Marshall L. Acceptance of a chlamydia screening program in community pharmacies. J Pharm Pract Res 2007; 37 287–91.
[37] Dabrera G, Pinson D, Whiteman S. Chlamydia screening by community pharmacists: a qualitative study. J Fam Plann Reprod Health Care 2011; 37 17–21.
| Chlamydia screening by community pharmacists: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 21367698PubMed |
[38] Thomas G, Humphris G, Ozakinci G, O’Brien K, Roberts SA, Hopkins M, et al A qualitative study of pharmacists’ views on offering chlamydia screening to women requesting emergency hormonal contraception. BJOG 2010; 117 109–13.
| A qualitative study of pharmacists’ views on offering chlamydia screening to women requesting emergency hormonal contraception.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1Mfhs1yrtw%3D%3D&md5=cad9f91304ca3ec54fa35d75299f0206CAS | 19775305PubMed |
[39] Department of Health and Ageing(DoHA). First national sexually transmissible infections strategy, 2005–2008. Canberra: DoHA; 2005.
