Opportunistic chlamydia screening evidence lacking
Mark Thomas/Science Photo Library
Community pharmacists can target young people for chlamydia screening
when they access other services |
There is little evidence to support opportunistic chlamydia screening, as offered by the national chlamydia screening programme in England, it is argued in last week’s BMJ (2007;334:725 and 2007;334:703).
However, the National Pharmacy Association believes there is room for
both an opportunistic
and a proactive (invited) approach to chlamydia screening.
Nicola Low, reader in epidemiology and public health at the University
of Bern, Switzerland, claims that acceptance of the effectiveness of
chlamydia screening programmes in Sweden and the US led to support for
funding of the national chlamydia screening programme in England before
the balance of benefits and harms was thoroughly understood.
Dr Low notes that opportunistic screening is widely assumed to be the
only acceptable model of service delivery for chlamydia. In England,
she says, the coverage of opportunistic screening was deemed adequate
before alternatives had been investigated. “The assumption about
coverage was based on high acceptance once chlamydia screening had been
offered. However, not everyone uses the services that provide testing,
and not everyone who uses those services is offered a test.” She
adds that subsequent research has shown that effective screening rates
are 30–40 per cent for both proactive and opportunistic approaches
and costs per screening invitation are similar.
Commenting on the article, Neal Patel, head of communications at the
NPA, said that there is evidence that shows attendance at sexual health
screening clinics is falling. For example, data from the NHS cancer screening
programme indicate that the number of women aged 25 to 29 years who attended
a smear appointment last year was down to 69 per cent, compared with
79 per cent 10 years ago.
“Although the reasons for this are not clear, this trend could
also apply to a recall-based chlamydia screening programme, so other
methods, such
as opportunistic screening, may be better placed to achieve a greater
number of tests in the target group — people under 25,” he
said. Community pharmacy is ideally placed to offer this screening, since
pharmacies are open at convenient times and can target people who are
not registered with a GP or are away from home, he added.
The NPA also believes the burden of treating those diagnosed with chlamydia
could be removed from genito-urinary medicine clinics by commissioning
community pharmacy to provide a treatment service.
|
The
Pharmaceutical Journal
Acrobat
Reader