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Chlamydia policy alert

Chlamydia screening is likely to widen health inequalities without action to increase uptake rates, an NHS evaluation concludes.

The report ratcheted up the pressure on the Department of Health to pay GPs for their involvement after advising use of practice registers and nurse-led partner notification.

The department admitted the involvement of GPs 'will be crucial to the success of the screening programme' – but stopped short of promising extra funding for sexual health.

But the study, to be circulated to PCTs as a Health Technology Assessment, warned the current opportunistic programme might not be enough to achieve satisfactory uptakes.

Researchers recommended a 'mixed model' be evaluated that targeted some patients actively, after finding active screening achieved relatively high uptake of 30 to 40 per cent but was not cost-effective.

Study leader Dr Nicola Low, a senior lecturer in epidemiology and public health at the University of Bern in Switzerland, told Pulse: 'With opportunistic screening there's a recommendation people who test positive should be retested every year. One way to make this happen is to use practice registers. Another of the clear messages was that partner notification can be done at least as well in primary care as in a GUM clinic.'

But Dr Low warned chlamydia screening 'has the potential to increase inequalities in sexual health', with high-risk women the hardest to engage in screening and uptake of invitations lower in deprived areas. She called on the Government to address the issue.

Dr Richard Ma, a member of the NICE guideline development group on preventing STIs in under-18s, said the concern was 'absolutely right', and that targeting people who might be missed was a real challenge that would need innovative solutions.

Dr Ma, a GP in Islington, north London, added that practice registers were the only routinely available data that could allow a systematic and proactive approach to chlamydia screening.

He agreed with Dr Low that offering GPs financial incentives would also contribute to improving uptake rates.

Screening evaluation findings

• General practice is 'best setting for opportunistic screening'

• Men must be targeted more intensively as 'their prevalence is same as women's'

• Practice registers could be used by central chlamydia screening offices to optimise process

• Mixed models should be evaluated to see if they give higher uptake than opportunistic or active screening alone

• Chlamydia screening could increase inequalities in health

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