Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, P.O. Box 1 (nr 75), BA 3720, The Netherlands.
Sex Transm Infect. 2012 Apr;88(3):205-11. doi: 10.1136/sextrans-2011-050219. Epub 2012 Jan 3.
Systematic screening for Chlamydia trachomatis by individual invitation can be optimised by filtering participants on risk profile, excluding people at no or low risk. The authors investigated this technique in a large-scale chlamydia screening programme in The Netherlands in one rural region where relatively low prevalence was expected (<2%).
Invitees were alerted by personal letter to log in to http://www.chlamydiatest.nl and fill in an 8-item questionnaire. Only invitees with sufficient score could proceed to request a test kit. The authors investigated the effect of selection on participation, positivity and acceptability in three screening rounds and on the number needed to invite and the number needed to screen.
The selection led to exclusion of 36% of potential participants and a positivity rate of 4.8% among participants, achieving similar number needed to screen values in the rural and urban areas. Higher scores were clearly related to higher positivity rates. Persons who were excluded from participation did not have a lower response in the next round. The acceptability study revealed disappointment about exclusion of 30% of excluded participants but most approved of the screening set-up.
Systematic selection of screening participants by risk score is feasible and successful in realising higher positivity rates. A somewhat stricter selection could be applied in the rural and urban areas of the screening programme. Multiple-item selection with a cut-off total score may work better than, more commonly used, selection by single criteria, especially in low-risk populations. Acceptability of selection is high but could still be improved by better communication on expectations.
通过个人邀请对沙眼衣原体进行系统筛查，可以通过对风险状况进行筛选来优化参与者的筛选，从而排除无风险或低风险人群。作者在荷兰一个农村地区进行了一项大规模的衣原体筛查项目中对此技术进行了研究，该地区预计（<2%）的患病率相对较低。
邀请者通过个人信件提醒登录 http://www.chlamydiatest.nl 并填写 8 项问卷。只有得分足够高的邀请者才能继续要求测试套件。作者在三个筛查轮次中研究了选择对参与度、阳性率和可接受性的影响，以及邀请人数和筛查人数的影响。
选择导致 36%的潜在参与者被排除在外，参与者的阳性率为 4.8%，在农村和城市地区实现了相似的筛查人数值。较高的分数显然与较高的阳性率有关。被排除参与的人在下一轮的反应并没有降低。可接受性研究显示，30%的被排除参与者感到失望，但大多数人对筛查方案表示认可。
通过风险评分对筛查参与者进行系统选择是可行且成功的，可以实现更高的阳性率。在筛查项目的农村和城市地区，可以采用更严格的选择标准。与更常用的单一标准选择相比，使用总分作为多项目选择的截止值可能效果更好，尤其是在低风险人群中。选择的可接受性很高，但通过更好地沟通期望，可以进一步提高。
