Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
Sex Transm Dis. 2012 Feb;39(2):97-103. doi: 10.1097/OLQ.0b013e3182383097.
In the Netherlands, an Internet-based Chlamydia Screening Implementation was initiated in 3 regions, aiming to reduce population prevalence by annual testing and treatment of people aged 16 to 29 years. We studied who was reached in the first screening round by relating participation and chlamydia positivity to sociodemographic and sexual risk factors.
Data from the 2008/2009 screening round were analyzed (261,025 screening invitations, 41,638 participants). Participation rates were adjusted for the sexually active population. Sociodemographic and behavioral correlates of screening participation and positivity were studied by (multilevel) logistic regression models.
The overall adjusted participation rate in the first screening round was 19.5% (95% confidence interval, 19.4-19.7) among sexually active people (women, 25%; men, 13%). Sociodemographic factors associated with lower participation were male gender (odds ratio [OR], male 1 vs. female 1.8), young age (OR, 16-19 1 vs. older groups 1.7-2.1), non-Dutch origin (OR between 0.7-0.9), lower education (OR, low 1 vs. high 1.4), high community risk level (0.8), and low socioeconomic status (0.9). Behavioral factors associated with lower participation were a long-standing relationship (0.7) and no reported history or symptoms of sexually transmitted infections (no symptoms, 0.4-0.6) . Factors most strongly related to higher Ct positivity were young age (OR, 1 vs. older groups 0.5-0.8), non-Dutch origin (1.4-2.8), non-Dutch steady partner (1.9-2.7), residence in a high-risk area (1.4-1.5), lower education (high, 0.3-0.5), and a history or symptoms of sexually transmitted infection (no symptoms, 0.4-0.6).
Sociodemographic factors associated with lower participation were also associated with higher Ct positivity, showing that high-risk demographic groups are more difficult to mobilize than low-risk groups. Independent of this, higher behavioral risk levels were associated with higher participation rates, suggesting self-selection for screening based on the persons' risk (perception) in both low- and high community risk groups. Our study shows the complexity of the process, including individual and community factors that also interact, when screening for chlamydia.
在荷兰，启动了一个基于互联网的衣原体筛查实施计划，旨在通过对 16 至 29 岁人群的年度检测和治疗，降低人群流行率。我们通过将参与度和衣原体阳性率与社会人口统计学和性风险因素相关联，研究了第一轮筛查中哪些人被涵盖。
对 2008/2009 年筛查轮次的数据进行了分析（261025 份筛查邀请，41638 名参与者）。调整了活跃性行为人群的参与率。通过（多层次）逻辑回归模型研究了筛查参与和阳性的社会人口学和行为相关性。
在活跃性行为人群中，第一轮筛查的总体调整后参与率为 19.5%（95%置信区间，19.4-19.7）（女性 25%，男性 13%）。与较低参与度相关的社会人口学因素包括男性性别（比值比[OR]，男性 1 比女性 1.8）、年轻（OR，16-19 岁 1 比年龄较大的组 1.7-2.1）、非荷兰血统（OR 为 0.7-0.9）、低教育水平（OR，低 1 比高 1.4）、社区风险水平高（OR 为 0.8）和社会经济地位低（OR 为 0.9）。与较低参与度相关的行为因素包括长期关系（OR 为 0.7）和没有报告性传播感染的既往史或症状（无症状 0.4-0.6）。与 Ct 阳性率较高相关性最强的因素包括年轻（OR，1 比年龄较大的组 0.5-0.8）、非荷兰血统（1.4-2.8）、非荷兰稳定伴侣（1.9-2.7）、居住在高危地区（1.4-1.5）、教育程度低（高 0.3-0.5）和性传播感染史或症状（无症状 0.4-0.6）。
与较低参与度相关的社会人口学因素也与较高的 Ct 阳性率相关，这表明高风险人群比低风险人群更难以动员。除此之外，较高的行为风险水平与较高的参与率相关，这表明在低社区风险和高社区风险群体中，筛查的基础是个人的风险（认知）。我们的研究表明，在筛查衣原体时，包括个体和社区因素相互作用的过程非常复杂。
