From the *Rush University Medical Center, Chicago, IL; †John H Stroger Hospital/Cook County Health and Hospital Systems, Chicago Center for AIDS Research, Chicago, IL; and ‡Cermak Health Services, Cook County Jail, Chicago, IL.
Sex Transm Dis. 2014 Mar;41(3):161-5. doi: 10.1097/OLQ.0000000000000106.
In April of 2011, the Cook County Jail initiated opt-out screening of all women for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) at the time of intake. In this retrospective review, we assess the impact of opt-out protocol on rates of testing, diagnoses, and successful treatment.
We collected the results of all CT and GC tests ordered during intake from April 2011 through December 2012 and reviewed the medical chart of every patient with a positive result for documentation of treatment. Univariable and multivariable analyses were performed to examine the factors associated with receipt of treatment.
Opt-out screening increased the number of diagnoses by more than 4-fold (from 9.3 to 40.8 cases/mo). Among 17,065 women eligible for screening, 3729 (22%) women opted out of screening, and screening was completed in 9265 (54.2%). There were 235 (2.5%) gonococcal infections and 702 (7.6%) chlamydial infections. Of 866 women with a positive test result, 602 (69.5%) received treatment while in jail. In multivariable analysis, older age (adjusted odds ratio [aOR], 1.73; 95% confidence interval [CI], 1.14-2.63), pregnancy (aOR, 2.51; 95% CI, 1.22-5.18), and longer length of stay in jail (aOR, 18.1; 95% CI, 11.7-28.1) were associated with greater likelihood of treatment.
Women entering the Cook County Jail have high prevalence of GC/CT infections. Opt-out screening increased the number of GC and CT diagnoses made, and a high proportion of women were treated while incarcerated. Significant challenges remain in ensuring that screening is completed for all women who do not opt out and in providing treatment to women with short duration of incarceration.
2011 年 4 月，库克县监狱开始在入监时对所有女性进行沙眼衣原体（CT）和淋病奈瑟菌（GC）的选择性筛查。在这项回顾性研究中，我们评估了选择性筛查方案对检测率、诊断率和治疗成功率的影响。
我们收集了 2011 年 4 月至 2012 年 12 月期间所有入监时进行的 CT 和 GC 检测结果，并查阅了所有阳性检测结果患者的病历，以了解治疗情况。我们进行了单变量和多变量分析，以研究与治疗相关的因素。
选择性筛查使诊断数量增加了 4 倍以上（从 9.3 例/月增加到 40.8 例/月）。在 17065 名符合筛查条件的女性中，有 3729 名（22%）女性选择不接受筛查，9265 名（54.2%）女性完成了筛查。共发现 235 例淋球菌感染和 702 例衣原体感染。在 866 例检测结果阳性的女性中，有 602 名（69.5%）在监狱中接受了治疗。多变量分析显示，年龄较大（调整后的优势比 [aOR]，1.73；95%置信区间 [CI]，1.14-2.63）、怀孕（aOR，2.51；95% CI，1.22-5.18）和入狱时间较长（aOR，18.1；95% CI，11.7-28.1）与更有可能接受治疗有关。
进入库克县监狱的女性淋病奈瑟菌/沙眼衣原体感染率较高。选择性筛查增加了淋病奈瑟菌和沙眼衣原体的诊断数量，并且很大一部分女性在监禁期间接受了治疗。仍然存在重大挑战，需要确保对所有未选择筛查的女性完成筛查，并为监禁时间较短的女性提供治疗。
