Increasing Chlamydia Screening through Collaborative Learning

Chlamydia is the most commonly reported notifiable condition in the United States, and it disproportionately affects young women and women of color. Chlamydia is usually asymptomatic, and when left untreated can cause pelvic inflammatory disease, infertility, and ectopic pregnancy. When identified, it can be easily treated with antibiotics. But since annual screening of sexually active women under 25 years of age was recommended 20 years ago, screening rates have remained relatively flat.

Between 2016 and 2019, JSI facilitated three cohorts of learning collaboratives involving 37 family planning organizations. This effort, intended to increase chlamydia screening, was funded by the Office of Population Affairs in the Department of Health and Human Services, the New York State Department of Health, and Planned Parenthood Federation of America. 

The learning collaboratives focused on the improvement of a monthly chlamydia screening measure (screening of sexually active women 16–24 years). The foundation of the learning collaboratives was the Chlamydia Screening Change Package, a document developed by JSI that summarizes evidence-based recommended practices for increasing chlamydia screening. Learning collaborative teams implemented this standard set of recommended practices, attended virtual learning sessions, reported progress and chlamydia screening data monthly, and provided qualitative feedback in an online endpoint assessment. 

Median screening rates increased 22%, 24%, and 11% in the three collaboratives and, where measured, increases were sustained after the collaboratives ended. At least 75% of teams increased screening rates in each collaborative. Sites that adopted normalizing language (i.e., “We screen everyone your age for chlamydia”) and an opt-out approach (i.e., “While you’re here today we’re going to screen you for chlamydia. Do you have any questions before we do that?”) saw the largest increases in screening rates. To help other providers adopt these practices, JSI as the Family Planning National Training Center developed a training activity for clinic staff about Using Normalizing and Opt-out Language for Chlamydia and Gonorrhea Screening and a Chlamydia Screening Toolkit.

Increasing chlamydia screening among young sexually active women is essential to managing the sexually transmitted infection epidemic currently facing the United States. Screening is an effective strategy for identifying asymptomatic disease, thereby reducing their spread, preventing devastating sequelae, and reducing health disparities. After years of stagnant screening rates, finding successful approaches for increasing screening is a timely need. Our results demonstrate that a learning collaborative is one such approach. 

Written by: Katie Quimby &  Jennifer Kawatu