Article

Chlamydia Positivity in American Indian/Alaska Native Women Screened in Family Planning Clinics, 1997–2004

Division of Allergy and Infectious Diseases, University of Washington, Washington, USA.
Sex Transm Dis (Impact Factor: 2.84). 05/2008; 35(8):753-7. DOI: 10.1097/OLQ.0b013e31816d1f7d
Source: PubMed
ABSTRACT
Previous studies demonstrated high levels of Chlamydia trachomatis (CT) infections within American Indian/Alaskan Native (AI/AN) populations but there are few analyses of CT prevalence in these populations over time.
We analyzed data from 7374 visits at which diagnostic tests for CT were collected in AI/AN women aged 15 to 24 years seen at family planning clinics associated with the Region X Infertility Prevention Project. Trends in population characteristics and test positivity were examined and compared with non-AI/AN women tested in the same setting and time period. Chlamydia positivity was adjusted for changes in diagnostic test type. Multivariable logistic regression was used to identify characteristics associated with infection.
Adjusted CT positivity in AI/AN women rose from 7.8% to 11.0%, which was 1.5 to 2.2 times the non-AI/AN population levels over the study period (absolute difference 2.8%-6.6%). Differences persisted after correction for test type and age. Temporal changes in positivity among AI/AN women were associated with a rise in reported risk behaviors and decline in age of the population being tested. Risk factors associated with positivity among AI/AN women were younger age, > or =1 behavioral risks, > or =1 clinical findings, partner with chlamydia, chlamydia in past year, and pregnancy related visit.
AI/AN women had consistently higher levels of chlamydia positivity than non-Native women, even after adjustment for age and diagnostic test. Further investigation of risks for chlamydia, related outcomes, access to screening, sexual networks, and enhanced surveillance would be beneficial for improving health in this vulnerable population.

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Chlamydia Positivity in American Indian/Alaska Native Women
Screened in Family Planning Clinics, 1997–2004
LINDA GORGOS, MD, MSC,* DAVID FINE, PHD,† AND JEANNE MARRAZZO, MD, MPH*
Background: Previous studies demonstrated high levels of Chla-
mydia trachomatis (CT) infections within American Indian/Alaskan
Native (AI/AN) populations but there are few analyses of CT preva-
lence in these populations over time.
Methods: We analyzed data from 7374 visits at which diagnostic
tests for CT were collected in AI/AN women aged 15 to 24 years seen
at family planning clinics associated with the Region X Infertility
Prevention Project. Trends in population characteristics and test pos-
itivity were examined and compared with non-AI/AN women tested in
the same setting and time period. Chlamydia positivity was adjusted
for changes in diagnostic test type. Multivariable logistic regression
was used to identify characteristics associated with infection.
Results: Adjusted CT positivity in AI/AN women rose from 7.8%
to 11.0%, which was 1.5 to 2.2 times the non-AI/AN population levels
over the study period (absolute difference 2.8%–6.6%). Differences
persisted after correction for test type and age. Temporal changes in
positivity among AI/AN women were associated with a rise in reported
risk behaviors and decline in age of the population being tested. Risk
factors associated with positivity among AI/AN women were younger
age, >1 behavioral risks, >1 clinical findings, partner with chlamydia,
chlamydia in past year, and pregnancy related visit.
Conclusions: AI/AN women had consistently higher levels of chla-
mydia positivity than non-Native women, even after adjustment for
age and diagnostic test. Further investigation of risks for chlamydia,
related outcomes, access to screening, sexual networks, and enhanced
surveillance would be beneficial for improving health in this vulnera-
ble population.
CHLAMYDIA TRACHOMATIS (CT) INFECTIONS ACCOUNT
for the largest proportion of sexually transmitted infections re-
ported to the Centers for Disease Control and Prevention (CDC),
with an estimated 2.8 million new cases per year in the United
States.
1
American Indians/Alaskan Natives (AI/AN) represent a
racial minority population within the United States with a unique
social, cultural, and biologic background. AI/AN bear a dispro-
portionate burden of illness for many diseases, including sexually
transmitted infections.
1– 4
A high prevalence of chlamydial infection has been reported in
AI/AN communities, ranging from 24% to 30% among prenatal
patients in the Southwest
5,6
to 23% of all women screened in a
remote Alaskan village.
7
In 2004, women aged 15 to 44 years
screened for chlamydia in 2 Indian Health Service (IHS) regions
had chlamydia positivities of 10.7% versus 6.3% for women
screened in family planning clinics nationwide.
8
In a recent report,
the overall chlamydia rate in 2004 among AI/AN residing in IHS
provision areas was 2.3 times higher than the corresponding US
rates, with 3 IHS areas having chlamydia rates 4.9 to 6 times
higher than the US rate.
3
However, there are few analyses of
chlamydia infections over time in AI/AN populations.
We sought to more clearly define the clinical epidemiology and
trends in test positivity of chlamydial infections in AI/AN women
by examining data representing 15- to 24-year-old AI/AN women
attending family planning clinics in the Region X Infertility Pre-
vention Project (IPP) network during the years 1997–2004. This
represents a cohort of women for whom universal screening for
chlamydia was recommended throughout the study period.
9,10
Materials and Methods
Sources of Data
Data on chlamydia tests were obtained from the Region X IPP,
an ongoing program since 1988 that provides for the screening and
treatment of chlamydial infections throughout Alaska, Idaho, Or-
egon, and Washington states. All women aged 15 to 24 years who
presented to family planning clinics enrolled in the IPP and who
self-identified as AI/AN, whether as a sole racial category or in
combination with another racial or ethnic category, were included
in this analysis. Since inception of the IPP in 1988, screening has
been recommended for all women aged 24 years and younger for
chlamydial infection at least annually as recommended by the
CDC and the US Preventive Services Task Force.
10,11
All Region X family planning clinics used a common medical
record form and laboratory slip to record a standard set of infor-
mation. Information collected included age, race, ethnicity, spec-
imen collection date, reason for visit, specified clinical exam
findings (ectopy, friable cervix, pelvic inflammatory disease, cer-
vicitis), self-reported sexual risk behaviors (having had a new sex
partner in the past 60 days, multiple sex partners in the past 60
days, a symptomatic sex partner in the past 60 days, a sex partner
who was diagnosed with chlamydia, and condom use during last
sex), having had chlamydia in the past year, laboratory test type,
and chlamydia test result. CT diagnostic tests with unsatisfactory
or indeterminate results were excluded from the analysis.
Supported by US Public Health Service Training Grant AI-07140 (to
L.G.); Region X Infertility Prevention Project.
Correspondence: Linda Gorgos, MD, MSc, Harborview Medical Center,
Center for AIDS and STD, Mailbox 359931, 325 Ninth Avenue, Seattle,
WA 98104. E-mail: lmg23@u.washington.edu.
Received for publication November 19, 2007, and accepted February 11,
2008.
From the *Division of Allergy and Infectious Diseases, University of
Washington; and †Center for Health Training, Seattle, Washington
Sexually Transmitted Diseases, December 2008, Vol. 35, No. 12, p.000 000
DOI: 10.1097/OLQ.0b013e31816d1f7d
Copyright © 2008, American Sexually Transmitted Diseases Association
All rights reserved.
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