Chlamydia Screening Implementation Project

Early detection and treatment (screening) of infections with Chlaymydia
trachomatis (CT) is a strategy to reduce complications in infected individuals
and to limit the spread of the infection in the population. In a recent
publication, the National Health Council advises to start a pilot
implementation. The Minister of Health has now issued a directive to perform
such a pilot implementation.

The aim of this pilot implementation is first to make a serious start in
Chlamydia screening and secondly to determine feasibility, affectivity and
cost-effectivity. The results of this pilot implementation will be leading for
the decision about the national roll-out of screening in the Netherlands.

Intervention study by means of a selective systematic home-based screening.
Three hundred fifteen thousand persons will be invited to participate two times
in a 3 year period. They will be invited according to the so called stepped
wedge cluster-randomized designwithin randomized clusters. Stepped wedge design
is a *Sequential roll-out of an intervention to individuals (or clusters) over
a number of time periods. By the end of the study, all participants have
received the intervention, although the order in which they receive the
intervention is determined at random*.

Implementation (regional) of selective systematic home-based screening for
chlamydia trachomatis. In Amsterdam and Rotterdam (high population density)
all members of the target population will be invited to participate. In the
eastern part of the lower population density area South Limburg, only part of
the target population will be invited based on a specific risk analysis

Screening might have potential side effects. These effects relate to issues
like somatic fixation (feeling dirty; *am I now infertile?*), negative
consequences in the partner relation and a potential negative effect on safer
sex (*I have myself tested and don*t need to do it safe*). However, in our
PILOT CT study we did not find evidence that intention for safer sex decreased,
and among persons tested positive it even increased. Thus, screening can also
have positive side effects and be instrumental to discuss safer sex and give
rise to tailored prevention counselling in primary care. Acceptance of the
screening approach will be studied during the evaluation

The target population are sexually active individuals in the 16 to 29 age
bracket. Minors (16 and 17) are also included because both nationally (Pilot
Ct) as internationally it has been clear that individuals of 25 years and
younger are a very important group to include in screening projects due to
their relatively high background prevalence.
No medical risks for the participants are involved in this implementation
project.