Screening for Chlamydia trachomatis in an anonymous and confidential HIV counseling and testing site - Feasibility and prevalence rates

Background: Chlamydia trachomatis is the most common bacterial sexually tra nsmitted disease (STD) in the United States. The development of nucleic aci d amplification tests for C trachomatis in urine specimens allows for scree ning outside traditional clinic settings. Persons visiting an HIV counselin g and testing site may be at increased risk for STDs, including C trachomat is. Goal: To measure the acceptance of C trachomatis urine screening and the pr evalence of C trachomatis infection among clients at an HIV counseling and testing site. Study Design: Site HIV counselors offered urine C trachomatis screening to clients, administered a questionnaire, and collected urine samples. Results: Of 808 counseling and testing site clients approached for C tracho matis screening, 572 (71%) accepted. The most common reasons for declining screening mere absence of symptoms (33%) and recent STD testing (32%). Men were more likely to accept urine screening than women (risk ratio, 1.31; 95 % CI, 1.06-1.62), as were clients who practiced oral sex, had a history of STD, or who had never been screened for STD. Of 560 urine specimens process ed, only 8 (1.43%; 95% CI, 0.66-2.91%) were infected with C trachomatis. Conclusions: Sites offering HIV testing and counseling are a feasible alter native to clinical settings for C trachomatis screening. Prevalence may be too low for screening to be cost effective unless higher-risk subpopulation s can be identified.