Reviewer's report
Title:Delivery of chlamydia screening to young women requesting emergency
hormonal contraception at pharmacies in Manchester, UK : a prospective study.
Version: 1Date:2 February 2009
Reviewer: Catherine Aicken
Reviewer's report:
MAJOR COMPULSORY REVISIONS
1. Please explain how the results of this study relate to the current service
context (i.e. since the introduction of the National Chlamydia Screening
Programme). It is confusing that the NCSP is described in the first paragraph of
the Background section, but elsewhere it is stated that the study took place
before the NCSP started in Manchester.
2. Authors need to state the limitations of the study. For example, since the
National Chlamydia Screening Programme's implementation (after data collection
for this study), it is possible that awareness, acceptability and knowledge of the
importance of CT screening changed (among young women and/or among
pharmacists). 3. Authors should draw a clearer distinction between Boots
pathfinder opportunistic screening through pharmacies, and the more targeted
screening evaluated here. The former (as I understand it) is for all sexually active
young men and women. The screening programme evaluated here focuses on
young women who are accessing EHC and therefore can be assumed to have
had recent unprotected sex. It is relevant to reducing transmission by screening
(and treating) a particularly high-risk group (the mention of active case-finding is
highly appropriate). It is less relevant to attempts to screen a large percentage of
the 15-24 year old sexually active population. Results may not generalise to all
pharmacy-based Chlamydia screening and authors should avoid making this
generalisation in the conclusion, unless it can be justified.
4. Related to this, the purpose of screening EHC clients attending pharmacies
should be more clearly stated. While this is described as a means to increase
ACCESS to screening, it seems that offering screening to young EHC clients is a
means of TARGETING those women who may be at increased risk of
Chlamydia. To a lesser extent the screening programme is concerned with
increasing access to screening (it only addresses access among a very specific
target group). An intervention simply to increase access to screening, while
maintaining a focus on the age group with the highest Chlamydia rates, would
surely offer screening to all sexually active young women and young men. It is
essential that the authors mention targeting, or active case-finding, in the
conclusion, particularly given that the better-known Pathfinder and NCSP
schemes aim to screen a broader section of the population (as well as targeting
particular risk groups).
MINOR ESSENTIAL REVISIONS
1. Background section: Where the screening and testing rate of 35% is given,
authors should state what time period this refers to (e.g. per year), and what
population. Also mention that this target applies only if ‘effective partner
notification and management’ are also undertaken, as in the reference document.
Authors could consider accessing the original research.
2. Page 6: the phrase ‘if they had consented’ - please confirm whether all
participants consented to take part in the research.
3. Analyses 1, 2, and 3 are described in the Methods section. This is very helpful,
but please refer back to these analyses in the Results section, so readers can
see which results derive from which analyses.
4. In the Abstract it states that 46.4% of EHC clients accepted a screening kit, but
only a quarter of EHC clients were offered screening. Page 8 states that the
46.4% is the percentage of EHC clients OFFERED SCREENING, who accepted
it. Please make the correction in the abstract.
5. Page 10: ‘Approximately half of EHC clients accepted a kit but only 17%
returned a sample’. Please clarify whether this means 17% of all EHC clients, or
17% of those who accepted the kit.
6. Page 10: ‘They may not have perceived themselves to be at risk…’ Given the
previous sentence, it seems that those who accepted screening did not perceive
themselves to be at risk. If ‘they’ are the people who did not return the sample,
please rephrase the sentence appropriately.
7. Page 9: Please remove the phrase ‘for one or other reason’ and be clear
whether the reasons are unknown, or whether you state the reasons elsewhere.
8. Page 9: ‘Consistency is more difficult to identify…’ - I did not understand this
sentence. Consider saying ‘maintain’, ‘measure’ or ‘assess’ instead of ‘identify’.
9. Page 9 – Add a full stop at the end of the sentence ‘Other postal screening
studies…’; Page 11: Pharmacist’s should be Pharmacists’ .
DISCRETIONARY REVISIONS
1. If the sub-studies you mention are in press or published, it would be helpful to
could provide references.
2. Remove the commas in the following sentences: p8 sentence starting ‘Only
236 (17.6%) women …’; and p9 sentence starting ‘We tracked protocol
deviations…’
3. If possible please provide the Gateway reference numbers for the DH
publications cited, as these are difficult to find.
4. Page 6: ‘…the laboratory…notified by telephone the contact details of
women…’ Better to say that the laboratory notified the women by telephone,
using the contact details provided.
5. Page 8: I do not understand what you mean by ‘pharmacists circumscribed
access by offering a postal kit to only 25% of [eligible?] clients’. I think
‘circumscribed’ may not make sense in this context.
6. Page 9: The sentence beginning ‘This should be possible when…’ could
possibly be reworded.
7. Page 10: ‘if the pharmacists were offered enhanced training’ I am not sure
what is meant by this, given that pharmacists appear already to have been given
extra training.
8. Page 11: Consider elaborating on how pharmacists’ selection of clients
undermines 'the principles of a screening programme', given that they already
have to do some selection on the basis of age, gender, and use of EHC. (It
certainly undermines the principles of this screening programme.)
9. Conclusion: I was unsure whether you meant 'coverage' of the target group, or
coverage of the area.
10. Authors may wish to mention as a background point, the reason why
Chlamydia screening in the UK targets under-25s.
11. Consider describing the limitations of the type of screening being evaluated
(e.g. that women who had unprotected sex in the more distant past, who do not
access services, or who do not access EHC because they use LARC methods
(but not condoms), may also be at increased risk of Chlamydia, but will not be
reached by a programme that targets EHC clients). The absence of partner
notification (if this is the case) may also be a major weakness.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.