Additional Interventions for North Carolina to Stem the Rising Incidence of Chlamydia trachomatis
Creators: name: Holt, Patricia
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2014

description: BACKGROUND: Since 2006 incidence rates of chlamydia (C. trachomatis) have increased in the United States to epidemic proportions. The estimated prevalence is four million people. The reported chlamydia infection rate for North Carolina is 524/100,000 compared to the national rate of 426/100,000. The NC rates in 2011 for black/ African Americans (B/AA) were 1073/100,000 in men and 3569/1000 in women less than 25 years old (Center for Disease Control and Prevention [CDC], 2011). OBJECTIVE: This paper describes the urgent need in North Carolina for increased chlamydia prevention strategies and resources specifically for high risk subpopulations like young B/AA men and women. RESEARCH QUESTION: What additional interventions should be implemented in North Carolina to reduce chlamydia infection rates? STUDY DESIGN: Textbooks and online sources were consulted for background etiologic information and CDC records were examined for 2006-2012 chlamydia prevalence. Health policies were researched using CDC references and individual state websites from a cohort of states with similar chlamydia incidence rates similar to those of North Carolina. PubMed, Rand Corporation, and Robert Wood Johnson Foundation databases were searched for intervention programs. RESULTS: Data reviewed for 2012 showed North Carolina had the fourth highest reported chlamydia incidence rate in the nation. The subpopulations of highest chlamydia incidence were B/AA male and female less than 25 years old and men who have sex with men (MSM). Chlamydia infections and reinfections continue to burden the limits of the healthcare resources. Research continues to implicate co-morbidities of chlamydia and HIV infections emphasizing the urgency on two fronts. Public health policies in ten states with high chlamydia were compared to NC for improved outcomes. Other states and nations have taken stronger prevention and control actions and those steps were analyzed for feasibility in NC. CONCLUSIONS: Increased screening among men and women under 26 years old could decrease chlamydia incidence, in conjunction with existing policies in North Carolina. Interventions require improved access and partner management especially among young teens, age and gender specific healthy behavior education and increased community involvement targeting three high risk groups: minorities, men, and pregnant women (USPTF, 2007). Other subgroups with rates higher than the state average include MSM, those with multiple sexual partners or recent sexual disease infections, the incarcerated, the homeless and high risk women of child bearing age (National Survey of Sexual Health and Behavior, 2010) (Behavior Risk Factor Surveillance Survey, 2007) (Stein, 2013) (Brewer, 2012). More frequent screening is recommended to contain the disease in the target groups. Physicians, legislators, and insurance providers would benefit by working together for new state health policies and funding to expand chlamydia screening, linking services with Medicaid or other healthcare insurance providers. Increased screening may be linked to established policies or procedures such as pregnancy tests, annual physicals, PAP smears, and admittance to correctional institutions and homeless shelters.