'Catching chlamydia': combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.

In Australia and elsewhere, chlamydia screening rates for those aged between 16 and 30 years continue to be low. Innovative, age-appropriate approaches are necessary to increase chlamydia screening among this target group to prevent short- and long-term consequences of the infection such as pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy and infertility. Studies have demonstrated that offering chlamydia screening in community pharmacies may be a useful adjunct to current screening services. Approximately 90% of Australians visit a pharmacy at least once a year. Chlamydia screening and education in community pharmacies with remuneration may provide another option for opportunistic testing as part of a national chlamydia screening scheme. Compensation is an accepted practice in the field of research and has been demonstrated to improve adherence to health promotion activities. In 2011, a cross-sectional study of community pharmacy-based chlamydia screening offered in conjunction with an A$10 cash incentive to participate was conducted in the Australian Capital Territory. As part of this study young people were asked about their experience of, and views about, pharmacy-based chlamydia screening. The views of consented participants were collected using the one-page questionnaire consisting of 10 closed questions and one open-ended question. Participants completed the questionnaire when they returned their urine sample and before being given the cash incentive. Overall participants were highly satisfied with the pharmacy-based chlamydia screening service. Over 60% of questionnaire respondents felt that the payment did affect their decision to have the chlamydia test, and 23% stated that it made no difference. Young people reported that pharmacy-based screening is acceptable and convenient. Accessibility and the small cash incentive played significant roles in increasing participation.

Can pharmacy assistants play a greater role in public health programs in community pharmacies? Lessons from a chlamydia screening study in Canberra, Australia.

BACKGROUND: Little is known about the engagement of pharmacy assistants (PA) in public health service provision. OBJECTIVE: To explore the experiences of PA participating in a study to determine whether a cash reward, offered to consumers and pharmacy businesses, increased participation in community pharmacy-based chlamydia screening. METHODS: PA experience of the study education and training package, participant recruitment and conducting screening (providing information about chlamydia, specimen collection and handling urine samples) were evaluated using knowledge assessment, a questionnaire and focus groups. RESULTS: Twenty PA participated in the study: 15 (75%) completed all education and training components, 20 (100%) completed the questionnaire and 10 (50%) attended a focus group. PA rated all education and training components as effective (mean visual analog scale scores >8.5). Most PA (13/18, 72.2%) did not support/were unsure about continuing the program, citing the 25% repeat testing rate (presumed to relate to the cash reward) and privacy/confidentiality issues as reasons. Qualitative analysis suggested that minimizing repeat testing, improved workload management and recognition of, and remuneration for, education and training would make this model more acceptable to PA. CONCLUSION: Findings from this study support the assertion that PA can play a significant role in public health initiatives.

Community pharmacy and cash reward: a winning combination for chlamydia screening?

OBJECTIVES: To date, the uptake of chlamydia screening in community pharmacies has been limited. The objective of this cross-sectional study was to determine if a cash reward, offered to both the provider and the consumer of chlamydia screening, increased the uptake of screening in community pharmacies. METHODS: During 4 weeks in 2011, chlamydia screening and education were offered in four city and two suburban pharmacies to people aged 16-30 years. Those who provided a urine sample for testing, contact details, and completed a brief questionnaire were rewarded with $A10. Positive participants, and their nominated contacts, were offered treatment. RESULTS: Over a period of 751.5 h, 979 testing kits were requested, and 900 (93%) urine samples returned. Using probabilistic linkage methods, we determined that 671/900 (75%) urine samples were from unique individuals. 0.9 unique samples were obtained/hour of screening, 63% of which were provided by men. 19/671 (2.8%; 95% CI 1.7% to 4.4%) people tested positive, 5.2% (95% CI 2.8% to 8.8%) of women, and 1.4% (1.4 0.5 to 3.1) of men. 11/19 (58%) people were contacted and treated-two for suspected pelvic inflammatory disease. CONCLUSIONS: Providing a cash reward to encourage chlamydia screening in community pharmacies resulted in greater participation rates than previously reported pharmacy-based studies, particularly among men. Easily implemented mechanisms to reduce inappropriate repeat screening, incorrect contact details and effects on pharmacy work flow may enhance the efficiency of this approach.

A pragmatic assessment of the relative efficiency of outreach chlamydia screening events conducted in non-clinical settings.

BACKGROUND: Opportunistic screening for chlamydia in non-clinical settings is becoming more common, but little is known about which settings (or events) offer the best return on investment. We measured the relative efficiency of each screening site and event during the conduct of a chlamydia education and screening outreach program which used a cash incentive to encourage participation (SOC2). METHODS: SOC2 staff identified sites and organised events in non-clinical sites where young people were likely to congregate. 16 to 30 years olds were offered chlamydia education and a cash reward of AUD10 if they chose to be screened for chlamydia. Data collected during these activities were used to calculated five measures of efficiency: i) screening yield' (proportion of people providing a sample), ii) proportion of positive tests, iii) 'event screening tempo' (number of screens performed for every hour that screening is offered), iv) 'staff hour screening tempo' (number of screens performed per hour of staff time) and v) 'chlamydia detection tempo' (number of positive tests detected per hour of screening). RESULTS: 3011 people (71% male) were screened during 18 events at 10 venues. Overall 'screening yield' was 43.8% (range: 20-77%) and 1.7% (95% CI: 1.1-3.0) of tests were positive (by event range 1-3%). Overall, the 'event screening tempo' was 23.7 screens per event hour (range 8.0-79.0), the 'staff hour screening tempo' was 6.5 screens per staff hour and the 'chlamydia detection tempo' was 0.4 positive tests per hour (range: 0-1.75). CONCLUSION: Assessing the efficiency of screening sites and programs should be integral to their conduct. We suggest the use of five measures to enable pragmatic assessment of any screening program. We introduce the terms 'event screening tempo', 'staff hour screening tempo' and 'chlamydia detection tempo' to describe three of these simple measures.