Investigating socioeconomic variations in access to chlamydia testing in young people in England

Project funded by: MRC Research Training Fellowship

November 2008-October 2011

Key contact: Jessica Sheringham

PhD Supervisor panel: Professor Rosalind Raine (primary - UCL), Dr Ian Simms, (Health Protection Agency), Dr Mai Stafford (UCL), Professor Graham Hart (UCL).

Chlamydia trachomatis is a common sexually transmitted infection in young people that may cause reproductive problems in later life. Since 2008, a National Chlamydia Screening Programme (NCSP) has been available in all areas of England. In 2008/2009, the NCSP conducted 3/4 million tests, accounting for 50% of chlamydia testing in young people. The PhD was conducted in two parts.

Part 1. Socioeconomic variations in access to chlamydia testing

It is not known whether chlamydia testing reaches young people in disadvantaged socioeconomic circumstances (SEC), who often have poorer access to preventive healthcare than people in more affluent circumstances. This part of the PhD addressed two aims:

I. Selection of suitable SEC indicators for use in young people

A systematic review found the relationship between SEC and chlamydia in young people varied according to the measure of SEC used. Living in disadvantaged areas and a lack of educational participation were most consistently associated with a higher risk of chlamydia. A series of focus groups also provided insight into how young people in diverse circumstances use local areas to form social and sexual relationships.

II. Examination of variations in young people's access to chlamydia testing by SEC

Analysis of the NCSP in 2008 indicated that, in contrast to other preventive health services, screening coverage was higher in deprived areas. Young people in deprived areas were also more likely to test positive for chlamydia.

In a cross-sectional study, educational participation was also collected in young people tested for chlamydia in a variety of locations. Testing was high in deprived areas but the relationship between chlamydia and SEC varied by gender and local context.

Part 2. The rationale for a national programme of chlamydia screening in England

In 2009, the National Audit Office challenged the rationale for a chlamydia screening programme in England. This followed growing recognition of gaps in the evidence surrounding the risks associated with infection and the benefits of screening. Interviews with chlamydia screening experts will be analysed with policy documents and journal commentaries to evaluate the rationale for the NCSP.

For further information, contact Jessica Sheringham (email: j.sheringham@ucl.ac.uk; tel: 020 7679 8286)