Article type
Abstract
Background: Chlamydia trachomatis (CT) infection is recognised as a public health issue. It is the first cause of curable Sexually Transmitted Disease in men and the second in women. Generally, it presents as an asymptomatic infection but, in some cases, can evolve to Pelvic Inflammatory Disease (PID) in women and epididymitis/prostatitis in men, with consequences for fertility in both sexes. Several diagnostic techniques are available, however, in Colombia there is not a policy regarding CT screening.
Objectives: To perform a synthesis of evidence for policy concerning the methods of screening for CT infection.
Methods: The evidence synthesis took into consideration the procedures stated in the SUPPORT tool proposed by the Evidence informed policy network (EVIPNET). Four screening alternatives for CT infection were assessed: no screening, population-based screening, risk group-based screening and opportunistic screening. Systematic reviews and meta-analysis (SR-MA) were retrieved as the main sources of information. Other analysis (costs, social perception and equity) were based on economic evaluations, observational or qualitative studies. All the study searches followed a systematic method. Quality of studies was assessed by AMSTAR for SR-MA and QHES for economic studies. Data extraction included details of the alternatives, information about benefits, potential risks and harms, cost-effectiveness, uncertainties, monitoring, and the perception of social groups.
Results: No health benefits were identified from not screening patients. Home testing represented a good alternative for population-based screening (patients between 18 and 35 years old). Risk group-based screening (women below 25 years old, pregnant women, sexual workers, men and men who have sex with men) has limited evidence, but screening young women was found to be useful to reduce the incidence of PID. Opportunistic screening was not a cost-effective alternative.
Conclusions: Methodologies to provide information on alternatives for health policies are valuable in the process of decision making. This information is intended to aid policy development for CT in Colombia.
Objectives: To perform a synthesis of evidence for policy concerning the methods of screening for CT infection.
Methods: The evidence synthesis took into consideration the procedures stated in the SUPPORT tool proposed by the Evidence informed policy network (EVIPNET). Four screening alternatives for CT infection were assessed: no screening, population-based screening, risk group-based screening and opportunistic screening. Systematic reviews and meta-analysis (SR-MA) were retrieved as the main sources of information. Other analysis (costs, social perception and equity) were based on economic evaluations, observational or qualitative studies. All the study searches followed a systematic method. Quality of studies was assessed by AMSTAR for SR-MA and QHES for economic studies. Data extraction included details of the alternatives, information about benefits, potential risks and harms, cost-effectiveness, uncertainties, monitoring, and the perception of social groups.
Results: No health benefits were identified from not screening patients. Home testing represented a good alternative for population-based screening (patients between 18 and 35 years old). Risk group-based screening (women below 25 years old, pregnant women, sexual workers, men and men who have sex with men) has limited evidence, but screening young women was found to be useful to reduce the incidence of PID. Opportunistic screening was not a cost-effective alternative.
Conclusions: Methodologies to provide information on alternatives for health policies are valuable in the process of decision making. This information is intended to aid policy development for CT in Colombia.