Chlamydia Screening Programme,HMP Hydebank Wood Young Offender Centre,Belfast,Northern Ireland,UK

INTRODUCTION

In Northern Ireland (population of 1.6 million), the 2002 Investing for Health Strategy ¹ identified sexual health as an important area for action. As a result, the Department of Health, Social Services and Public Safety, developed a Sexual Health Promotion Strategy in 2004. ² One of the strategy's key objectives is to reduce the incidence of sexually transmitted infections (STIs) by 25% by 2009. A seroprevalence study conducted in Northern Ireland Prisons 2004 ³ found that while blood-borne virus infections were not endemic, risk factors for STIs were reported. The study found that 70% of respondents had never used condoms during intercourse and that 15% of respondents had previously been treated for an STI. The median age of respondents in this study was 26 years and the majority of respondents were men, with 1.66% women. Chlamydia trachomatis is the most common bacterial STI diagnosed in the UK, ⁴ affecting approximately one in 10 sexually active young men and women. The prevalence was highest in sexually active adults, especially women aged 16–24 years and men aged 18–29 years. ⁵ Against this background, it was agreed by the Prison Service Healthcare Management to fund a chlamydia screening pilot at Hydebank Wood Young Offender Centre. Hydebank Wood is the only young offender centre in Northern Ireland, accepting male prisoners aged 16–21 years, housing normally 200 prisoners.

OBJECTIVES

METHODS

All prisoners housed in Hydebank Wood were eligible to participate in the screening programme. C. trachomatis screening was promoted to prisoners through posters, leaflets and staff communication. Chlamydia testing was a urine nucleic acid amplification test (Abbott Multi-Collect. Abbott Laboratories, Maidenhead, Berks, UK). Trained health-care staff completed a Chlamydia Testing Questionnaire with prisoners who expressed an interest in screening. This included signed prisoner consent for chlamydia testing and treatment. The questionnaire covered a checklist to ensure that prisoners are currently asymptomatic for chlamydia. It also asked two questions regarding the prisoner's recent sexual history. The behavioural risk factor questions were taken from the National Chlamydia Screening Programme in England. ⁵ The screening was carried out according to a Standard Operating Procedure. A trained nurse under Patient Group Direction gave all prisoners with positive results antibiotic treatment. This involved a single dose of 1 g of azithromycin. They were also referred to the GU medicine specialist, who offered further STI screening and partner notification. STI testing included HIV, syphilis, hepatitis B and C, and gonorrhoea. All negative chlamydia results were recorded and prisoners were informed and counselled on sexual health by a trained nurse.

RESULTS

The principal results are presented in Table 1.

The 204 male prisoners who were offered a chlamydia test were aged 17–23 years. There was a high level of screening uptake, with 98% of prisoners agreeing to testing. Twenty-one (10.5%) of the prisoners screened, tested positive for chlamydia and 18 (86%) prisoners were treated under PGD. Three male prisoners were discharged before treatment. All those with a positive test were treated with azithromycin 1 g orally as a single supervised dose. Seventeen positive patients saw the GU medicine specialist. One patient was released before his appointment. Of the 17 patients seen by the GU medicine specialist, three refused to have further STI tests. Of the 14 patients with further STI tests, all were negative for HIV, syphilis, hepatitis B and C, and gonorrhoea. The GU medicine specialist offered chlamydia-positive patients partner notification. Partners were treated and follow-up was attempted at the local GU medicine clinic.

The behavioural risk factors are presented in Table 2.

A high percentage of prisoners in both chlamydia-positive and chlamydia-negative groups reported having had two or more sexual partners within the last 12 months. A greater percentage of the chlamydia-positive group reported a new sexual partner within the last three months than the chlamydia-negative group, although the overall numbers audited were low.

DISCUSSION

This screening audit has established that chlamydia screening in this male prison population was acceptable, with a high uptake level of 98% achieved. This screening audit established a chlamydia-positive level of 10.5% in the prison population. This is comparable to the male positivity rate of 10.2% from the National Chlamydia Screening Programme in England. ⁵ We did not achieve 100% treatment rate of positive prisoners as a small proportion were released from prison before the results were received from the lab. In these cases, results were forwarded to the prisoner's general practitioner. No other STI was identified in the chlamydia-positive prisoners. Partner tracing was offered to chlamydia-positive prisoners. For practical reasons, it was not possible to obtain details of these partners. The numbers tested in this audit are low and so do not establish a statistically significant link between behavioural risk factors and chlamydia incidence. It does indicate that the main risk factors of having acquired a new sex partner recently and having several sex partners are reported in this young male prisoner group.

In conclusion, a chlamydia screening service has been provided for all current prisoners and will now be offered to all prisoners entering Hydebank Wood at committal. This audit has also ensured that those testing positive have had prompt antibiotic treatment under PGD, and a consultation with a GU medicine specialist. This has ensured that, when possible, prisoners have received appropriate sexual health promotion and access to a full sexual health screen.