Investigating socio-economic variations in access to chlamydia testing in young people in England.
Doctoral thesis, UCL (University College London).
In England over 2 million young people were tested for Chlamydia trachomatis (chlamydia) in 2010/2011 to control infection and prevent reproductive health problems. Since 2008, the National Chlamydia Screening Programme (NCSP) has delivered a significant proportion of this testing. The main part of my thesis focused on delivery, specifically on socio-economic variations in access to chlamydia testing amongst young people. It is not known whether testing reaches people in disadvantaged socio-economic circumstances (SEC) who often have worse access to preventive healthcare yet poorer outcomes than socially advantaged groups. Firstly, I undertook a systematic review and re-analysis of Natsal-2000 data to select suitable SEC indicators for use in young people. Living in disadvantaged areas and a lack of education were most consistently associated with a higher risk of chlamydia. Secondly, I examined socio-economic variations in young people's access to chlamydia testing at national and local levels. Data from the NCSP's first year of national delivery indicated that chlamydia screening reached more individuals in disadvantaged areas, where positivity was also higher. A cross-sectional study informed by focus groups found that local delivery varied by service model, particularly when SEC was measured by educational participation. It also showed that other social factors need to be considered to understand how SEC may affect young people's risk of chlamydia. The last part of my thesis evaluated the NCSP's rationale. In 2009, the National Audit Office questioned the justification for the Programme, given the lack of evidence surrounding the benefits of screening. My qualitative study revealed there was an implicit driver around improving young people's sexual healthcare underpinning the NCSP's establishment, in combination with the explicit aims of chlamydia control. The implications of my findings with respect to the delivery of chlamydia testing are discussed in light of this implicit rationale for chlamydia screening.
|Title:||Investigating socio-economic variations in access to chlamydia testing in young people in England|
|Open access status:||An open access version is available from UCL Discovery|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Epidemiology and Public Health|
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