The chlamydia care cascade of young people attending Australian general practices; a descriptive study to assess gaps in care

Background Most chlamydia infections in Australia are diagnosed in general practice. The care cascade concept (testing, treatment and re-testing) can be utilised to explore the management of chlamydia infections. We explored the chlamydia care cascade among young people attending general practices in Australia.Methods We analysed de-identified electronic medical record data for 16-29-year-old individuals attending 70 Australian general practices between January 2018 and December 2020. Five outcomes: (1) chlamydia testing, (2) positivity, (3) treatment, (4) re-testing and (5) re-infection were summarised as annual counts and proportions per calendar year. Logistic regression was used to investigate the association of age, gender and clinic location with each outcome.Results During the study period, a total of 220 909 clinical episodes involving 137 358 16-29-year-olds were recorded. Of these episodes, 10.45% (n = 23 077, 95% CI 8.73-12.46) involved a chlamydia test. Of 1632 chlamydia cases, 88.79% (n = 1449, 95% CI 86.37-90.82) had appropriate antibiotics recorded as defined in Australian sexually transmitted infection management guidelines. Of 183 chlamydia cases that did not have appropriate antibiotics recorded, 46.45% (n = 85) had re-attended the clinic within 90 days of diagnosis. Among 1068 chlamydia cases that had appropriate antibiotic recorded in 2018 and 2019, 22.57% (n = 241, 95% CI 20.15-25.18) were re-tested within 6 weeks to 4 months of their diagnosis. One-third of episodes of chlamydia cases that did not have a re-test recorded (n = 281) had re-attended the clinics within 4 months of diagnosis.Conclusion Our study provides insight into chlamydia management by analysing general practice medical records, indicating substantial gaps in testing and re-testing for 16-29-year-olds. These data can also be used to explore the impact of future interventions to optimise chlamydia management. Chlamydia infection in Australia is common in individuals under 30 years old. General practitioners play an important role in facilitating testing, treatment and re-testing of chlamydia infections. We identified substantial gaps in testing and re-testing for 16-29-year-olds attending general practitioner clinics, with only 10% of patients tested and 22% of positive cases re-tested within recommended timeframes. This study demonstrated the value of utilising routinely collected general practice data in a research setting and provided insight into chlamydia management in primary care.