Welcome to the Toolkit

Chlamydia is the most commonly reported notifiable disease in the United States. In 2016, there were over 1.6 million cases of chlamydia reported to the Centers for Disease Control and Prevention (CDC). The highest chlamydia rates are among adolescent (ages 15–19) and young adult (ages 20–24) women. While usually asymptomatic, if left untreated, chlamydia infection in women can lead to pelvic inflammatory disease, a major cause of infertility, ectopic pregnancy, and chronic pelvic pain. Chlamydial infection also increases susceptibility to the transmission of HIV. Chlamydia is easily detected and, if identified, treatable with antibiotics.

The goal of this toolkit is to support an increase in Title X grantees’ chlamydia screening rates. This toolkit supports improvement on the HEDIS chlamydia screening measure: the percentage of women 16‐24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year.

Illustration of a woman meeting with a doctor in exam room.

This toolkit includes a series of training guides and complementary resources that support the facilitation of interactive learning sessions about how to implement best practice recommendations outlined in the Chlamydia Screening Change Package. Each training guide consists of a PowerPoint slide deck with talking points and an accompanying discussion guide. The resources in this toolkit can be used in any order according to a site’s needs and priorities. Training guides can be adapted and revised as needed, and may be used to:

  • Convene staff from one or more family planning clinics for a standing meeting (e.g., monthly) to discuss each Best Practice (in order or as needed) from the Chlamydia Screening Change Package.
  • Convene a one-time meeting with clinic staff about this topic.

The toolkit walks sites through a process to increase chlamydia screening rates, organized around the four best practice recommendations of the Chlamydia Screening Change Package.

  • Assess baseline chlamydia rates and practices
  • Develop an improvement plan
  • Best Practice 1: Include chlamydia screening as a part of routine clinical preventive care
  • Best Practice 2: Use normalizing and opt-out language
  • Best Practice 3: Use the least invasive, high-quality recommended laboratory technologies
  • Best Practice 4: Utilize diverse payment options to reduce cost as a barrier
  • Sustain and spread improvements

This toolkit was adapted from a chlamydia screening learning collaborative facilitated by the FPNTC in 2017.

Sites should begin by assessing current chlamydia screening rates using Family Planning Annual Report (FPAR) data, and comparing site-level practices to established best practice recommendations.

Action Steps Supportive Resources

Review the best practice recommendations outlined in the Chlamydia Screening Change Package.

Chlamydia Screening Change Package

Calculate baseline chlamydia screening HEDIS measures using site FPAR data.

Chlamydia Screening Performance Measure Calculator

A participatory process for developing an improvement plan will ensure that staff have ownership and understand their respective roles in achieving change.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about the need for increasing chlamydia screening rates among target populations.

Increase Chlamydia Screening in Family Planning Settings Training Guide

Facilitate a discussion with clinic staff to develop a site-level plan for increasing chlamydia screening rates.

Develop a Site-Level Improvement Plan Training Guide

Chlamydia and gonorrhea screening should be incorporated as a routine part of preventive care for sexually active women 24 years of age and younger, for women over 24 who are at increased risk, and men at increased risk. In addition to preventive health visits, clinic staff should include a consideration for chlamydia screening for women 24 years and younger routinely in all visits, including walk-in visits, pregnancy testing, and emergency contraception counseling.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about how to incorporate chlamydia screening as a routine part of preventive care.

Include Chlamydia Screening as a Part of Routine Clinical Preventive Care (Best Practice 1) Training Guide

Lack of awareness of chlamydia screening guidelines and the social stigma associated with sexually transmitted diseases (STDs) may prevent clients, particularly adolescent and young women, from seeking chlamydia and gonorrhea screening services. Offering screening with normalizing language makes it a routine part of clinical services and is an effective way to build rapport with clients.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about how to use opt-out and normalizing language to promote chlamydia screening among sexually active women 24 years and younger.

Use Normalizing and Opt-Out Language to Explain Chlamydia Screening (Best Practice 2) Training Guide

According to the 2015 STD Treatment Guidelines from CDC, chlamydia can be diagnosed in women by testing clinician-collected, self-collected vaginal swabs, or urine specimens. Systems should be developed to make all of these options available, and all efforts should be made to use the least invasive, high-quality test that is acceptable to, and convenient for, the client.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about how to implement the current recommended laboratory technologies for chlamydia screening (for women and men) and streamline the specimen collection process.

Use the Least Invasive, High-Quality Recommended Laboratory Technologies for Chlamydia Screening, with Timely Turnaround (Best Practice 3) Training Guide

The Title X Family Planning Program provides services and information to all clients who want and need them, regardless of ability to pay. It is important to diversify payment options and to identify all available options to reduce the cost burden of chlamydia screening to the site and to clients.

Action Steps Supportive Resources

Facilitate a discussion with clinic staff about strategies for ensuring that cost is not a barrier for the facility or the client.

Utilize Diverse Payment Options to Reduce Cost as a Barrier for the Facility and the Patient (Best Practice 4) Training Guide

Implementation is not a one-time activity and does not end after initial improvement plan changes are made. Using a quality improvement approach, staff should prepare for how changes will be sustained at the site, and, once successful, how to spread them to other sites in the network.

Action Steps Supportive Resources

Learn more about quality improvement approaches.

Introduction to Quality Improvement for Family Planning eLearning (Module 1)

Facilitate a discussion with clinic staff about how to sustain and spread changes made to increase chlamydia screening rates.

Sustain and Spread Improvements Training Guide