Chlamydia prevention in Sweden—A case study of potential key factors in successful response

Charlotte Deogan, Cecilia Moberg, Lene Lindberg, Anna Månsdotter

Department of Neurobiology, Care Science and Health, Karolinska Institutet, Stockholm, Sweden.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

DOI: 10.4236/ojpm.2013.31009                

Abstract

Background: After a continuous increase of Chlamydia trachomatis (chlamydia) in Sweden, a general reduction in reported cases was seen in 2009. However, the number and decrease of chlamydia cases varied largely between geographical regions. Aim: The aim of the present study was to identify potential key factors of successful regional prevention of chlamydia and other sexually transmitted infections (STIs). Methods: A multiple case study was performed including seven Swedish counties. Data was collected via surveys and interviews with key informants, county council registry data, survey data on condom use, and surveillance data on reported cases of chlamydia. In a case comparison, factors of prevention structure and prevention activities were identified and rated as strengths or weaknesses compared to standard preventive measures. Potential key factors were identified by examining prevention strengths corresponding to high condom use and decrease of chlamydia cases. Results: Differences were found in prevention structure and activities across counties. Identified potential key factors were; adequate investments in STI prevention, suitable organizational structure, strong leadership, managing regional STI-networks, research connection, multiple local collaborations with health care and community, high testing coverage and strategic risk approach. Conclusions: This study shows that greater consideration to structural factors of chlamydia prevention may benefit the outcomes of STI-prevention activities.

Keywords

Chlamydia; STIs; Prevention; Prevention Structure; Case Study

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	(2012) Swedish Institute of Infectious Disease Control [Online]. http://www.smittskyddsinstitutet.se/statistik/klamydiainfektion/
[2]	Swedish National Board of Health and Welfare (2012) National action plan for chlamydia prevention. http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/8402/2009-126-180_2009126181.pdf
[3]	DuRant, R.H., Smith, J.A., Kreiter, S.R. and Krowchuk, D.P. (1999) The relationship between early age of onset of initial substance use and engaging in multiple health risk behaviors among young adolescents. Archives of Pediatrics & Adolescent Medicine, 153, 286-291.
[4]	Hansen, B.T., Kjaer, S.K., Munk, C., et al. (2010) Early smoking initiation, sexual behavior and reproductive health—A large population based study of Nordic women. Preventive Medicine, 51, 68-72. doi:10.1016/j.ypmed.2010.03.014
[5]	Deogan, C., Cnattingius, S. and M?nsdotter, A. (2012) Risk of self-reported Chlamydia trachomatis infection by social and lifestyle factors—A study based on survey data from young adults in Stockholm, Sweden. European Journal of Contraception and Reproductive Health Care, in Press. doi:10.3109/13625187.2012.729624
[6]	Ellis, S. and Grey, A. (2004) Prevention of sexually transmitted infections (STIs): A review of reviews into the effectiveness of non-clinical interventions. Evidence briefing. Health Development Agency, London. http://www.nice.org.uk/nicemedia/documents/prevention_stis_evidence_briefing.pdf
[7]	National Institute for Health and Clinical Excellence (2007) Public health intervention guidance 3. One to one interventions to reduce the transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18 conceptions, especially among vulnerable and at risk groups. National Institute for Health and Clinical Excellence, London. http://www.nice.org.uk/Guidance/PH3/Guidance/pdf/English
[8]	Bernard, D., Kippax, S. and Baxter, D. (2008) Effective partnership and adequate investment underpin a successful response: Key factors in dealing with HIV increases. Sexual Health, 5, 193-201. doi:10.1071/SH07078
[9]	Griew R. (2008) Policy and strategic implications of Australia’s divergent HIV epidemic among gay men. Sexual Health, 5, 203-205. doi:10.1071/SH08003
[10]	Farley, C., Grulich, A., Imrie, J. and Pitts, M. (2008) Investment in HIV prevention works: A natural experiment. Sexual Health, 5, 207-210. doi:10.1071/SH08017
[11]	Miller, R.L., Bedney, B.J. and Guenther-Grey, C. (2003) Assessing organizational capacity to deliver HIV prevention services collaboratively: Tales from the field. Health Education & Behavior, 30, 582-600. doi:10.1177/1090198103255327
[12]	Sylvan, S. and Hedlund, J. (2009) Efficacy of partner notification for Chlamydia trachomatis among young adults in youth health centres in Uppsala County, Sweden. Journal of the European Academy of Dermatology and Venereology, 23, 517-522. doi:10.1111/j.1468-3083.2008.03080.x
[13]	Lin, J.S., Whitlock, E., O’Connor, E. and Bauer, V. (2008) Behavioural counseling to prevent sexually transmitted infections: A systematic review for the US. Preventive Services Task Force. Annals of Internal Medicine, 149, 497-508.
[14]	L?fdahl, M., Rydevik, G., Blaxhult, A. and Hermann, B. (2008) Chlamydia infection among Swedish women. Contact tracing and reporting routines must be improved. L?kartidningen, 105, 3116-3120.
[15]	Kamb, M.L., Fishbein, M., Douglas, J.M., et al. (1998) Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases. Journal of the American Medical Association, 280, 1161-1167.
[16]	Petersen, R., Albright, J., Garrett, J.M. and Curtis, K.M. (2007) Pregnancy and STD prevention counseling using an adaptation of motivational interviewing: A randomized controlled trial. Perspectives on Sexual and Reproductive Health, 39, 21-28. doi:10.1363/3902107
[17]	Outlaw, A.Y., Naar-King, S., Parsons, J.T., Green-Jones, M., Janisse, H. and Secord, E. (2010) Using motivational interviewing in HIV field outreach with young African American men who have sex with men: A randomized clinical trial. American Journal of Public Health, 100, 146-151. doi:10.2105/AJPH.2009.166991
[18]	Scmeidl, R. (2004) School-based condom availability programs. The Journal of School Nursing, 20, 16-21. doi:10.1177/10598405040200010401
[19]	Oakley, A., Fullerton, D., Holland, J., France-Dawson, M., Kelley, P. and McGrellis, S. (1995) Sexual health educations interventions for young people: A methodological review. British medical Journal, 310, 158-162. doi:10.1136/bmj.310.6973.158
[20]	Velicko, I., Kühlmann-Berenzon and Blaxhult, A. (2007) Reasons for the sharp increase of genital chlamydia infections reported in the first months of 2007 in Sweden. Eurosurveillance, 12, E5-E6.
[21]	(2011) Statistics Sweden [Online] http://www.scb.se/default____2154.aspx
[22]	UngKAB09 (2009) Department of Social Work, Gothenburg University.
[23]	Yin, R.K. (2009) Case study research. Design and methods. SAGE Publications, Inc., Thousand Oaks.
[24]	Stake, R.E. (2006) Multiple case study analysis. The Guilford Press, New York.
[25]	Carré, H., Boman, J., Gardén, B. and Nylander, E. (2008) Improved contact tracing for Chlamydia trachomatis with experienced tracers, tracing for one year back in time and interviewing by phone in remote areas. Sexually Transmitted Infections, 84, 239-242. doi:10.1136/sti.2007.028068
[26]	Hassan, A. and Fleegler, E.W. (2010) Using technology to improve adolescent health care. Current Opinion in Pediatrics, 22, 412-417. doi:10.1097/MOP.0b013e32833b5360
[27]	Rainton, N., Odegard, O.R., Helgheim, A. and Moghaddam, A. (2007) Detection of chlamydia infection of an internet-based commercial product. Tidskr Nor Laegeforen, 127, 2080-2082.
[28]	Stenqvist, K., Lindqvist, A., Almerson, P., Jonsson, L. and Lander, R. (2010) Chlamydia test via internet a good alternative to testing in clinics. L?kartidningen, 107, 350-353.
[29]	(2012) Norwegian Ministry of Health. http://helsedirektoratet.no/english/publications/ungass-country-progress-report-norway-january-2008---december-2009/Publikasjoner/ungass-conuntry-progress-report-norway-2009.PDF
[30]	Malterud, K. (2001) Qualitative research: Standards, challenges and guidelines. Lancet, 358, 483-488.