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Emphasizing the importance of retesting to providers through adoption of clinic policies will likely be an important component of a multimodal strategy to ensure that patients are retested and that provider/clinic staff take advantage of opportunities to retest patients. Innovative approaches such as home-based retesting with self-collected vaginal swabs and use of cost-effective technologies to generate patient reminders should also be considered.

Background CT reinfection is common and linked with adverse reproductive sequelae. Despite strengthened national recommendations and clinician education efforts in California (CA), retesting rates remain low. Our objective was to use a systematic QI approach (assess, intervene, assure, evaluate) to build an effective, feasible, multi-pronged strategy for increasing CT retesting rates in the CA family planning (FP) setting. Methods We assessed underlying barriers to retesting using two data sources: (1) clinical encounter data from a CA FP program screening 1 million low-income women for CT annually was analysed to determine clinic return and retesting rates among female CT patients 1e6 months post-treatment; and (2) a survey of FP clinicians was used to identify retesting knowledge, attitudes, and practices. A pilot strategy designed from these findings was refined after iterative sessions with key clinic staff and evaluation of existing protocols and electronic systems at select sites. Results Claims data analyses revealed that while 60% of female CT patients returned to clinic 1e6 months post-treatment, only half were retested. Missed opportunities for retesting were associated with limited visits such as pregnancy tests and birth control refills. Clinician survey results showed that 79% did not prioritise CT retesting, only 33% utilised active retesting strategies, and 73% attributed low retesting rates to low patient return rates. A 4-pronged strategy was implemented: (1) to promote retesting as a high priority, medical directors were shown clinic data demonstrating high reinfection rates, high patient return rates, and low retesting rates; (2) clinic systems-level interventions were introduced (chart prompts, clinic practice tools, express STD screening visits); (3) all levels of clinic staff were trained to provide comprehensive counselling to CT-positive patients on reinfection, partner treatment, and practical ways to remember to retest; and (4) patient education materials were revised to improve readability and reinforce messaging. A detailed checklist was developed as a quality assurance tool to facilitate implementation of each intervention and ensure that any operational loopholes were closed. A plan for evaluating the strategy through future monitoring of retesting rates was developed. Conclusions By employing a systematic QI approach we were able to tailor specific interventions to address multiple underlying causes of low CT retesting rates.

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