Contribution of general practitioners and sexual health centres to sexually transmitted infection consultations in five Dutch regions using laboratory data of Chlamydia trachomatis testing

Abstract

Effective sexually transmitted infection (STI) control requires opportunities for appropriate testing, counselling and treatment. In the Netherlands, people may attend general practitioners (GPs) and sexual health centres (SHCs; also known as STI clinics) for STI consultations. We assessed the contribution of GPs and SHCs to STI consultations in five Dutch regions with different urbanization levels, using data of urogenital Chlamydia trachomatis (CT) testing. Data (2011–2016) were retrieved from laboratories, aggregated by gender and age group (15–24 and 25–64 years). Results show that test rates and GP contribution varied widely between regions. GP contribution decreased over time in Amsterdam (60–48%), Twente (79–61%), Maastricht (60–50%) and Northeast-Netherlands (82–77%), but not in Rotterdam (65–67%). Decreases resulted from increases in SHC test rates and slight decreases in GP test rates. GPs performed more tests for women and those aged 25–64 years compared to SHCs (relative risks ranging from 1.49 to 4.76 and 1.58 to 7.43, respectively). The average yearly urogenital CT positivity rate was 9.2% at GPs and 10.7% at SHCs. Overall, GPs accounted for most STI consultations, yet SHC contribution increased. Continued focus on good quality STI care at GPs is essential, as increasing demands for care can not be entirely covered by SHCs.

Area-based comparison of risk factors and testing rates to improve sexual health care access: cross-sectional population-based study in a Dutch multicultural area

“… 20 A limited number of studies investigated spatial differences in STI testing on population level. A Dutch study found large nationwide differences in STI testing in the general population, 1 but no studies investigated differences in STI testing at a smaller geographical level. Although testing rates may not be directly associated with area-specific positivity, it is likely that it drives the relative number of observed cases, for example, as observed by a study on pertussis.…”

“… 1 The contribution to STI testing by GPs was much lower in more urban regions, where SHCs play a more prominent role. 1 Even within a smaller area, for example, a metropolitan area, spatial differences in STI testing may occur. No studies have investigated spatial differences in STI testing on such geographical level.…”

“…Sexual health centres (SHCs) are important additional providers for key groups. 1–4 STI testing at an SHC is on request and free-of-charge, but only individuals considered as high risk are admitted based on triage (eg, notified for an STI, STI-related complaints, non-western migratory background, <25 years-of-age, men who have sex with men (MSM)). An STI test at the GP is performed on patient request—in principle without risk assessment—and on doctors’ reasoning and advice.…”

“…Due to healthcare organisation and policy in the Netherlands, general practitioners (GPs) have a pivotal role in provision of sexual healthcare and STI testing. Sexual health centres (SHCs) are important additional providers for key groups 1–4. STI testing at an SHC is on request and free-of-charge, but only individuals considered as high risk are admitted based on triage (eg, notified for an STI, STI-related complaints, non-western migratory background, <25 years-of-age, men who have sex with men (MSM)).…”

Who is providing HIV diagnostic testing? Comparing HIV testing by general practitioners and sexual health centres in five regions in the Netherlands, 2011−2018

“…The five participating regions accounted for 24% of the total Dutch population of 17.2 million in 2018. 7 These regions were selected because a collaboration was already established, 8 and to provide an overview of HIV testing in settings with varying levels of urbanisation in the Netherlands. As shown in figure 1, each region consists of one or more municipalities, varying in level of urbanisation (number of residents per square kilometre, based on 2018 data).…”