Amersham Vale Practice

Objectives To assess the feasibility and acceptability of offering self-sampling for Human Papillomavirus (HPV) testing to cervical screening non-attenders when they consult primary care for any reason. Methods In a pilot implementation study, six general practices in London, UK, offered self-sampling kits during consultation to women aged 25-64 who were at least six months overdue for cervical screening (no cytology test recorded in the past 3.5 years if aged 25-49, or 5.5 years if aged 50-64). Eligible women were identified using an automated real-time search (during consultation) of the general practice electronic medical record system. Women collected samples either in clinic or at home (dry flocked swabs analysed using Roche Cobas®4800). Results Of approximately 5000 eligible women, 3131 consulted primary care between January and December 2014 (mean recruitment period 9.5 months). Of these, 21% (652) were offered kits, 14% (443) accepted, and 9% (292) returned a self-sample. The proportion of eligible women offered kits varied considerably among practices (11-36%). Sample return rates increased with kit offered rates ( r = 0.8, p = 0.04). Of 39 HPV positive women 85% (33) attended follow-up, including two with invasive cancers (stage 2A1 and 1A1). Conclusions Offering self-sampling to cervical screening non-attenders opportunistically in primary care is feasible. Return rates could be increased if more women were offered kits. A large trial is needed to identify how self-sampling is best integrated into the national screening programme, and to identify determinants of uptake.

A 24 year old woman was offered opportunistic chlamydia screening during a routine general practice appointment for another problem. It is practice protocol to offer a test for chlamydia to all patients under the age 25, and clinicians are alerted to this with a computer prompt. She had a 3 year old son but was no longer in a relationship with the father. She had been in a new relationship for the past eight months, however, and said that she occasionally used condoms in addition to oral contraception. She had been tested for chlamydia when she was pregnant but the result was negative. She accepted the screening offer and provided a self collected lower vaginal swab, which she collected in the practice toilet during the consultation. Two days later her result came back positive and she was invited back to the practice for further discussion and treatment. ### 1 Why is screening for chlamydia important in patients under the age of 25? #### Short answer The prevalence of chlamydia is highest in young people under the age of 25. #### Long answer The National Chlamydia Screening Programme recommends that all people under the age of 25 who are sexually active should be tested for chlamydia at least once a year or after a change in sexual partner. An infection with chlamydia can occur at any age but is most common in people under the age of 25,1 with rates of diagnosis peaking in women aged 16-19 and men aged 20-24.2 ### 2 What complications may follow chlamydial infection? #### Short answer Infections with chlamydia can cause ectopic pregnancy and tubal infertility, epididymitis, pelvic inflammatory disease, chronic lower abdominal or pelvic …