Access to chlamydia testing in remote and rural Scotland

Introduction: The aim of this study was to assess access to sexual health care in remote and rural settings using Chlamydia testing as a focus by measuring the extent of Chlamydia testing and positivity across the Scottish Highlands in relation to the Scottish Index of Multiple Deprivation Quintile (SIMD) and Urban Rural 8-fold index (UR8). Methods: Tests processed through Raigmore Hospital in Inverness, the main testing laboratory for microbiology tests in North and West and South and Mid Highlands, were studied. Where people are tested in relation to where they live was assessed, as well as the type of test they opt for. Also assessed was the rate of positivity in male and female patients in rural compared with urban settings using the Scottish Government UR8 and in relation to the SIMD. Results: 9644 results were analysed. 77.2% of the results were for females and 22.4% for males. 8.1% of the results were positive and 84.4% were negative. There were proportionately more positive tests from the sexual health sources than from general practice. The proportion of men who had positive tests was almost double that for women (12.7% vs 6.6%) although men made up only 27.9% of the total number of tests. There was no significant difference in positivity when compared with UR8 index or SIMD. 37.7% of people living in the most rural areas (UR8 7-8) had their test performed in a more urban setting (UR8 1-6), and 20.4% people had their test performed in a very urban setting (UR8 1-2). Of these tests, there was a tendency for UR8 7-8 patients to be more likely to have a positive test if tested in an urban setting. Conclusions: These results are similar to previous results in other countries that suggest that Chlamydia positivity is similar in rural and urban settings. A large proportion of people living in more rurally classified areas, and perhaps those with a higher risk, have their test in a central setting, suggesting that they may be bypassing local resources to get a test. The reason for this is not clear. The results also show that men are more likely to have their test in a genitourinary setting as well as have proportionately more positive results. These results support the case for customising sexual health services to the most rural areas and suggest that providing an anonymous testing service in these areas might be beneficial, especially for men.