Increasing Chlamydia Screening Among Sexually Active Females, Ages 16-24, in a Rural Clinic Setting

Introduction: Chlamydia is the most commonly reported sexually transmitted infection in the U.S., disproportionately affecting young women. If left untreated, it can result in pelvic inflammatory disease, infertility, and ectopic pregnancy. Despite being a high-impact preventive service, chlamydia screening rates remain suboptimal, especially in rural areas with limited healthcare access. This quality improvement project aimed to increase screening rates among sexually active females aged 16–24 at two nurse practitioner-led rural health clinics in California. Methods: The intervention involved monthly staff training on evidence-based screening practices obtained from the Family Planning National Training Center. Nine staff members participated. The initiative included ongoing coaching, workflow changes, and Plan-Do-Study-Act (PDSA) cycles to support clinic improvements. Screening rates were tracked using data from the California Quality Incentive Pool Program, focusing on the rural clinics’ Medicaid managed care population. Staff feedback was collected through a post-intervention survey. Results: Screening rates for the eligible Medicaid managed care population rose from 60.81% in 2023 to 63.49% in 2024, closing the gap to the national 90th percentile benchmark (67.39%) by 40.73%. Eight of nine staff completed the survey, reporting high satisfaction with the training and improved adherence to screening protocols. Discussion: Training on evidence-based practices, supported by coaching and PDSA cycles, can improve chlamydia screening in rural clinics. This project highlights the role of nurse practitioners in expanding STI screening and addressing barriers to preventive care. Future efforts should explore patient-centered strategies to reduce screening hesitancy and sustain progress.