***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives Rates of sexually transmitted infections ( STIs ) in UK young people remain high in men and women . However , the National Chlamydia Screening Programme has had limited success in reaching men . The authors explored the acceptability of various medical , recreational and sports venues as setting s to access  self-collected testing kits  for STIs and HIV among men in the general population and those who participate in sport . Methods A stratified r and om probability survey of 411 ( weighted n=632 ) men in Great Britain aged 18–35 years using computer-assisted personal and self-interviews . Results Young men engaged well with healthcare with 93.5 % registered with , and 75.3 % having seen , a general practitioner in the last year . 28.7 % and 19.8 % had previously screened for STIs and HIV , respectively . Willingness to access self-collected tests for STIs ( 85.1 % ) and HIV ( 86.9 % ) was high . The most acceptable pick-up points for testing kits were general practice 79.9 % , GUM 66.8 % and pharmacy 65.4 % . There was a low acceptability of sport venues as pick-up points in men as a whole ( 11.7 % ) , but this was greater among those who participated in sport ( 53.9 % ) . Conclusions Healthcare setting s were the most acceptable places for accessing STI and HIV self-testing kits . Although young men frequently access general practice , currently little STI screening occurs in this setting . There is considerable potential to screen large numbers of men and find high rates of infection through screening in general practice . While non- clinical setting s are acceptable to a minority of men , more research is needed to underst and how these venues could be used most effectively BACKGROUND Opportunistic screening for genital chlamydia infection is being introduced in Engl and , but evidence for the effectiveness of this approach is lacking . There are insufficient data about young peoples ' use of primary care services to determine the potential coverage of  opportunistic screening  in comparison with a systematic population -based approach . AIM To estimate use of primary care services by young men and women ; to compare potential coverage of opportunistic chlamydia screening with a systematic postal approach . DESIGN OF STUDY Population based cross-sectional study . SETTING Twenty-seven general practice s around Bristol and Birmingham . METHOD A r and om sample of patients aged 16 - 24 years were posted a chlamydia screening pack .  We collected details of face-to-face consultations from general practice records . Survival and person-time methods were used to estimate the cumulative probability of attending general practice in 1 year and the coverage achieved by opportunistic and systematic postal chlamydia screening . RESULTS Of 12 973 eligible patients , an estimated 60.4 % ( 95 % confidence interval [ CI ] = 58.3 to 62.5 % ) of men and 75.3 % ( 73.7 to 76.9 % ) of women aged 16 - 24 years attended their practice at least once in a 1-year period . During this period , an estimated 21.3 % of patients would not attend their general practice but would be reached by postal screening  , 9.2 % would not receive a postal invitation but would attend their practice , and 11.8 % would be missed by both methods . CONCLUSIONS Opportunistic and population -based approaches to chlamydia screening would both fail to contact a substantial minority of the target group , if used alone . A pragmatic approach combining both strategies might achieve higher coverage OBJECTIVE To determine whether asking general practitioners to offer chlamydia screening at the same time as Pap screening increases chlamydia screening rates . DESIGN A pragmatic cluster r and omised controlled trial . PARTICIPANTS AND SETTING Doctors from 31 general practice s in the Australian Capital Territory performing more than 15 Pap smear screens per year , and all women aged 16 - 39 years attending those practitioners between 1 November 2004 and 31 October 2005 . INTERVENTION Doctors in the intervention practice s were asked to routinely offer combined chlamydia and Pap screening to eligible women ; doctors in the control practice s  were asked to implement screening guidelines based on a risk assessment of the individual patient ( ie , usual practice ) . MAIN OUTCOME MEASURE Chlamydia screening rate per visit . RESULTS There were 26 876 visits by eligible women during the study period : 16 082 to intervention practice s and 10 794 to control practice s.  Chlamydia screening occurred during 6.9 % ( 95 % CI , 6.5%-7.3 % ) of visits to intervention practice s and 4.5 % ( 95 % CI , 4.1%-4.9 % ) of visits to control practice s. After controlling for clustering and potential confounders , there were twofold greater odds of chlamydia screening occurring during a visit by an eligible woman to an intervention practice than to a control practice ( adjusted odds ratio , 2.1 [ 95 % CI , 1.3 - 3.4 ] ) . CONCLUSION Combining chlamydia and Pap screening increases the rate of chlamydia screening in general practice . Implementing this approach would require little additional infrastructure support in setting s where a cervical screening program already exists Background Financial incentives have been used for many years internationally to improve quality of care in general practice . The aim of this pilot study was to determine if offering general practitioners ( GP ) a small incentive payment per test would increase  chlamydia testing in women aged 16 to 24 years , attending general practice . Methods General practice clinics ( n = 12 ) across Victoria , Australia , were cluster r and omized to receive either a $ AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia . Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods : 12 month pre-trial and 6 month trial period . The impact of the intervention was assessed using a mixed effects logistic regression model , accommodating for clustering at GP level . Results Testing increased from 6.2 % ( 95 % CI : 4.2 , 8.4 ) to 8.8 % ( 95 % CI : 4.8 , 13.0 ) ( p = 0.1 ) in the control group and from 11.5 % ( 95 % CI : 4.6 , 18.5 ) to 13.4 % ( 95 % CI : 9.5 , 17.5 ) ( p = 0.4 ) in the intervention group . Overall , the intervention did not result in a significant increase in chlamydia testing in general practice . The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 ( 95 % CI : 0.6 , 1.2 ) . Major barriers to increased chlamydia testing reported by GPs included a lack of time , difficulty in remembering to offer testing and a lack of patient awareness around testing . Conclusions A small financial incentive alone did not increase chlamydia testing  among young women attending general practice . It is possible small incentive payments in conjunction with reminder and feedback systems may be effective , as may higher financial incentive payments . Further research is required to determine if financial incentives can increase testing in Australian general practice , the type and level of financial scheme required and whether incentives needs to be part of a multi-faceted package . Trial Registration Australian New Zeal and Clinical Trial Registry ACTRN12608000499381 Background Chlamydia infection is a significant public health issue for young people ; however , testing rates in Australian general practice are low . Practice nurses ( PNs ) could have an important role in contributing to increasing chlamydia testing rates . The Australian Chlamydia Control Effectiveness Pilot ( ACCEPt ) , a large cluster r and omised control trial of annual testing for 16 to 29 year olds in general practice , is the first to investigate the role of PNs in maximising testing rates . In order to assess the scope for PN involvement , we aim ed to explore PN ’s views in relation to involvement in chlamydia testing in general practice . Methods Semi structured interviews were conducted between June 2011 and April 2012 with a purposive sample of 23 PNs participating in ACCEPt . Interview data was thematically analysed using a conventional content analysis approach . Results The participants in our study supported an increased role for PNs in chlamydia testing and identified a number of patient benefits from this involvement , such as an improved service with greater access to testing and patients feeling more comfortable engaging with a nurse rather than a doctor . An alleviation of doctors ’ workloads and expansion of the nurse ’s role were also identified as benefits at a clinic level . Time and workload constraints were commonly considered barriers to chlamydia testing , along with concerns around privacy in the “ small town ” rural setting s of the general practice s. Some felt negative GP attitudes as well as issues with funding for PNs ’ work could also be barriers . The provision of training and education , streamlining chlamydia testing pathways in clinics and changes to pathology ordering processes would facilitate nurse involvement in chlamydia testing . Conclusion This study suggests that PNs could take a role in increasing chlamydia testing in general practice and that their involvement may result in possible benefits for patients , doctors , PNs and the community . Strategies to overcome identified barriers and facilitate their involvement must be further explored BACKGROUND Opportunistic testing and screening for genital chlamydia infection in sexually active women under the age of 25 years can lead to a reduction in chlamydia infection and its related morbidity . AIMS To explore the barriers to testing for genital chlamydial infection in primary care . DESIGN OF STUDY Qualitative study with focus groups . SETTING Rural and urban general practice in Southwest Engl and . METHODS Focus groups were held with r and omly selected high- and lowtesting general practice s in Herefordshire , Gloucestershire and Avon . The high- and low-testing practice s did not differ in their age/sex make-up , or by deprivation indices . Open questions were asked about the management of genitourinary symptoms and opportunistic testing for chlamydia . Data were collected and analysed concurrently until saturation occurred . RESULTS Although staff from high test rate practice s were much more aware of the evidence for opportunistic chlamydia testing and screening , none of the practice s were happy to discuss chlamydia in a consultation unrelated to sexual health . The greatest barriers to opportunistic chlamydia testing and screening were lack of knowledge of the benefits of testing , when and how to take specimens , lack of time , worries about discussing sexual health , and lack of guidance . Healthcare staff stated that any increased testing should be accompanied by clear , concise primary care trust guidance on when and how to test , including how to obtain informed consent and perform contact tracing . Staff felt that testing could be undertaken at family planning clinics or with cervical smears if patients received information before the consultation . Alternatively , in larger practice s specific chlamydia clinics could be held . CONCLUSION The Department of Health needs to be aware of the extreme pressures that primary care staff are under , and the potential barriers to any screening implementation . Efforts to increase chlamydia screening in this setting should be accompanied by clear guidance and education . Any chlamydia clinics or increased testing must have appropriate financial and staff re sources . Genitourinary medicine ( GUM ) clinics , or level three practice s with GUM expertise , will need to be increased in parallel with testing in primary care to provide appropriate contact tracing and follow-up Study objective : To assess whether  opportunistic and postal screening strategies  for Chlamydia trachomatis can be compared with usual care in a r and omised trial in general practice . Design : Feasibility study for a r and omised controlled trial . Setting : Three West of Scotl and general medical practice s : one rural , one urban/deprived , and one urban/affluent . Participants : 600 women aged 16–30 years , 200 from each of three participating practice s selected at r and om from a sample of West of Scotl and practice s that had expressed interest in the study . The women could opt out of the study . Those who did not were r and omly assigned to one of three groups : postal screening , opportunistic screening , or usual care . Results : 38 % ( 85 of 221 ) of the approached practice s expressed interest in the study . Data were collected successfully from the three participating practice s. There were considerable workload implication s for staff . Altogether 124 of the 600 women opted out of the study . During the four month study period , 55 % ( 81 of 146 ) of the control group attended their practice but none was offered screening . Some 59 % ( 80 of 136 ) women in the opportunistic group attended their practice of whom 55 % ( 44 of 80 ) were offered screening . Of those , 64 % ( 28 of 44 ) accepted , representing 21 % of the opportunistic group . Forty eight per cent ( 59 of 124 ) of the postal group returned sample s. Conclusion : A r and omised controlled trial comparing postal and opportunistic screening for chlamydial infection in general practice is feasible , although re source intensive . There may be problems with generalising from screening trials in which patients may opt out from the offer of screening Background Australia is developing a chlamydia screening program . This study aim ed to determine the attitudes of young women to the introduction of chlamydia screening in Australian General Practice . Methods In-depth face-to-face interviews with 24 young women from across Victoria , Australia , attending a r and omly selected sample of general practice s. Results Young women reported that they would accept age-based screening for chlamydia in general practice , during both sexual-health and non-sexual-health related consultations . Trust in their general practitioner ( GP ) was reported to be a major factor in the accept 
    Output:
    
The COM-B model provided the framework for underst and ing the complexity of chlamydia testing behaviour .
While we can not at this juncture state which component represents the most salient influence on chlamydia testing , across all three levels , multiple barriers and facilitators were identified relating psychological capability and physical and social opportunity .