Chlamydia prevention in Sweden—A case study of potential key factors in successful response

Background: After a continuous increase of Chlamydia trachomatis (chlamydia) in Sweden, a general reduction in reported cases was seen in 2009. However, the number and decrease of chlamydia cases varied largely between geographical regions. Aim: The aim of the present study was to identify potential key factors of successful regional prevention of chlamydia and other sexually transmitted infections (STIs). Methods: A multiple case study was performed including seven Swedish counties. Data was collected via surveys and interviews with key informants, county council registry data, survey data on condom use, and surveillance data on reported cases of chlamydia. In a case comparison, factors of prevention structure and prevention activities were identified and rated as strengths or weaknesses compared to standard preventive measures. Potential key factors were identified by examining prevention strengths corresponding to high condom use and decrease of chlamydia cases. Results: Differences were found in prevention structure and activities across counties. Identified potential key factors were; adequate investments in STI prevention, suitable organizational structure, strong leadership, managing regional STI-networks, research connection, multiple local collaborations with health care and community, high testing coverage and strategic risk approach. Conclusions: This study shows that greater consideration to structural factors of chlamydia prevention may benefit the outcomes of STI-prevention activities.