Screening Males for Chlamydial Infection Through Community Based Organizations and Street Outreach

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Screening Males for Chlamydial Infection
ThroughCommunity Based Organizations and Street
Outreach

• Kees Rietmeijer, MD, MSPH
• Stewart Thomas
• Denver Public Health

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Definitions

• Community based organizations (CBOs)
• Non-profit organizations who provide
  facility-based services to youth at high risk for
  STDs and who traditionally do not provide
  STD-related services
• Street outreach
• Non-profit organizations who provide street-based
  services to youth at high risk for STDs

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Two Models for Collaboration

• Integration of STD screening within the package
  of routinely offered services conducted by
  CBO/Outreach staff
• Offering STD screening on a regular basis as an
  add-on service (e.g, Pee Drives) conducted by
  or with assistance of project staff

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Denver

• CBOs
• Project-staffed Pee-drives at a number of
  organizations serving at-risk youth
• Out of school activities, e.g., The Spot
• Street Outreach
• Focus on homeless youth in collaboration with and
  staffed by a CBO serving this population (Urban
  Peak)

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Community-Based Organizations
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Street Outreach
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(No Transcript)
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San Francisco

• CBOs
• Pee drives during neighborhood street fairs and
  community college health fairs
• Pee drives at Pacific Islander Wellness Centers
• Outreach
• Project Yuthe Peer youth outreach into
  neighborhoods with high-prevalence
• Outreach day laborers

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Seattle

• CBOs
• Non-profit organizations serving families and
  runaways/homeless youth
• Outreach
• Mobile van

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CBO/Street outreachDelivering partner services

• Who performs partner services for Ct infections
  identified through CBO/street outreach
  activities?
• BaltimoreDOH DIS
• DenverProject staff
• San FranciscoDOH DIS
• SeattleSchool clinic staff (nurse)

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CBO/Street outreachAcceptability

• Eligible Approached Accepted
• CBOs
• Denver 112 80 26 32.5
• Seattle 72 45 62.5
• Outreach
• Denver 50 45 8 18.0
• Seattle 33 7 21

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CBO/Street outreachTesting Data

• Screened CT () Treated () Interval
• CBOs
• Denver 271 25 (9.2) 23 (92) 9.1 (0 -
  43)
• San Francisco 1119 13 (1.2) 10
  (77) Seattle 72 1 (1.4) 1
  (1.0) 14
• Outreach
• Denver 212 26 (12.3) 18 (69)
  5.1 (0 - 22)
• San Francisco 196 7 (3.6) 7 (1.0)
• Seattle 33 0 0 0

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CBO/Street outreachChallenges and obstacles

• Staff generally not trained in taking sexual
  histories and providing STD services
• Provider and client often reluctant to discuss
  sexual issues
• Providers may forget to offer testing when busy
• Testing often offered in group setting
• Embarrassment on side of both provider and client
• Transient population

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CBO/Street outreachFacilitators

• More time to interact with clients to
• Explain the risks of CT infection
• Benefits of testing
• Assure confidentiality
• Reminders on client charts / encounter forms
• Better training for providers (role for PT
  centers?)
• Incentives for clients (e.g., Sodas, Penlights,
  McDonalds coupons)
• Incentives for providers (books, movie tickets,
  etc.)

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CBO/Street outreachSummary

• Potential of reaching hard-to-reach populations
• Supported by CT prevalence data from this project
• Importance of identifying, educating, and
  training local staff
• Success is often dependent on the presence of a
  local champion at the site
• Role of targeted training opportunities?
  Incentives?
• How to sustain the collaboration?
• Data feed-back
• Developing and maintaining nurturing
  relationships between health departments and
  participating CBOs

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Greetings from Denver...
Home of the Worlds Smallest STD Clinic!