Screening Males for Chlamydial Infection Through

Community Based Organizations and Street Outreach

Kees Rietmeijer, MD, MSPH

Stewart Thomas

Denver Public Health

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

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

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)

Community-Based Organizations

Street Outreach

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

Seattle

• CBOs–Non-profit organizations serving families and

runaways/homeless youth

• Outreach–Mobile van

CBO/Street outreachDelivering partner services

• Who performs partner services for Ct infections identified through CBO/street outreach activities?

– Baltimore—DOH DIS

– Denver—Project staff

– San Francisco—DOH DIS

– Seattle—School clinic staff (nurse)

CBO/Street outreachAcceptability

Eligible Approached Accepted %

CBOsDenver 112 80 26 32.5Seattle 72 45 62.5

OutreachDenver 50 45 8 18.0Seattle 33 7 21

CBO/Street outreachTesting Data

Screened CT+ (%) Treated (%) Interval

CBOsDenver 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

OutreachDenver 212 26 (12.3) 18 (69) 5.1 (0 - 22)San Francisco 196 7 (3.6) 7 (1.0)Seattle 33 0 0 0

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

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., Soda’s, Penlights,

McDonalds’ coupons)• Incentives for providers (books, movie tickets,

etc.)

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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Home of the World’s Smallest STD Clinic!