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

1. Screening Males for Chlamydial Infection ThroughCommunity Based Organizations and Street Outreach Kees Rietmeijer, MD, MSPH Stewart Thomas Denver Public Health

2. 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

3. 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

4. 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)

5. Community-Based Organizations

6. Street Outreach

8. 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

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

10. 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)

11. 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

12. 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

13. 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

14. 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.)

15. 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

16. Greetings from Denver... Home of the World’s Smallest STD Clinic!