Screening males for chlamydial infection in high schools Charlotte Gaydos, Dr.P.H. Johns Hopkins University Baltimore, Maryland

School screening Developing a collaboration How can programs identify schools for collaboration? –Determine if school health services are under auspices of state or local public health department –Determine whether local schools have existing female screening programs Who should be approached to explore collaboration? –Local Department of Health –Opinion leaders among school clinic staff –Regional infertility project committee

School screening Sustaining a collaboration Discretion of screening activities- low key Consensus-building activities among clinic staff (lunches, newsletter) Sharing data from screening activities Input from clinic staff for goals and outcomes

School screening Integrating screening into existing services Baltimore model –Under supervision of BCHD –Female screening already existed –School-based clinics open daily –Staffed by nurse-practitioners –Reproductive services, acute care, condom distribution services provided –Male screening linked to administration of GAPS, sports physicals, campaigns in health classes, outreach to coaches & athletes

School screening Integrating screening into existing services Denver model –SBHCs supervised by Community Health Services –CHS & Denver Pub. Health Dept are part of Denver Health Authority –SBHCs open daily –Staffed by nurse-practitioners –Reproductive services, acute care services offered –No condom distribution –Women are referred for birth control –Male screening linked to clinic visits and sports physicals campaigns

School screening Integrating screening into existing services San Francisco model –Only in one school, San Francisco Dept P. H. –Clinic supervised by nurse practitioner, staff, health workers, peer educators –Reproductive health, mental health, acute care, condom distribution services offered –Male screening linked to opportunistic visits, sports physicals, health class campaigns, outreach to coaches

School screening Delivering partner services Who performs partner services in the schools? –Baltimore- Project DIS –Denver- Project staff –San Francisco- SF Dept. P.H. DIS staff Confidentiality

School screening Measures of effectiveness I Acceptance rate –No. eligible males Blt: 2108, Den: 77* SF:~600 –No. offered Blt: 1841, Den:60* SF:~600 –No. accepting Blt: 1364, Den: 9/60* SF: 303 Number of males screened –Baltimore % of eligible –Denver 25413% * bas. on 10 obs –San Francisco 303~50% of eligible

School screening Measures of effectiveness II Prevalence of Ct –Baltimore9.1% (124 /1364) –Denver9.1% (23/254) –San Francisco5.3% (16/303) Proportion of (+)’s treated, interval to treatment –Baltimore98.0%mean 6.7 days –Denver82.6%mean 5 days –San Francisco94.4%

School screening Measures of effectiveness III Partner services –No. of partners reported –Blt: 154Denver: 23 –No. (%) of partners with locating information –Blt: 94 (61%)Denver: 11 (47.8%) –No. (%) of partners located –Blt: 49 (52%)Denver: 7 (63.6%) –Infection rate among female partners –Blt: 18 (37%)Denver: 5 (71%)

School screening Challenges and obstacles Obtaining entry into school system Presence of infrastructure clinic in school Convincing staff of importance of screening males Convincing staff that asymptomatic males can be infected Building staff interest and support Funds Management of partners

BALTIMORE CHLAMYDIA PREVALENCE BY YEAR: HIGH AND MIDDLE SCHOOL FEMALES

BALTIMORE CHLAMYDIA PREVALENCE BY YEAR: HIGH SCHOOL MALES

BALTIMORE CHLAMYDIA PREVALENCE FOR Years HIGH SCHOOL MALES

BALTIMORE CHLAMYDIA PREVALENCE FOR HIGH SCHOOL FEMALES

School screening Advantages, opportunities It is where the prevalence may be! –Year 2000 CT rank: Balt #4 th, Denver 12 th, SF 34 th, Seattle 52 th Relatively easy to get urine samples vs. urethral swabs Not difficult to get infected males treated Opportunity to find and treat partners Female partners are probably young enough to prevent early PID Risk behaviors are high among this age group

Collaborators Jonathan Ellen Nancy Willard Julie Schillinger Cornelis Rietmeijer Charlotte Kent Stewart Thomas Johanna Chapin