Screening males for chlamydial infection in detention settings Charlotte K. Kent, MPH

Screening in detention Developing a collaboration How can programs identify detention settings for collaboration? –Choose health jurisdictions with moderate to high rates of disease –Determine relationship between detention (or other correctional services) and state or local public health department –Determine whether any detention facilities have existing female screening programs Who should be approached to explore collaboration? –Department of Health –Detention facilities - opinion leaders among administrators & providers of health care –Regional infertility project committee

Screening in detention Sustaining the collaboration –Funding –Provide something to detention/medical staff – pregnancy testing –Familiarity increases acceptance by detention staff –Communication Distinctions between adult and juvenile detention settings

Detention screening Integrating screening into existing services, activities Baltimore model –Adult detention DOH staff offer at intake unit, weekly via PA system Offer CT, GC syphilis, and HIV No age criteria for screening

Detention screening Integrating screening into existing services, activities Denver model –Juvenile detention Medical staff at initial processing (75%) STD staff weekly – inmates sign up for screening (25%) Offer CT & GC, every 3 months –Adult detention Medical staff at initial processing (25%) STD staff twice weekly – inmates sign up for screening (75%) Offer CT, GC, syphilis, HIV, HCV, HAV vaccine, HBV vaccine, every 3 months No age criteria

Detention screening Integrating screening into existing services, activities San Francisco model –Juvenile detention Medical staff at initial processing before shower Offer CT –Adult detention STD staff at processing (50%) Medical staff after processing (50%) Offer CT, GC and syphilis Screen years, every 2 months

Detention screening Integrating screening into existing services, activities Seattle model –Juvenile detention Screening offered at STD class taught 1/month by assigned DOH staff (attendance mandatory) Offer CT & GC

Detention screening Delivering treatment & partner services Who performs treatment follow-up & partner services? –Baltimore—DOH DIS –Denver—Project staff –San Francisco—DOH DIS –Seattle—DOH DIS Confidentiality

Detention screening Measures of effectiveness I Acceptance rate – varies widely in how measured –No. of eligible males –No. offered screening –No. accepting screening –Contrast to no. of eligible males

Number of males CT screened in detention facilities by site

Percentage of males CT positive screened in detention facilities by site BaltimoreDenverSan FranciscoSeattle N tested

Percentage of CT positive males treated in or out of detention facilities by site N CT BaltimoreDenverSan FranciscoSeattle 22171

Sentinel Surveillance in the San Francisco County Jail, Subjects by residence Female chlamydia rates by neighborhood for San Francisco, 2000 Central Jail Southeast HC

San Francisco: Decline in CT prevalence among women at Southeast HC and men at the city jail n tested % CT +

Detention Screening: San Francisco Venue rank for identifying CT & GC –Males Jails 2 nd for CT & GC (following STD clinic) Youth detention 3 rd for CT –Females Jails 1 st for CT & GC Youth detention 3 rd for CT & GC

Detention screening Challenges and obstacles Public health not priority to detention staff nor medical staff Limited resources – space, staff, cost of urine tests Many settings difficult to access inmates Difficult environment – personnel problems

Detention screening Advantages, opportunities Large population with moderate to high prevalence across all sites Adult detention may one of few ways to access men years at greatest risk for CT In moderate prevalence communities may be most effective way to screen large volume of men at risk for CT

Female chlamydia rates by neighborhood for San Francisco, 2000 Southeast HC

Sentinel Surveillance in the San Francisco County Jail, Subjects by residence Central Jail