1. Evaluation of Chlamydia and Gonorrhea Field Delivered Therapy San Francisco Dept. of Public Health STD Prevention and Control Services V Davila, CK Kent, L Fischer, J Chaw, J Klausner

2. Background Single dose therapy available Cefixime 400 mg – Gonorrhea Azithromycin 1 g – Chlamydia Precedent Directly observed therapy in the field for tuberculosis (TB)

3. Background (cont.) Gonorrhea (GC) and Chlamydia (CT) cases identified through STD screening at youth and adult detention centers and STD clinic Disease Intervention Specialists (DIS) assigned cases for follow-up Of cases assigned, high proportion (43%) not treated

4. Background (cont.) Screening expanded in jails (1999) Increase in GC and CT cases assigned Field Delivered Therapy (FDT) protocol implemented to help reach the growing number of clients and improve treatment

5. Objectives 1.Offer treatment to individuals with uncomplicated GC and CT infection who are unlikely, unable or unwilling to come to STD clinic 2.Evaluate FDT by measuring the number of individuals accepting medication in the field and the proportion of persons treated

6. Protocol Development Enable DIS to treat clients in the field Acting under the medical license of the STD Controller Design portable field pack for DIS to take into the field

7. Field Pack Contents Consent forms Medication instructions 3x5 card Medication packets Dosing cups Condoms STD fact sheets 8 oz. bottle of water Stationary Identification badge Cellular phone

8. Field Pack

9. Staff Training Two 1-hour training sessions Allergic reactions Concurrent medications Behavior assessment Direct observations Documentation

10. DIS Field Activities Follows standard confidentiality practices Educates client about infection and medication Obtains consent to treat Observes client taking medication Counsels client about STDs and partner notification Documents treatment

11. Percentage Receiving Treatment of Persons Assigned for Treatment Follow-Up 57% 14% 10% 61%60% (N=460)(N=620)(N=641)

12. Results 39% increase in number of cases assigned for treatment follow-up from 1998 – 2000 27% increase in proportion of cases treated after FDT was implemented

13. Conclusions FDT increases the number of clients treated Field Delivered Therapy is: Feasible Effective Beneficial

14. Implications Program FDT may assist other programs in increasing treatment follow-up of difficult to motivate individuals Research FDT should be evaluated in other communities

15. Acknowledgments Anna Branzuela Felipe Acosta Sharon Penn Terrance Sha Ilene Zolt Bettye Spears Kate Steiner

16. Contact Information Veronica Davila SFDPH STD Prevention and Control Services 1372 Mission Street San Francisco, CA 94103 (415) 554-9634 E-mail: Veronica.Davila@sfdph.org