1. The Need for Sexually Transmitted Disease Screening in School-Based Health Centers M Nsuami 1, SN Taylor 1, LS Sanders 1, TA Farley 2, DH Martin 1 1 Louisiana State University Health Sciences Center, New Orleans, LA; 2 Tulane School of Public Health, New Orleans, LA.

2. Background Growing number of SBHCs Year # of sites 1970 1 1988 (spring) 120 1995-1996 900 1997-1998 1,157 1999-2000 1,380

3. Background SBHCs Provide students with a wide range of health services, including medical, social and mental health services; High students’ utilization of services; Several positive outcomes, including delay in students’ initiation of sexual activity and increased contraception; Rates of pregnancy not statistically significantly lower compared to adolescents with no access to SBHCs or to urban youth nationally; Impact on the prevalence of STDs and on the number of adolescents diagnosed and treated for STDs has not been explored.

4. Objectives 1. To compare the prevalence of CT and GC in schools with and without SBHCs; 2. To determine the proportion of studens who report being tested or treated for STD at their SBHCs in the past 90 days; 3. To determine the prevalence of CT and GC among students who report seeking care at their SBHCs in the past 90 days.

5. Methods Setting A school-based CT and GC screening program using DNA amplification technology in urine specimens has been offered every year since the school-year 1995-1996 in a Louisiana urban school district serving predominantly low income African American youth. A school-based CT and GC screening program using DNA amplification technology in urine specimens has been offered every year since the school-year 1995-1996 in a Louisiana urban school district serving predominantly low income African American youth.

6. Methods SCREENING PROCEDURES During the testing period throughout the day, classes are escorted to the testing area (a hallway outside restrooms, an auditorium, gymnasium, or vacant classroom); During the testing period throughout the day, classes are escorted to the testing area (a hallway outside restrooms, an auditorium, gymnasium, or vacant classroom); Each student is counseled individually regarding the opportunity to participate in the testing; Each student is counseled individually regarding the opportunity to participate in the testing; Students whose parents have not provided consent are sent back to their classroom; Students whose parents have not provided consent are sent back to their classroom; Those having consent and willing to participate complete a survey form in front of a program staff who provide assistance when needed; and they are sent to a nearby restroom with a urine collection cup and asked to collect the first 30 ml of the urine stream; Those having consent and willing to participate complete a survey form in front of a program staff who provide assistance when needed; and they are sent to a nearby restroom with a urine collection cup and asked to collect the first 30 ml of the urine stream; Specimens are delivered to the laboratory on the same day for testing using strand displacement amplification (SDA) technology (BDProbeTec ET System, Sparks, MD). Specimens are delivered to the laboratory on the same day for testing using strand displacement amplification (SDA) technology (BDProbeTec ET System, Sparks, MD).

7. Methods COUNSELING AND TREATMENT School nurses provide treatment and counseling to infected students under direct observation with Azithromycin 1g sachet orally for CT and ciprofloxacin 500mg orally for GC; School nurses provide treatment and counseling to infected students under direct observation with Azithromycin 1g sachet orally for CT and ciprofloxacin 500mg orally for GC; Infected students are asked to seek an additional STD examination and HIV testing at the city STD clinic; Infected students are asked to seek an additional STD examination and HIV testing at the city STD clinic; They are also asked to refer their sex partners to the city STD clinic for treatment; They are also asked to refer their sex partners to the city STD clinic for treatment; Partners enrolled in the same school can obtain treatment from school nurses. Partners enrolled in the same school can obtain treatment from school nurses.

8. Methods In 2002-2003 and 2003-2004, students in schools with SBHCs were asked: Whether they have had symptoms of STDs in the past 90 days; Whether they have had symptoms of STDs in the past 90 days; Whether they were registered in their SBHCs; Whether they were registered in their SBHCs; The number of times they had been at their SBHCs for services in the past 90 days; The number of times they had been at their SBHCs for services in the past 90 days; Whether they had been at the SBHCs in the past 90 days because they needed testing or treatment for STDs; Whether they had been at the SBHCs in the past 90 days because they needed testing or treatment for STDs; Whether they were tested or treated for STDs at their SBHCs in the past 90 days. Whether they were tested or treated for STDs at their SBHCs in the past 90 days.

9. Methods In 2003-2004, participants were additionally asked: Whether they would still participate in the screening if the program was offered by and at the SBHC; Whether they would still participate in the screening if the program was offered by and at the SBHC; Reasons for not willing to participate for those who stated they would not participate. Reasons for not willing to participate for those who stated they would not participate.

10. Participation in the school year 2002-03 Total enrolled Participated Schools SBHC + (n=2) SBHC - (n=5) SBHC - (n=5) Total Total 148651466632 487 (32.8%) 1748 (34.0%) 2235 (33.7%) % male 52.453.4 Mean Age, years 16.7716.96 % black 98.698.5

11. Prevalence of CT and GC during the 2002-2003 school year (n=2235)

12. Respondents from schools with SBHCs (n=629) MaleFemaleTotal School Year 2002-2003 2003-2004 2003-200475.124.979.320.7 76.9 (484) 23.1 (145) School A B80.8*19.268.2*31.8 75.2 (473) 24.8 (156) Age 14-15 years 16-17 years 16-17 years >=18 years >=18 years mean (yrs) mean (yrs)13.8*45.640.717.1*17.1*52.530.416.8* 15.3 (96) 48.6 (306) 36.1 (227) 17.0 Grade 9th 10th 10th 11th 11th 12 th 12 th24.120.324.131.525.923.726.324.1 24.9 (156) 21.9 (137) 25.0 (157) 28.2 (177) *p<0.03

13. Clinic registration, STD symptoms and clinic visits among all respondents (n=619) Male(%)Female(%)Total % (n) SBHC registration yes no no Don’t know Don’t know64.6*22.213.277.9*14.18.0 70.6 (436) 18.6 (115) 10.8 (67) STD symptoms yes no no Don’t know Don’t know3.590.65.96.289.44.4 4.7 (29) 90.1 (554) 5.2 (32) Visited SBHC 49.3*59.7* 53.9 (333)** *p<0.01; **76.4% (333/436) of those registered in the SBHCs

14. Number of visits, frequency of STD symptoms, visits for STD test/tx and STD test/tx at the SBHCs Male (n=170) Female (n=163) Total(n=333) # of visits (mean) 2.05*2.41*2.23 STD symptoms yes no no Don’t know Don’t know4.888.07.26.789.04.3 5.8 (19) 88.5 (292) 5.8 (19) Visit for STD test/tx yes no no3.696.47.492.6 5.5 (18) 94.5 (311) Tested/treated for STD yes no no6.593.59.390.7 7.9 (26) 92.1 (304) *p<0.01

15. STD prevalence among clinic users and non-users

16. Conclusions CT and GC were similarly prevalent in schools with and without SBHCs; CT and GC were similarly prevalent in schools with and without SBHCs; The high clinic registration and the high recent utilization of SBHC services indicate that SBHCs are an important venue for health services delivery in this student population; The high clinic registration and the high recent utilization of SBHC services indicate that SBHCs are an important venue for health services delivery in this student population; STD control in these SBHCs based on managing symptomatic diseases will unlikely reduce the burden associated with CT and GC among adolescents served in these facilities; STD control in these SBHCs based on managing symptomatic diseases will unlikely reduce the burden associated with CT and GC among adolescents served in these facilities;

17. Conclusions The need for screening outweighs STD screening services students recently received at their SBHCs; The need for screening outweighs STD screening services students recently received at their SBHCs; The high prevalence of CT and GC among students who recently utilized SBHC services suggests that universal screening among students attending SBHCs is justified; The high prevalence of CT and GC among students who recently utilized SBHC services suggests that universal screening among students attending SBHCs is justified; Three quarters of students interviewed would be willing to be tested if routine STD screening was offered at and by their SBHC. Lack of such screening clearly represents missed opportunities for early detection of CT and GC among adolescents; Three quarters of students interviewed would be willing to be tested if routine STD screening was offered at and by their SBHC. Lack of such screening clearly represents missed opportunities for early detection of CT and GC among adolescents; This study provides evidence that local STD prevalence, and not the frequency of STD symptoms, should be the key to guide provision of STD-related services to adolescents in SBHCs. This study provides evidence that local STD prevalence, and not the frequency of STD symptoms, should be the key to guide provision of STD-related services to adolescents in SBHCs.