1. Innovative Approaches to Screen School Populations for Sexually Transmitted Infections Paritosh Kaul, MD Douglas B Richardson Gerrit Bruintjes Cornelis A Rietmeijer, MD PhD Denver Health and Hospitals Denver Public Health University of Colorado Health Sciences Center

2. Background Chlamydia trachomatis most commonly reported disease. Chlamydia trachomatis most commonly reported disease. Since 1994 – largest proportion of STIs Since 1994 – largest proportion of STIs Highest age - specific rates in 2005 15-19 yr olds (2,796.6 cases per 100,000 females) Highest age - specific rates in 2005 15-19 yr olds (2,796.6 cases per 100,000 females) Chlamydia - common STI among teens Chlamydia - common STI among teens

3. Denver School Based Health Centers Collaboration between Denver Health Denver Public Schools St Anthony’s Hospitals The Mental Health Center of Denver The Children’s Hospital Arapahoe House

4. School Based Health Centers Service Sites High Schools6 Middle Schools5 Elementary1

5. School Based Health Centers Services Provided Primary Health Care Primary Health Care Confidential Visits Confidential Visits Mental Health Counseling Mental Health Counseling Substance Abuse Services Substance Abuse Services Health Education Health Education Insurance Enrollment Insurance Enrollment

6. School Based Health Centers Visit Type in 2005 - 2006 (N = 27,007)

7. School Based Health Centers Clinic Users by Ethnicity

8. School Based Health Centers Insurance Status

9. School Based Health Centers Medical High School Visits

10. Objectives To look for feasibility of screening and prevalence for Chlamydia among adolescents in school based health centers.

11. Methods Partnership between Denver School Based Health Centers and Denver Public Health Partnership between Denver School Based Health Centers and Denver Public Health Study feasibility and prevalence of Chlamydia among adolescents in School Based Health Centers. Study feasibility and prevalence of Chlamydia among adolescents in School Based Health Centers. Sexually active adolescents were screened for Chlamydia by Urine based screening Sexually active adolescents were screened for Chlamydia by Urine based screening Adolescents were treated if they were positive at the SBHC. Adolescents were treated if they were positive at the SBHC.

12. Methods (cont’d) Urine Based screening Urine Based screening –Non – invasive –Improves efficiency –Saves provider time –Treatment easy – captive audience –Non-traditional medical and non-clinical settings.

13. Results All Schools p = 0.26 PositiveNegativeTotal Males (n = 136) 22 (16.3%) 114 (83.7%) 136 Females (n = 852) 108 (12.7%) 744 (87.3%) 852 996

14. Results High Schools p = 0.29 PositiveNegativeTotal Males (n = 135) 22 (16.3%) 113 (83.7%) 135 Females (n = 809) 105 (13%) 704 (87%) 809 952

15. Results Middle Schools p = 0.78 PositiveNegativeTotal Males (n = 1) 0 (0%) 1 (100%) 1 Females (n = 43) 3 (6.8%) 40 (93.2%) 43 44

16. Barriers School system School system –central administration –local administration. Financial resources Financial resources –test –treatment

17. Public Health Implications Chlamydia affects 976,445 people (2005 CDC) and the highest age specific rates are among the 15-19 year old females Chlamydia affects 976,445 people (2005 CDC) and the highest age specific rates are among the 15-19 year old females Chlamydia long term morbidity among women – screening important Chlamydia long term morbidity among women – screening important Within SBHC the students can be screened, treated and educated regarding STIs Within SBHC the students can be screened, treated and educated regarding STIs

18. Conclusion Urine Based screening is a feasible method of screening for Chlamydia among adolescents in school based health centers.