1. Screening Males for Chlamydial Infection Through Community Based Organizations and Street Outreach Kees Rietmeijer, MD, MSPH Stewart Thomas Denver Public Health

2. Definitions Community based organizations (CBOs) – Non-profit organizations who provide facility- based services to youth at high risk for STDs and who traditionally do not provide STD- related services Street outreach – Non-profit organizations who provide street- based services to youth at high risk for STDs

3. Two Models for Collaboration Integration of STD screening within the package of routinely offered services conducted by CBO/Outreach staff Offering STD screening on a regular basis as an add-on service (e.g, “Pee Drives”) conducted by or with assistance of project staff

4. Denver CBOs – Project-staffed “Pee-drives” at a number of organizations serving at-risk youth Out of school activities, e.g., The Spot Street Outreach – Focus on homeless youth in collaboration with and staffed by a CBO serving this population (Urban Peak)

5. Community-Based Organizations

6. Street Outreach

8. San Francisco CBOs – Pee drives during neighborhood street fairs and community college health fairs – Pee drives at Pacific Islander Wellness Centers Outreach – Project Yuthe: Peer youth outreach into neighborhoods with high-prevalence – Outreach day laborers

9. Seattle CBOs – Non-profit organizations serving families and runaways/homeless youth Outreach – Mobile van

10. CBO/Street outreach Delivering partner services Who performs partner services for Ct infections identified through CBO/street outreach activities? – Baltimore—DOH DIS – Denver—Project staff – San Francisco—DOH DIS – Seattle—School clinic staff (nurse)

11. CBO/Street outreach Acceptability EligibleApproached Accepted % CBOs Denver112 80 26 32.5 Seattle 72 45 62.5 Outreach Denver 50 45 8 18.0 Seattle 33 7 21

12. CBO/Street outreach Testing Data Screened CT+ (%) Treated (%)Interval CBOs Denver 271 25 (9.2) 23 (92) 9.1 (0 - 43) San Francisco1119 13 (1.2) 10 (77) Seattle 72 1 (1.4) 1 (1.0)14 Outreach Denver 212 26 (12.3) 18 (69) 5.1 (0 - 22) San Francisco 196 7 (3.6) 7 (1.0) Seattle 33 0 0 0

13. CBO/Street outreach Challenges and obstacles Staff generally not trained in taking sexual histories and providing STD services – Provider and client often reluctant to discuss sexual issues – Providers may forget to offer testing when busy Testing often offered in group setting – Embarrassment on side of both provider and client Transient population

14. CBO/Street outreach Facilitators More time to interact with clients to Explain the risks of CT infection Benefits of testing Assure confidentiality Reminders on client charts / encounter forms Better training for providers (role for PT centers?) Incentives for clients (e.g., Soda’s, Penlights, McDonalds’ coupons) Incentives for providers (books, movie tickets, etc.)

15. CBO/Street outreach Summary Potential of reaching hard-to-reach populations – Supported by CT prevalence data from this project Importance of identifying, educating, and training local staff – Success is often dependent on the presence of a local “champion” at the site – Role of targeted training opportunities? Incentives? How to sustain the collaboration? – Data feed-back – Developing and maintaining “nurturing” relationships between health departments and participating CBOs

16. Greetings from Denver... Home of the World’s Smallest STD Clinic!