Screening Males for Chlamydial Infection Through
Community Based Organizations and Street Outreach
Kees Rietmeijer, MD, MSPH
Stewart Thomas
Denver Public Health
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
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
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)
Community-Based Organizations
Street Outreach
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
Seattle
• CBOs–Non-profit organizations serving families and
runaways/homeless youth
• Outreach–Mobile van
CBO/Street outreachDelivering 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)
CBO/Street outreachAcceptability
Eligible Approached Accepted %
CBOsDenver 112 80 26 32.5Seattle 72 45 62.5
OutreachDenver 50 45 8 18.0Seattle 33 7 21
CBO/Street outreachTesting Data
Screened CT+ (%) Treated (%) Interval
CBOsDenver 271 25 (9.2) 23 (92) 9.1 (0 - 43)San Francisco 1119 13 (1.2) 10 (77)Seattle 72 1 (1.4) 1 (1.0) 14
OutreachDenver 212 26 (12.3) 18 (69) 5.1 (0 - 22)San Francisco 196 7 (3.6) 7 (1.0)Seattle 33 0 0 0
CBO/Street outreachChallenges 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
CBO/Street outreachFacilitators
• 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.)
CBO/Street outreachSummary
• 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
Greetings from Denver...
Home of the World’s Smallest STD Clinic!