# Presentation: 816367

## 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

## Slide 7

## 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 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)

## CBO/Street outreachAcceptability

- 		Eligible	Approached	Accepted 	%
- CBOs
- 	Denver		112				80				26			32.5
- 	Seattle	   					72				45			62.5
- Outreach
- 	Denver		  50				45				  8			18.0
- 	Seattle							33				  7			 21

## CBO/Street outreachTesting Data

- 		Screened	  CT+ (%)	 Treated (%)	Interval
- CBOs
- 	Denver		  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
- 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

## 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

## 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.)

## 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

## Greetings from Denver...

- Home of the World’s Smallest STD Clinic!