# Presentation: 671277

## The Need for Sexually Transmitted Disease Screening in School-Based Health Centers

- _M Nsuami_1, SN Taylor1, LS Sanders1, TA Farley2, DH Martin1

- 1Louisiana State University Health Sciences Center,                                                                       New Orleans, LA;
- 2Tulane School of Public Health, New Orleans, LA.

## Background

- _Growing number of SBHCs_
- _Year_                     _# of sites_
- 1970                            1
- 1988 (spring)            120
- 1995-1996                900
- 1997-1998             1,157
- 1999-2000             1,380

## 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.

## 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.

## 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.

## 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);
- 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;
- 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).

## 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;
- 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;
- Partners enrolled in the same school can obtain treatment from school nurses.

## 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 were registered in their SBHCs;
- 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 were tested or treated for STDs at their SBHCs in the past 90 days.

## 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;
- Reasons for not willing to participate for those who stated they would not participate.

## Participation in the school year 2002-03

|  | Total enrolled | Participated |
| --- | --- | --- |
| Schools  SBHC + (n=2)
             SBHC - (n=5)

             Total
                                  | 1486
5146

6632 | 487 (32.8%)
1748 (34.0%)

2235 (33.7%) |
| % male | 52.4 | 53.4 |
| Mean Age, years | 16.77 | 16.96 |
| % black | 98.6 | 98.5 |

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

## Respondents from schools with SBHCs (n=629)

|  | Male | Female | Total |
| --- | --- | --- | --- |
| School Year         2002-2003
                          2003-2004 | 75.1
24.9 | 79.3
20.7 | 76.9 (484)
23.1 (145) |
| School                 A
                          B | 80.8*
19.2 | 68.2*
31.8 | 75.2 (473)
24.8 (156) |
| Age                    14-15 years
                         16-17 years
                         >=18 years
                         mean (yrs) | 13.8*
45.6
40.7
17.1* | 17.1*
52.5
30.4
16.8* | 15.3 (96)
48.6 (306)
36.1 (227)
17.0 |
| Grade                  9th
                          10th
                          11th
                          12th | 24.1
20.3
24.1
31.5 | 25.9
23.7
26.3
24.1 | 24.9 (156)
21.9 (137)
25.0 (157)
28.2 (177) |

- *p<0.03

## Clinic registration, STD symptoms and clinic visits among all respondents (n=619)

|  | Male 
(%) | Female
(%) | Total
% (n) |
| --- | --- | --- | --- |
| SBHC registration  yes
                           no
                           Don’t know | 64.6*
22.2
13.2 | 77.9*
14.1
8.0 | 70.6 (436)
18.6 (115)
10.8 (67) |
| STD symptoms     yes
                           no
                           Don’t know | 3.5
90.6
5.9 | 6.2
89.4
4.4 | 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

## 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
                           Don’t know | 4.8
88.0
7.2 | 6.7
89.0
4.3 | 5.8 (19)
88.5 (292)
5.8 (19) |
| Visit for STD test/tx       yes
                                    no | 3.6
96.4 | 7.4
92.6 | 5.5 (18)
94.5 (311) |
| Tested/treated for STD   yes
                                    no | 6.5
93.5 | 9.3
90.7 | 7.9 (26)
92.1 (304) |

- *p<0.01

## STD prevalence among clinic users and non-users

## Conclusions

- 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;
- 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;

## Conclusions

- 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;
- 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.