screening males for chlamydial infection in high schools
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Screening males for chlamydial infection in high schools. Charlotte Gaydos, Dr.P.H. Johns Hopkins University Baltimore, Maryland. School screening Developing a collaboration. How can programs identify schools for collaboration? - PowerPoint PPT PresentationTRANSCRIPT
Screening males for chlamydial infection in high schools
Charlotte Gaydos, Dr.P.H.
Johns Hopkins University
Baltimore, Maryland
School screeningDeveloping a collaboration
• How can programs identify schools for collaboration?– Determine if school health services are under auspices
of state or local public health department– Determine whether local schools have existing female
screening programs
• Who should be approached to explore collaboration?– Local Department of Health– Opinion leaders among school clinic staff– Regional infertility project committee
School screeningSustaining a collaboration
• Discretion of screening activities- low key
• Consensus-building activities among clinic staff (lunches, newsletter)
• Sharing data from screening activities
• Input from clinic staff for goals and outcomes
School screeningIntegrating screening into existing services
• Baltimore model– Under supervision of BCHD– Female screening already existed– School-based clinics open daily– Staffed by nurse-practitioners– Reproductive services, acute care, condom
distribution services provided– Male screening linked to administration of GAPS,
sports physicals, campaigns in health classes, outreach to coaches & athletes
School screeningIntegrating screening into existing services
• Denver model– SBHCs supervised by Community Health Services– CHS & Denver Pub. Health Dept are part of Denver
Health Authority– SBHCs open daily– Staffed by nurse-practitioners– Reproductive services, acute care services offered– No condom distribution– Women are referred for birth control– Male screening linked to clinic visits and sports
physicals campaigns
School screeningIntegrating screening into existing services
• San Francisco model– Only in one school, San Francisco Dept P. H.– Clinic supervised by nurse practitioner, staff,
health workers, peer educators– Reproductive health, mental health, acute care,
condom distribution services offered– Male screening linked to opportunistic visits,
sports physicals, health class campaigns, outreach to coaches
School screeningDelivering partner services
• Who performs partner services in the schools?– Baltimore- Project DIS– Denver- Project staff– San Francisco- SF Dept. P.H. DIS staff
• Confidentiality
School screeningMeasures of effectiveness I
• Acceptance rate– No. eligible males Blt: 2108, Den: 77* SF:~600– No. offered Blt: 1841, Den:60* SF:~600– No. accepting Blt: 1364, Den: 9/60* SF: 303
• Number of males screened– Baltimore 1364 56% of eligible
– Denver 254 13% *bas. on 10 obs
– San Francisco 303 ~50% of eligible
School screeningMeasures of effectiveness II
• Prevalence of Ct– Baltimore 9.1% (124 /1364)– Denver 9.1% (23/254)– San Francisco 5.3% (16/303)
• Proportion of (+)’s treated, interval to treatment – Baltimore 98.0% mean 6.7 days – Denver 82.6% mean 5 days– San Francisco 94.4%
School screeningMeasures of effectiveness III
• Partner services– No. of partners reported
– Blt: 154 Denver: 23
– No. (%) of partners with locating information – Blt: 94 (61%) Denver: 11 (47.8%)
– No. (%) of partners located– Blt: 49 (52%) Denver: 7 (63.6%)
– Infection rate among female partners– Blt: 18 (37%) Denver: 5 (71%)
School screeningChallenges and obstacles
• Obtaining entry into school system• Presence of infrastructure clinic in school• Convincing staff of importance of
screening males• Convincing staff that asymptomatic males
can be infected• Building staff interest and support• Funds• Management of partners
BALTIMORE CHLAMYDIA PREVALENCE BY YEAR:HIGH AND MIDDLE SCHOOL FEMALES
12
10.2
12.112.8
8.9
10.8
14.213.1
0
2
4
6
8
10
12
14
16
1994 1995 1996 1997 1998 1999 2000 2001
242 667 885 1021 2277 2242 1873 2716
BALTIMORE CHLAMYDIA PREVALENCE BY YEAR:HIGH SCHOOL MALES
10.2
8.2
0
2
4
6
8
10
12
2000 2001
529 709
BALTIMORE CHLAMYDIA PREVALENCE FOR Years 2000-2001 HIGH SCHOOL MALES
0
5
10
15
20
25
30
DUN L C N W PAT SOU S W WAL TOT
2000 2001
BALTIMORE CHLAMYDIA PREVALENCE FOR 2000-2001HIGH SCHOOL FEMALES
10.2
14.5 14.7
9.8
14.8
18.417.2
14.2
0
2
4
6
8
10
12
14
16
18
20
DUN L C N W PAT SOU S W WAL TOT
413 372 150 286 182 365 349 2117
School screeningAdvantages, opportunities
• It is where the prevalence may be!– Year 2000 CT rank: Balt #4th, Denver 12th, SF 34th, Seattle 52th
• Relatively easy to get urine samples vs. urethral swabs
• Not difficult to get infected males treated • Opportunity to find and treat partners• Female partners are probably young
enough to prevent early PID• Risk behaviors are high among this age
group
Collaborators
• Jonathan Ellen
• Nancy Willard
• Julie Schillinger
• Cornelis Rietmeijer
• Charlotte Kent
• Stewart Thomas
• Johanna Chapin