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Screening males for chlamydial infection in high schools

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?

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Screening males for chlamydial infection in high schools

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  1. Screening males for chlamydial infection in high schools Charlotte Gaydos, Dr.P.H. Johns Hopkins University Baltimore, Maryland

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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%

  10. 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%)

  11. 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

  12. BALTIMORE CHLAMYDIA PREVALENCE BY YEAR: HIGH AND MIDDLE SCHOOL FEMALES 242 667 885 1021 2277 2242 1873 2716

  13. BALTIMORE CHLAMYDIA PREVALENCE BY YEAR: HIGH SCHOOL MALES 529 709

  14. BALTIMORE CHLAMYDIA PREVALENCE FOR Years 2000-2001 HIGH SCHOOL MALES

  15. BALTIMORE CHLAMYDIA PREVALENCE FOR 2000-2001 HIGH SCHOOL FEMALES 413 372 150 286 182 365 349 2117

  16. 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

  17. Collaborators • Jonathan Ellen • Nancy Willard • Julie Schillinger • Cornelis Rietmeijer • Charlotte Kent • Stewart Thomas • Johanna Chapin

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