Evaluation of Chlamydia and Gonorrhea Field Delivered Therapy

1. Evaluation of Chlamydia and GonorrheaField Delivered Therapy V Davila, CK Kent, L Fischer, J Chaw, J Klausner San Francisco Dept. of Public Health STD Prevention and Control Services

2. Background • Single dose therapy available • Cefixime 400 mg – Gonorrhea • Azithromycin 1 g – Chlamydia • Precedent • Directly observed therapy in the field for tuberculosis (TB)

3. Background (cont.) • Gonorrhea (GC) and Chlamydia (CT) cases identified through STD screening at youth and adult detention centers and STD clinic • Disease Intervention Specialists (DIS) assigned cases for follow-up • Of cases assigned, high proportion (43%) not treated

4. Background (cont.) • Screening expanded in jails (1999) • Increase in GC and CT cases assigned • Field Delivered Therapy (FDT) protocol implemented to help reach the growing number of clients and improve treatment

5. Objectives Offer treatment to individuals with uncomplicated GC and CT infection who are unlikely, unable or unwilling to come to STD clinic Evaluate FDT by measuring the number of individuals accepting medication in the field and the proportion of persons treated

6. Protocol Development • Enable DIS to treat clients in the field • Acting under the medical license of the STD Controller • Design portable field pack for DIS to take into the field

7. Field Pack

8. Staff Training • Two 1-hour training sessions • Allergic reactions • Concurrent medications • Behavior assessment • Direct observations • Documentation

9. DIS Field Activities • Follows standard confidentiality practices • Educates client about infection and medication • Obtains consent to treat • Observes client taking medication • Counsels client about STDs and partner notification • Documents treatment

10. 14% 10% 57% 60% 61% Percentage Receiving Treatmentof Persons Assigned for Treatment Follow-Up (N=460) (N=620) (N=641)

11. Results • 39% increase in number of cases assigned for treatment follow-up from 1998 – 2000 • 27% increase in proportion of cases treated after FDT was implemented

12. Conclusions • FDT increases the number of clients treated • Field Delivered Therapy is: • Feasible • Effective • Beneficial

13. Implications • Program • FDT may assist other programs in increasing treatment follow-up of difficult to motivate individuals • Research • FDT should be evaluated in other communities

14. Acknowledgments • Anna Branzuela • Felipe Acosta • Sharon Penn • Terrance Sha • Ilene Zolt • Bettye Spears • Kate Steiner