2002 National STD Conference - Poster Abstracts 101-125
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Innovations in Quality: a Pilot Review of an Integrated Reproductive Health Record in Delaware
MT Hogan1,2, R McKenna3,4, RJ Coppola3,4, T Kariem-White3,4, S Bonu2, K O'Connor5, J Welch5, D Mann3,4, AM Rompalo1,2
1Region III STD/HIV Prevention Training Center; 2Johns Hopkins University; 3TRAINING 3; 4Family Planning Council, Inc.; 5Delaware Division of Public Health
Background: In March 2000, the Delaware Division of Public Health received a grant from the CDC to develop a comprehensive quality improvement system. A record review demonstrated that family planning (FP) and STD clinic records did not support documentation of chlamydia (CT) prevention counseling and/or partner referral activity. An ad hoc committee was identified to develop an integrated medical record for use by FP and STD clinics statewide. In June, the program requested that TRAINING 3 (T3) and Region III STD/HIV Prevention Training Center (PTC) submit a proposal to offer technical assistance to evaluate the process. A joint proposal to conduct a performance consultation, including a qualitative and a quantitative component, was submitted. In this presentation, we will describe the quantitative compnent.
Objective: To determine the effectiveness of the record to capture required data.
Methods: The team reviewed the structure of the current and the proposed records, developed a data-gathering tool, and conducted a record review in three STD clinics and eight FP clinics. The team determined sentinel fields and reported the completeness of data entry. Data were entered into Access, and analysis was performed in STATA.
Results: Forty-four medical records were reviewed, 21 (47.7%) identified as new, and 23 (52.3%) as old; 65.9% were FP, 11.4% STD; 43 (97.7%) incorporated the primary information form and were complete for date of visit, name, age, address and birthdate; 13 of 15 initial visits and 0 of 16 return visits indicated STD/HIV education; 26 of 31 had sexual history documented; and 8 of 31 showed DIS referral.
Conclusions: Neither record enhanced documentation.
Implications for Programs/Policy: The lack of documentation may indicate a need for clearer direction.
Implications for Research: Further study is necessary to understand the challenges to integrating reproductive health services, prevention and partner services, and the instruments necessary for supporting the process.
Results of a Patient Satisfaction Survey in an STD Clinic
L Lamprecht
CDC, STD Washington DC, Public Health Prevention Service, Atlanta, GA
Background: In order to improve patient care and service delivery, the DC STD Control Program needed to obtain client clinical experience feedback.
Objectives: To determine whether patients were optimally serviced at the STD Clinic.
Methods: STD counselors asked patients who received STD clinical services in September 2000 to complete a written survey. The survey questioned patients about services received, reason for the visit, behavior, and demographic information. Three hundred thirteen surveys were analyzed using Microsoft Access.
Results: Patients were questioned about their comfort level, understanding of health information, reception at the clinic, and who they felt was most helpful to them. Most patients came for STD check-ups and testing/treatment for bodily discharge but 18% came for HIV testing. Approximately 95% of patients completed their visit in two or fewer hours. Patients (54%) feel that the doctors/clinicians were most helpful to them. Fifty-three percent reported having one to two sex partners and 69% percent reported "sometimes" or "often" using condoms in the last year. Ninety-nine percent would tell a friend to come to the clinic. Geographically, most patients came from DC. Two-thirds of the patients were male and 32% were 20 to 24 years of age. Several developmental and administration limitations from this survey were addressed in the revised survey. Results from the revised survey and a comparison between the two will be discussed.
Conclusions: Patient satisfaction surveys can provide valuable information if questions are well-constructed and administered in a fashion to reduce bias and literacy/language barriers.
Implications for Programs/Policy: Programs that provide STD services should conduct satisfaction surveys so services are tailored to their patients' needs.
Implications for Research: Information about patient satisfaction surveys in STD clinics is limited; however, it is necessary for meeting the needs of high-risk populations.
Measurable Learning Objectives:
1. Participants will be able to describe obstacles in administering a patient satisfaction survey in an STD clinic with recipients of clinical care.
2. Participants will be able to develop questions that elicit the desired information.
Contact Information: Lara Lamprecht / Phone 202 727-5623 / lamprecht8@hotmail.com
Performance Measurement of the National STD Program: Identification of Candidate Measures to be Pilot Tested
SM Berman
Centers for Disease Control and Prevention, Atlanta, GA
Background: For more than 18 months, CDC and the National Coalition of STD Directors have collaborated on a workgroup to develop and implement a performance measurement system for the nation's STD programs. Any measure that would be utilized in this system would need to be pilot tested first.
Objectives: Identify a comprehensive set of candidate measures to address STD prevention activities on a community-wide basis, which would be suitable for pilot testing.
Methods: A logic model, which considered STD prevention from a community-wide perspective, was constructed and served as the basis for further development. Critical components for prevention were then identified by the workgroup, as were the specific activities and specific "outputs" associated with those components. Decisions concerning selection and construction of candidate measures were based on perceived importance of the activity measured and feasibility of being able to obtain relevant data.
Results: Over 30 candidate measures were identified, addressing "case and laboratory reporting," "partner services", "client counseling/behavior change," "screening," "clinical services," and "STD awareness." Approximately half of these measures are still in a formative stage and the rest are further along in development. In Fall 2001, these measures underwent further refinement and will be pilot tested to assess data availability, data quality, utility, and appropriateness for inclusion in a national performance measurement system.
Conclusion: The identification and pilot testing of candidate measures are important steps toward the implementation of a performance measurement system for the national STD program.
Implications for Programs: When implemented, the performance measurement system will involve all of the nation's STD project areas.
Implications for Research: Studies will need to address reliability and quality of the data utilized in the candidate measures, and identify techniques for improving program performance.
Learning Objectives: Participants will be able to describe the process by which the candidate measures were developed and describe the activities that the measures address.
Contact Information: Stuart M. Berman, Division of STD Prevention, CDC / smb1@cdc.gov
Logic Models: A Roadmap for Program Evaluation Planning
B Apt, K Childers
Centers for Disease Control and Prevention, Atlanta, GA
Background: Logic models are graphic representations of the relationships between program objectives, activities, indicators, and resources. Elements that are linked within a logic model may vary, but commonly include inputs (resources dedicated to the program), activities (what the program does with its inputs to achieve its objectives), outputs (the direct products of program activities), and outcomes ranging from short- to long-term (benefits for participants during and after the program activities). STD program managers can use logic models to enhance their ability to plan new programs by providing a roadmap to show how a program is expected to work, what activities are needed, and how desired outcomes are to be achieved.
Objective: To describe how logic models can be used to aid in the development and evaluation of STD programs
Methods: Logic model terminology will be defined and a sample logic model for a typical STD intervention will be displayed that will show the process of designing a logic model.
Results: This poster will be used to present information that (1) demonstrates the uses and benefits of logic models and (2) build participants' capacity to develop logic models for their STD programs.
Conclusions: Logic models are a useful tool that can be used by STD program stakeholders to identify key issues and questions to be addressed when evaluating existing or future programs. They can also be used to identify deficiencies, monitor changes, and denote activities that need to be redirected.
Implications for Programs: More work needs to be done with STD programs to expose them to logic modeling as tools for program planning and evaluation, and to provide examples for other areas of how they can be used.
Learning Objectives: Participants will be able to:
1. Name and describe the elements of a logic model.
2. Outline the uses and benefits of logic models in STD prevention programs.
3. Demonstrate skills in creating logic models for STD prevention programs.
Contact information: Betty Apt / Phone 404-639-8035 / bapt@cdc.gov
Partner Notification and Medication Delivery Intentions in Substance Abusers Screened for Gonorrhea and Chlamydia
PG Braslins1, JM Liebschutz1, EP Finley1, D Christiansen2, JH Samet1,2
1Boston Medical Center, Boston, MA; 2Boston University School of Public Health, Boston, MA
Objectives: To assess partner notification (PN) preferences and acceptability of providing medication to index cases to deliver to the sex partner/s (SP) of substance abusers.
Method: Substance abusers in detoxification or methadone maintenance programs were offered a test for gonorrhea and chlamydia. Consenting participants provided urine and completed a structured interview (demographics, drug history, prior STDs, HIV status, risk behavior, and history of physical/sexual abuse). Participants were asked, if they tested positive, about their preferred method of PN, and whether they would notify SP, deliver medication to their SP, and provide SP names to the Department of Public Health (DPH) or clinic nurse (CN).
Results: Two hundred eighty-two heterosexual participants enrolled. Ninety-seven percent reported positive PN intentions. Ninety-five percent reported positive intention to deliver medication (89% all, 6% some). Fewer participants reported that they would name SP to DPH (72% all, 5% some) or the CN (69% all, 4% some). Predictors were assessed for stated refusal to notify SP (n = 9), deliver medication to any partners (n = 18), and give names to DPH (n = 67) or CN (n = 78). There were no statistically significant associations in univariate tests of age, gender, race/ ethnicity, income, education, current drug use, behavioral risk, or history of sexual abuse (? = 0.1). Associations were found between: no intention to notify SP and physical abuse (p=.005); no intention to DM and HIV(+) status (p=.057) and not being sexually active (p=.03); and prior STD and no intention to name SP to DPH (p=0.003) or CN (p=.008). Multivariate and gender stratified models will be examined using possible predictors of significance.
Conclusion: Partner notification by self-referral is preferred by substance abusers. Giving medication to deliver to sex-partner/s was highly acceptable, more so than provider referral.
Implications for Programs/Policy: To substance abusers, provision of antibiotics to deliver to sex partner/s is an acceptable strategy for notifying and treating partners for STDs.
Learning Objective: Participants will be able to discuss the partner notification preferences of substance abusers in treatment and the predictors of their partner notification intentions, when screened for gonorrhea and chlamydia.
Contact Tracing Sexual Partners from Infected and Non-Infected Research Subjects
C Kennel1, D Orr2, B Batteiger2, JD Fortenberry2
1Marion County Health Department; 2Indiana University School of Medicine, Indianapolis, IN
Background: Awareness that sexual networks are important factors in the spread of STDs requires researchers to recruit sexual partners of uninfected, but at-risk individuals. Little information exists about the feasibility of identifying and recruiting partners of uninfected subjects.
Objective: To analyze how infection status affects the contact-tracing process and how research contact tracing benefits a STD clinic.
Methods: Projects using a disease intervention specialist (DIS) trained for research provided the data. Index subjects with chlamydia and/or gonorrhea were defined as infected (n = 68), others were non-infected (n = 83). DIS partner tallies and field record dispositions of infected non-research patients (n = 1,088) were compared against those of the research DIS to assess how research involvement influenced contact tracing.
Results: Mean numbers of sexual contacts of infected (2.01, SD 1.34) and non-infected (1.93, SD 1.62) research subjects were similar. However, partners of infected subjects were more likely to enroll (0.54 vs. 0.30 per index) in research and less likely to refuse (0.25 vs. 0.43 per index) than partners to non-infected subjects (?2 = 9.4, P <0.01). Infected research subjects named more partners than infected non-research patients (1.38 vs. 0.62 per index, P <0.001), with no significant difference in the proportion of partners whom either DIS group contacted. The research DIS found 0.94 partners per infected index. Due to random sampling, 31% of research DIS interviews and 39% of partner investigations involved infected subjects, thus contributing to the health department's mission.
Conclusions: People exposed to infected subjects are more likely to enroll as partners in research. Infected subjects who participate in research may be more willing to provide partner information.
Implications for Programs: Research can benefit STD clinics by sharing the contact-tracing burden and possibly increasing the number of contacts traced.
Implications for Research: Recruiting sexual partners of non-infected subjects for research purposes is difficult. Information about partnerships increases our understanding about STD transmission.
Contact Information: Christopher Kennel / Phone 317-221-8314 / ckennel@iupui.edu
Randomized Trial of Supplementary Interviewing Techniques to Enhance Recall of Sexual Partners in Contact Interviews
DD Brewer1, JJ Potterat2, SQ Muth2, PZ Malone2, PA Montoya2, DA Green2, HL Rogers2, LA Plummer2, T Maldonado2, S Hurlbutt2, D Dorobiala2, P Cox2
1Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington; 2El Paso County Department of Health and Environment, Colorado Springs, Colorado
Background: Research indicates that people with multiple sex partners tend to forget a significant proportion of their partners. Other work shows that certain supplementary interviewing techniques can enhance recall of sex partners in a research study context that does not involve actual tracing of partners.
Objectives: To evaluate supplementary interviewing techniques for enhancing recall of sex partners in a partner notification context.
Methods: We conducted a randomized trial of supplementary interviewing techniques in the course of routine contact interviews for chlamydia, gonorrhea, and syphilis in Colorado Springs, Colorado. We randomly assigned 114 patients with multiple sexual partners in the last 3 months to one of three techniques, administered after patients recalled their partners on their own. One experimental set of techniques included cues based on locations where people meet partners, role relationships, network ties, and first letters of names. Another experimental technique included common first names as cues. The control technique had an equal number of cues based on individual characteristics (e.g., physical appearance).
Results: The location/role/network/alphabetic cues elicited more additional sexual partners (mean = 0.58) than the first name cues (mean = 0.31) or individual characteristic cues (mean = 0.25). The supplementary techniques increased the number of infected persons brought to treatment by 10% (29 elicited before the supplementary techniques, three elicited by the supplementary techniques). Other results include changes in sexual network properties due to the contacts elicited by the supplementary techniques, comparisons between technique-elicited partners with those elicited prior to the techniques on epidemiologic variables, and patient correlates of responsiveness to the techniques.
Conclusions: Sex partner recall can be enhanced in contact interviews with simple interviewing techniques.
Implications for Programs/Research: The improved ascertainment of sexual contacts allows some infected persons to be identified and treated earlier than they might be otherwise, thereby preventing further transmission.
Learning Objectives: Participants will be able to describe the components of supplementary interview techniques to enhance recall of sexual partners and the evidence for their effectiveness.
Contact Information: Devon D. Brewer / Phone 206-731-2257 / ddbrewer@u.washington.edu
Integrating Partner Notification into HIV Reporting: The New York State Experience
R Thomas1, FB Coles1, HIV Reporting Workgroup2
1Bureau of STD Control, New York State Department of Health, Albany, NY; 2Representatives from AIDS Institute, Bureau of HIV/AIDS Epidemiology, Bureau of Legal Affairs, Division of Epidemiology, Bureau of STD Control, New York State Department of Health, Albany, NY
Background: NY was the first state to integrate partner notification (PN) with HIV reporting, including known partners and their PN status on provider reports of initial cases of HIV infection, HIV-related illness and AIDS. Reports (outside NYC) are entered into a centralized electronic tracking system and conveyed to local Partner Notification Assistance Programs (PNAP) for follow-up primarily by STD field staff.
Objectives: To describe: a) the evolution of PN policies under new reporting regulations; b) provider PN patterns/outcomes; and c) challenges of integrating PN into HIV reporting.
Methods: Analysis of quantitative data from the electronic tracking system (number of partners/notification status/outcomes reported by providers, and level/ outcomes of PNAP involvement) and qualitative process evaluation feedback.
Results: Provider PN patterns* showed the majority of PN was "closed" within the patient/provider encounter, without request for PNAP services, with often limited documentation. NYS subsequently changed follow-up procedures to offer PN assistance on each report (providers receptive), which progressed to initiating PN collaboration at the earliest possible level (lab report). Challenges included adopting separate case management systems for HIV and STD PN, and rollout and training for the new tracking system. (*Specific outcome data will be presented; cannot include here because they are pending approval for public release.)
Conclusions: Data on completeness of reporting, PN outcomes, and approaches used by providers served as a catalyst to revise PNAP response. Mandatory provider reporting of partners helped legitimize expanded PNAP program contacts with providers.
Implications for Programs/Policy: Data support the need to ensure providers develop necessary knowledge/skills for eliciting and notifying partners. This model may require that PNAP staff reallocate job duties, given time investment required with enhanced provider communications around PN.
Implications for Research: Research needed on longer-term impact of the law; and relative effectiveness of initiating HIV PN in different stages/settings.
Learning Objectives: During this presentation, attendees will: learn the scope and operational procedures of the recent New York state law that requires information on partners and notification status be included as part of HIV reporting; review data highlights from an initial reporting period on provider and DIS PN patterns; and understand key issues identified (e.g., expansion of DIS role, new communication procedures with providers, and dual case management systems for HIV/STD PN) in implementation of the law.
Methods and Effectiveness of Partner Notification of Syphilis Patients Attending STD Clinic in Shenzhen
H Zhou, H Dai, L Shi
Shenzhen, China
Background: Partner notification, also known as contact tracing, is the process of contacting the sexual partners of an individual with a sexually transmitted disease (STD) and advising them that they have exposed to infection. It constitutes one aspect of STD control alongside health education and screening and treatment of cases. It has long been regarded as a cornerstone of STD control. China is confronted with a hard time of STD prevalence. The current methods of STD control, such as health education and treatment of cases, have gradually shown their shortcomings as they can cure the individuals who come to get medical examination but can not help those who may be infected but unaware of their risk of infection. Partner notification is a good compensation for these methods. By conducting the research, we hope to make clear the outlook and effect of partner notification in China.
Objective: To find out the best method and evaluate the effectiveness of partner notification for syphilis.
Method: Syphilis patients who attended a STD hospital in Shenzhen during June to July 1999 were asked about their sexual contacts, then the index patients selected a method to notify their partners and asked them to get medical examination.
Results: Seventy-five index patients reported 133 partners; the average number of partners is 1.8. Twenty-two (16.5%) of the partners had already received a medical examination, 52 (39.1%) could not be notified, 50 (37.6%) could be initiated partner notification, and 9 (6.8%) index patients declined to notify. All the index patients selected patient referral and declined provider referral and contract referral. Forty-two (84.0%) of the 50 were notified, and 39 of the notified got medical examination in the same or other hospitals, and the infection rate was 43.6%. Partner notification made 44.3% of the fixed partners, 25% of the casual partners, and 2.4% of the commercial partners get a medical examination.
Conclusions: As the infection rate is relatively high, partner notification should be conducted to enhance the health of the partners. The most acceptable method of syphilis partner notification is patient referral. The effectiveness of partner notification for syphilis was mainly affected by the type of the partner. More research must be conducted on partner notification.
Building and Mobilizing Community Partnerships in the Inner City, Bronx, New York, 2000
M Freeman1, D Hazel2, G Stover3, D Arthur4, R Fishlowitz1, R Friedman5, S Blank1,6
1New York City Department of Health Sexually Transmitted Disease Control Program, New York, NY; 2Planned Parenthood, Project Street Beat Bronx, NY; 3Montefiore Adolescent AIDS Program, Bronx, NY; 4Better Bronx For Youth, Bronx, NY; 5Mailman School of Public Health, Columbia University, New York, NY; 6Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Background: In the Morrisania-Highbridge neighborhood (M-H) of Bronx, New York, the year 2000 chlamydia rate was 1,340 per 100,000 females (n = 1275), the second highest neighborhood rate in New York City. Eighty-seven percent of M-H cases were among women <25 years of age.
Objective: To cultivate a community coalition to assess how best to address the disproportionately high rates of chlamydia among youth aged 12-24 years in the affected neighborhood.
Methods: Via extensive outreach to all community-based organizations (CBOs) serving persons aged 12-24 years, we established an adolescent advisory group (AAG). Surveillance data provided the basis for community response.
Results: Out of this effort, the adolescent advisory group (AAG) expanded to include local educators, faith-based and youth leaders, medical providers, and political leaders. The AAG inventoried existing outreach efforts and community resources, and incorporated input from youth leaders. The AAG developed a "hot spot" map to indicate venues where risk-taking behaviors were occurring and which could be targeted for outreach. Outreach included an anonymous street survey to assess sexually transmitted disease (STD) knowledge and relevant behaviors. Survey data highlighted inconsistencies between STD knowledge and healthy sexual practices. The AAG action plan is under development and will include peer leadership training and skill building for existing AAG members and local CBOs.
Conclusion: AAG activities facilitated the creation of a community resource inventory and the use of community assessment for action plan development.
Implications for Programs: Input from adolescents and health department capacity to provide technical assistance to CBOs are critical tools in mobilizing community engagement.
Implications for Research: The determinants of risky behaviors for this population need to be elucidated so that these factors can be addressed on a community level.
A Faith-Based Response to STD Programs: The PETRA Model
JA Johnson
Shaw University Divinity School, Raleigh, NC
Background & Rationale: There seems to be a prevailing attitude among researchers that prevention and reduction of STD and HIV/AIDS must come through behavior modification. CDC reports that 1 out of 200 college students is infected with HIV. This vulnerable population needs an array of prevention messages that will enhance behavior modification. One challenge lies in providing information in practical formats useful to this population. In view of the 16 universities that comprise the North Carolina University System, Shaw University Divinity School, the graduate entity for Shaw University, is in a strategic position to serve as an enabling institution in order to effectively address high-risk behaviors among the university's multicultural population. The Shaw University Divinity School will couple theological perspectives with cross-training initiatives to address the need for behavior modification. In doing so, the Shaw University Divinity School offers a faith-based response to STD programs by planning effectively to reach the targeted population through Prevention, Education, Training, Research, and Awareness (the PETRA Model).
Purpose: The purpose of this participatory workshop is three-fold. First, we will discuss the PETRA Model. Second, we will share a faith response to prevention, education, training, research, and awareness as each relates to STD and HIV/AIDS. Third, we will offer the PETRA Model as a faith-based vehicle that can be adapted for replicability by other universities for STD and HIV/AIDS prevention programs.
Methods: Using Shaw University, (a historically black university) as a model, presenters will share the fundamental structure of the PETRA Model using a combination of methods: PowerPoint; role-playing; and questions/answers. Related statistical and evaluative data will be presented to reflect the effectiveness and acceptance of PETRA components in three domains: the campus; local churches; and surrounding communities. Participants will be invited to engage in dialogue regarding prevention strategies that could lead to reduction of STD and HIV/AIDS cases on university campuses.
Measurable Learning Objectives: By the end of this workshop, participants will be able to: 1) Identify components of the PETRA Model from a theological perspective. 2) Provide at least two faith-based responses to STD programs. 3) Identify at least two strategies of prevention as well as ways to replicate the model in a special setting, such as a university.
Working as a Community: How Public Health Can Partner with Business
M Headlee, M Krempasky, J Finley, C Cameron, C Thomas, M Carlock, K Dorian
Columbus Health Department, Columbus, OH
Background: Columbus, Ohio like many other areas of the country has received an increasing number of immigrants into our community. We have noticed many areas that have become home to certain ethnic communities. One of these areas is a large apartment complex of about 5,000 residents that are over 50% Hispanic. Sexual health services are not readily accepted or wanted in the Hispanic community.
Objectives: To find a way to work directly with the apartment complex. To offer sexual health education, counseling, and/or testing to a hard-to-reach population.
Methods: A meeting was set with the complex owner to introduce the Columbus Health Department services and discuss how sexual health needs impact the community. The owner was extremely receptive and offered to provide a townhouse free of charge to offer services to the. Other challenges included how to get other public health services to use the space, how to get the Hispanic community to utilize a sexual health clinic, and how to meet everyone's needs using the space.
Results: Currently, Columbus and Franklin County Health Departments are using the apartment. Services include sexual health, blood sugar screenings, prenatal classes, TB testing and blood pressure screenings. Franklin County also receives funds for syphilis elimination, and education sessions are being offered for men, women, and youth in the community. The community is starting to build a trust with the staff and more residents are seeking services.
Conclusions: There are benefits to taking services into a hard-to-reach community instead of expecting them to access a system that they may not be familiar or comfortable with.
Implications for Programs: Building strong community relationships, which should include the businesses in the area.
Implications for Research: Additional research could determine how to better reach the Hispanic community and provide effective services.
Learning Objectives: Participants will be able to find new ways to work with business owners and ethnic communities.
Collaborative Efforts for Prevention/Screening of STD's
M Rowser, K Bawel
University of Southern Indiana (USI) School of Nursing and Health Professions, Evansville, IN
Background: Research findings suggest that incarcerated persons are susceptible to STDs, and are less likely to seek health care. The National Commission on Correctional Health recommends voluntary health exams and STD screening within 10-14 days of incarceration. Detainees are either released prior to screening or decline screening.
Objectives: The School of Nursing has established a collaborative arrangement with the county correctional facilities, Health Department, and the community health center. The purpose of this project is to:
- Develop a collaborative model to provide education, health exams, and STD screenings.
- Provide community health care referrals.
- Provide students the opportunity to deliver culturally-diverse care.
Methods: This model permits the delivery of supplemental health care, screening and treatment for STDs and follow-up care post incarceration. Providers include advanced-practice nurses from the university and community health center, students, an RN case manager, the health department staff, and the jail medical staff. Qualitative and quantitative methods are used to evaluate the effectiveness of this model.
Results: During the first seven months of this project, faculty, staff, and students contributed 1025 hours to this project. Of 374 inmates encountered, 58% (n = 218) agreed to be tested for STDs. Thirty-four percent tested positive for one or more STD and were referred for treatment.
Conclusions: This collaborative effort links the services of four organizations in the screening and prevention of STDs. An outcome of this model is easy access to supplemental health screening, treatment ,and community health resources via case management. However, preliminary findings suggest that screening efforts need to be increased.
Implications for Policy/Programs: Findings will be used for continued development and expansion of this collaborative model, which will include education of all participants in the project of the high rates of STDs in this population and the need for increased screening efforts.
Implications for Research: will be to identify barriers to participation by the inmates in this project.
Going to the Chapel: Assessment of STD and HIV Prevention Needs Among Faith-Based Organizations in the Chicago Area
B Ford Lattimore, D Broussard, J Johnson
Chicago Department of Public Health STD/HIV Prevention and Care Program, Chicago, IL
Background: Faith-based organizations (FBOs) are one of the foundations for many communities. Chicago residents and consumers have requested STD and HIV prevention information and other resources from their respective FBOs. Because of this, FBOs have requested assistance from the health department in delivering prevention messages to their congregations and providing other services (i.e., pastoral HIV/AIDS education, technical assistance). This needs assessment will assist in the capacity building of the FBOs so that they may provide greatly needed STD and HIV prevention education and services.
Objective: To examine and to identify the unmet needs of African-American FBOs in STD and HIV prevention education and services throughout Chicago.
Methods: A combination of quantitative and qualitative data collection methods was used. Congregations were surveyed to determine their needs regarding STD and HIV prevention education and services. Focus groups were used to obtain information from church and community leaders regarding their efforts with STD and HIV prevention education and services.
Results: Preliminary results indicate some of the unmet needs perceived by FBOs were, for example, the lack of grant writing skills, the need for pastoral HIV/AIDS education, and the lack of faith-based educational materials around HIV/AIDS and STDs. These results also reveal that the health department could provide services such as an information hotline and program evaluation tools.
Conclusions: The conclusions are forthcoming following the completion of the data analysis.
Implications for Programs/Policy: A task force bringing together various FBOs will be formed to develop a seamless network of STD and HIV prevention resources and services to support FBOs in their work.
Implications for Research: This needs assessment can serve as a template for future needs assessments to support the ongoing efforts of FBOs in delivering STD and HIV prevention education and services to their congregations. Also, the data from the needs assessment can provide baseline data for evaluation.
Contact Information: Bernadette Ford Lattimore / Phone 312-747-7967 / bgf2@cdc.gov
Trends in Pelvic Inflammatory Disease Hospitalizations and Ambulatory Visits, United States, 1985-1999
MY Sutton, M Sternberg, A Zaidi, M St. Louis, W Levine
Division of Sexually Transmitted Disease Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
Background: Pelvic inflammatory disease (PID), a serious sequela of some sexually transmitted infections, is a major cause of infertility and ectopic pregnancy. No national surveillance system exists for PID, mainly because the clinical diagnosis lacks sensitivity and specificity. Although some surveys document a decline in hospitalized PID, it is not known whether this reflects a true decrease in PID, or a shift toward ambulatory management.
Objective: To estimate PID diagnosed in hospital and ambulatory settings.
Methods: Estimates of PID incidence (defined by ICD-9 codes) were calculated from 3 national surveys (National Hospital Discharge Survey, National Hospital Ambulatory Medical Care Survey, and National Ambulatory Medical Care Survey), which include data on patients discharged from hospitals or those visiting emergency departments, outpatient clinics, or physicians' offices.
Results: Hospitalized cases of PID declined 69% from 1985 through 1999. Ambulatory PID visits also decreased significantly. During the 1990's, approximately 950,000 cases of PID were diagnosed annually in the United States, 11% of which were associated with inpatient care. Women ages 15-29 were at highest risk of PID.
Conclusions: Hospitalized and ambulatory PID visits decreased during the study period. These expanded surveys in outpatient and emergency departments provide important estimates of total diagnosed PID. Efforts to promote optimal management of PID should target ambulatory settings, where an estimated 89% of PID is managed.
Implications for Programs: Programs should monitor local PID trends and help assure optimal ambulatory management of PID.
Implications for Research: Trends in PID should continue to be monitored, and systems to obtain more accurate estimates of disease burden should be implemented.
Endometritis Does Not Predict Long-Term Outcomes Following Pelvic Inflammatory Disease
CL Haggerty1, RB Ness1, DE Soper2 , RL Holley3, J Peipert4, H Randall5, RL Sweet1,6, SJ Sondheimer7, SL Hendrix8, A Amortegui1,6, G Trucco1,6, T Songer1, JR Lave1, SL Hillier1,6, SF Kelsey1, for the PID Evaluation and Clinical Health (PEACH) Study Investigators
1University of Pittsburgh, Pittsburgh, PA; 2Medical University of South Carolina, Charleston, SC; 3University of Alabama School of Medicine, Birmingham, AL; 4Women and Infants Hospital, Providence, RI; 5Emory University, Atlanta, GA; 6Magee-Women's Hospital, Pittsburgh, PA; 7University of Pennsylvania, Philadelphia, PA; 8Wayne State University, Detroit, MI
Background: Several studies have shown salpingitis is associated with infertility, ectopic pregnancy, recurrent pelvic inflammatory disease (PID), and chronic pelvic pain (CPP). No studies have examined reproductive morbidity following endometritis, a commonly used surrogate measure for PID.
Objectives: To determine the effect of endometritis on infertility, recurrent PID, and CPP.
Methods: Six hundred fourteen women in the PID Evaluation and Clinical Health (PEACH) Study with endometrial histology and culture were included. The PEACH Study is a randomized clinical trial that compares differences in reproductive morbidity by PID treatment modality (inpatient vs. outpatient). Histologic and culture-verified PID was defined as endometritis (>5 surface epithelium neutrophils absent of menstrual endometrium and/or >2 stromal plasma cells) and/or upper genital tract infection (UGTI, positive Chlamydia trachomatis or Neisseria gonorrhoeae culture). Interviews were conducted every 3-4 months (mean 35). Infertility was defined as unprotected intercourse without resulting conception during >12 months. CPP was defined as >2 consecutive pelvic pain reports. Logistic models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for age, race, education, and PID history. Additionally, models predicting pregnancy and infertility were adjusted for self-reported baseline infertility.
Results: Women with histologic or culture-confirmed PID were not significantly more likely than women with negative endometritis/UGTI to report infertility (OR 1.0), pregnancy (OR 0.8), recurrent PID (OR 0.6), or CPP (OR 0.6).
Conclusions: Endometritis is not associated with infertility, recurrent PID, or CPP in women with clinically suspected PID.
Implications for Programs/Policy: Endometritis may represent an inflammatory stage between cervicitis and salpingitis. The CDC guidelines consider endometritis to constitute a specific marker for PID. However, endometritis may not have the same clinical implications as salpingitis.
Implications for Research: Endometritis may not be an optimal measure of PID. Research in a cohort with a healthy control group would further delineate whether reproductive morbidities accrue following endometritis.
Measurable Learning Objectives: By the end of the session, participants will be able to discuss the implications of basing PID diagnosis on histologic rather than laparoscopic findings.
Presenting Author Contact Information: Catherine L. Haggerty/ Phone 412-624-3045 / clcst10@pitt.edu
Predicting Pregnancy Risk in Women Attending an STD Clinic
JC Shlay1,2,3, B Mayhugh1, M Foster1, ME Maravi1
1Departments of Public Health and 2Family Medicine, Denver Health and Hospital Authority; Department of Family Medicine3, University of Colorado Health Sciences Center, Denver, Colorado.
Background: Although STD clinics focus mainly on STD treatment and prevention, women attending these clinics are also at high risk for pregnancy. Objective: To evaluate the relationship between certain demographic and behavioral characteristics and the probability of pregnancy in women attending an urban STD clinic.
Methods: Non-contracepting women attending an STD clinic who stated a desire to avoid pregnancy and who enrolled into a randomized controlled contraception study (N = 877) were interviewed at baseline and incident pregnancies within 1 year of enrollment were measured. Association between baseline characteristics and incident pregnancy was assessed by Chi-square analysis, and logistic regression was used to assess factors associated with incident pregnancy.
Results: Of the 673 (76.7%) women with follow-up pregnancy information, 220 (32.7%) incident pregnancies occurred within one year. By logistic regression, controlling for study assignment, incident pregnancy was associated with age <19 years (OR 2.8; 95% CI: 1.5-5.2), sex at least once a week (OR 1.8; 95% CI: 1.2-2.6), chlamydia infection at enrollment (OR 1.8; 95% CI: 1.0-3.2), and previous abortion (OR 3.1; 95% CI: 1.7-5.4). By using an unweighted combination of demographic and behavioral characteristics, correlated by univariate analysis with incident pregnancy (i.e., age <19, non-Caucasian, <high school diploma or general equivalency diploma, previous pregnancy history, no use of birth control method with last intercourse, sex at least once a week, previous abortion, >3 partners within the past month and <17 years of age with first pregnancy), the cumulative risk of pregnancy with 6 or more of the 9 characteristics was 51% compared to 25.6% for women with <5 characteristics.
Conclusion: For this STD clinic population, a combination of demographic and behavioral characteristics was useful in identifying a subgroup of women at higher risk for subsequent pregnancy.
Implications for Program/Policy: Targeted intervention by STD providers should include the provision for both pregnancy and STD prevention counseling.
Implications for Research: Future research and evaluation should focus on implementing strategies to assist high-risk women prevent both pregnancy and STD/HIV.
Objectives: Participant will be able to describe a methodology for predicting pregnancy in high-risk women attending an STD clinic.
Contact information: Judy Shlay / Phone 303-436-7200 / jshlay@dhha.org
Assessment of STD Prenatal Screening Rates in Maine
J Gunderman-King1, SJ Shapiro1,2, P Kuehnert1
1Maine Bureau of Health; 2Centers for Disease Control and Prevention
Background: The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Obstetricians and Gynecologists recommended that all pregnant women be prenatally tested for hepatitis B, syphilis, gonorrhea, chlamydia, and HIV. Infected newborns may suffer chronic liver disease, physical and developmental abnormalities, blindness, as well as increased susceptibility to common pathogens. These complications can be prevented by appropriate screening and treatment of all pregnant women.
Objective: To determine prenatal STD screening rates in all Maine birthing hospitals through a collaboration between state STD, HIV, and Immunization programs.
Methods: A random sample of medical records of women giving birth between January 1, 1999, and June 30, 1999, at each birthing hospital was reviewed. Maternal demographic information and diagnostic test results were collected. Frequency and correlation data were calculated.
Results: Individual hospital screening data ranged from 62 to 100% screened for hepatitis B, 29-100% for syphilis, 0-97% for gonorrhea, 0-98% for chlamydia, and 0-86% for HIV. Frequency data were further categorized by geographic region and hospital size. Regional differences, as well as disparities among hospitals of varying sizes, were statistically significant.
Conclusions: Prenatal STD screening rates ranged from poor to excellent, depending on hospital size and location. Comprehensive strategies are needed to educate providers regarding appropriate prenatal STD screening and documentation of results.
Implications for Programs/Policy: All public health programs targeting prenatal health care providers should develop core prenatal care competencies, including recommendations for appropriate STD screening and documentation of results. Data could be used to develop legislation mandating prenatal STD screening.
Implications for Research: Surveys, focus groups, and interviews should be conducted describing health care providers' reasons for inadequate testing and/or documentation.
Learning Objective: By the end of the session, participants will be able to discuss the importance of evaluating prenatal STD screening rates and implications for disease prevention, public policy, and legislative action.
Azithromycin for Chlamydial Infection in Pregnancy
S Guerry1, M Rhew1, M Kang1, R Baxter2, H Bauer1, G Bolan1
1California Department of Health Services STD Control Branch, Berkeley, CA;2Kaiser Permanente Northern California
Background: Azithromycin, a single-dose, first-line treatment for chlamydia in non-pregnant women, is not recommended by the Center for Disease Control in pregnancy due to limited data on safety and efficacy. Erythromycin or amoxicillin taken four or three times a day, respectively, for seven days is presently the CDC recommended treatment for chlamydia infections in pregnancy despite poor efficacy and frequent side effects; azithromycin is listed as an alternative treatment.
Objectives: To determine the use, effectiveness, and safety of azithromycin in treatment of chlamydia in pregnancy compared with other antibiotics.
Methods: A retrospective cohort study of over 400 chlamydia-infected pregnant women treated with azithromycin or other antibiotics in a large northern California health maintenance organization. Changes in antibiotics, reported side effects, test-of-cure, pregnancy complications, post-partum complications, and neonatal/infant complications were determined from administrative data and chart review.
Results: Azithromycin was prescribed in about half of cases; other treatments included amoxicillin and erythromycin. Preliminary review of data showed no significant differences in pregnancy complications, post-partum infections, or infant morbidity in the group treated with azithromycin compared to the groups treated with other antibiotics.
Conclusion: Azithromycin is frequently used as initial treatment of chlamydia infection in pregnancy and appears to be equal in efficacy and in safety to current first-line agents. These data support the use of azithromycin as a first-line treatment in pregnancy.
Implications for Programs/Policy: Azithromycin, as a single-dose regimen, should be considered a safe and effective treatment for chlamydia infection in pregnancy. It is ideal for high-risk, low-compliance populations such as pregnant teens as well as patients with pregnancy-induced nausea.
Implications for Research: Randomized trials of azithromycin in pregnancy would best evaluate its safety and efficacy. Studies involving higher-risk pregnant patients, such as adolescent and indigent populations, should be conducted to determine whether treatment with azithromycin improves compliance.
Learning Objectives: By the end of this session participants will be able to describe appropriate treatment options for chlamydia infection in pregnancy.
Contact info: Sarah Guerry / Phone 510-883-6650 / sguerry@dhs.ca.gov
Assessment of Prenatal Syphilis Screening and Factors Influencing Likelihood of Screening in a High Morbidity Area - Marion County, Indiana, 1999
D DiOrio Rekas1,2, J Arno3,4, C Langley3,4, A Goldsmith4; S Fiorini5, M McLaughlin5
1Centers for Disease Control and Prevention, Atlanta, GA 2New Jersey STD Program, Trenton, NJ; 3Indiana University School of Medicine, Indianapolis, IN; 4Marion County Health Department, Indianapolis, IN; Indiana University School of Public & Environmental Affairs, Bloomington, IN
Background: Congenital syphilis (CS) cases are often attributed to lack of prenatal testing. CDC recommends syphilis testing for all pregnant women. Marion County, Indiana had the highest case rate of primary and secondary syphilis per 100,000 population in the U.S. in 1999. It did not know the extent of local compliance with prenatal testing recommendations. It was also unknown which, if any, factors contributed to a woman's likelihood of being screened.
Objective: To determine the level of prenatal syphilis testing in Indianapolis as well as to determine if there are factors affecting the likelihood of a woman being tested for syphilis during pregnancy.
Methods: Marion County birth certificate data was analyzed for frequency of first or second syphilis test recorded. Multivariate logistic regression was then utilized to determine if a woman's likelihood of receiving a syphilis test during pregnancy was influenced by selected factors.
Results: Ninety-one percent of women giving birth in Marion County during the study period had a prenatal syphilis test recorded on the birth certificate as first test and 84% had a test recorded as second test. Multivariate logistic regression showed that race and ZIP Code were not statistically significant predictors of a woman's likelihood of being tested during pregnancy. Factors emerging as predictors of a woman's likelihood of being tested included: adequacy of prenatal care, hospital, education, and drug use.
Conclusions: The high level of screening indicates compliance with state law and public health recommendations. Inadequate prenatal care, drug use during pregnancy, fewer years of education, and hospital of delivery reduced the likelihood of receiving a syphilis test in both first and third trimesters.
Implications for Programs: It is critical for health departments to know the level of testing in order to prevent CS and to target interventions to increase screening.
Implications for Research: Additional research should be conducted to assess local level of prenatal syphilis screening, to identify what factors affect likelihood of testing, and to identify missed opportunities for CS prevention.
Learning Objectives: Participants will be able to name factors influencing the likelihood of prenatal syphilis screening in Marion County, Indiana.
Contact Information: Dawne DiOrio Rekas / drekas.cdc@attglobal.net / dor7@cdc.gov
Congenital Syphilis Prevention Practices of Obstetrician-Gynecologists, and Delivering Hospitals in Florida, 2001
J Dettis, K Schmitt, P Moncrief and S Shiver
Florida Department of Health, Bureau of STD Prevention and Control
Background: Congenital syphilis has decreased dramatically in Florida in the past ten years. However, stillbirths due to syphilis and births that meet the diagnostic criteria for congenital syphilis continue to occur in Florida. Most are thought to be preventable.
Objectives: To determine congenital syphilis prevention practices of obstetrician-gynecologists and hospitals in Florida.
Methods: Surveys were mailed to all obstetrician-gynecologists in Florida to determine practices regarding performance of first-trimester syphilis serologies, early third-trimester serologies, and cord blood at delivery. All delivering hospitals and birthing centers in Florida were asked the same questions. Sixteen hundred surveys were mailed to obstetrician-gynecologists, and two hundred surveys were mailed to delivering hospitals and birthing centers. As of September 28, 2001, three hundred completed surveys have been received from physicians and fifty completed surveys have been received from delivering facilities (deadline for returning surveys is October 15, 2000).
Results: Results of surveys are pending, however, initial submissions reveal that most obstetrician-gynecologists in Florida perform a first-trimester prenatal serology and do not perform a later (third-trimester) serology. Additionally, preliminary data suggest that at 50% of deliveries, infant serology cord bloods are drawn.
Conclusions: Preliminary findings suggest that most Florida obstetrician-gynecologists are not in adherence to state law and standards of practice regarding routine performance of a third-trimester syphilis serology on pregnant clients. Implementation of standards for performance of early third-trimester serology on all pregnant women in Florida may assist syphilis and congenital syphilis eradication efforts. Implementation of training on this topic may be an outcome of the final completed survey analyses.
Implications for Policy: As above.
Implications for Research: As above.
Learning Objectives: The learner will be able to demonstrate an awareness of congenital syphilis prevention practices in Florida.
Contact: Johnna Dettis or Karla Schmitt / Phone 850-245-4303
North Carolina's HIV Perinatal Provider's Partnership
JM Owen-O'Dowd1, EM Foust1, K Troccoli2
1North Carolina Department of Health and Human Services, HIV/STD Prevention and Care Branch, Raleigh, NC; 2American College of Obstetrics and Gynecology, Washington, DC
Background: Although most prenatal care providers agree in principle with offering HIV testing to all pregnant women, only 50-75% actually does so. Public providers are more likely to offering testing than private providers. With that in mind, a group of public and private sector health care workers joined forces in North Carolina to identify and address prenatal HIV counseling and testing barriers.
Objective: To identify barriers that prenatal care providers encounter to HIV counseling and testing and develop strategies for addressing them.
Methods: The North Carolina American College of Obstetrics and Gynecology (NC ACOG) Section and Department of Health and Human Services initiated a project to increase rates of HIV testing in pregnancy. Over thirty health care providers, educators, public health representatives, and academics participated. They jointly developed a written survey that was mailed to all ob-gyns, family physicians practicing obstetrics, and certified nurse-midwives in the state. The results were used to develop a statewide educational campaign.
Results: The survey confirmed that many prenatal care providers are doing "risk assessment" to determine if a woman should be tested. The most significant barriers to HIV testing were treating an HIV-positive patient and informing a woman she is HIV-positive. Practitioners also want low-literacy and culturally appropriate patient education materials. In response, the partnership group developed a perinatal HIV resource packet that is being mailed to all prenatal care providers in NC. Perinatal outreach workers will conduct HIV counseling and testing trainings for providers.
Conclusions: Public/private partnerships are an effective strategy for addressing this and related issues. Additional work remains to ensure that prenatal care providers offer HIV testing to all pregnant patients.
Implications for Programs/Policy: Public and private providers in other states should work together to maximize resources and expertise to address perinatal HIV and related issues.
Implications for Research: Additional surveys on HIV counseling and testing barriers in other states would help to better understand how widespread these specific issues are.
Measurable Learning Objectives: Participants will be able to identify key barriers for prenatal providers to offering HIV counseling and testing to all their patients. They also will learn strategies for bringing public and private sector health care providers together to work on an issue of mutual concern.
Contact: Judy Owen-O'Dowd/Phone 919-733-9553/ judy.owen.odowd@ncmail.net
Sexually Transmitted Infections Among Antenatal Clinic Attendants in Cameroon
PM Ndumbe1, W Eseme1, E Asonganyi1, A Adimora2
1Department of Microbiology and Infectious Diseases, Faculty of Medicine, Yaounde Cameroon; 2University of North Carolina, Chapel Hill, USA
Background: Between 1986 and 2000, HIV prevalence in Cameroon soared from 0.01% to 11%. Despite the role of sexually transmitted infections (STIs) in facilitating HIV transmission, Cameroon still lacks an effective STI control strategy.
Object: By the end of this session, participants will be able to: (1) determine the prevalence of treatable STIs among pregnant women in urban areas of Cameroon; (2) identify programmatic issues in developing the STD component of the Cameroon HIV/AIDS control plan.
Methods: This is a descriptive study. Some 378 random antenatal clinic attendants from three hospitals in the administrative and commercial capitals of Cameroon (Yaounde and Douala) underwent testing for Neisseria gonorrhoea infection; 204 of these women were also tested for Chlamydia trachomatis, Candida albicans, syphilis, Trichomonas vaginalis, and bacterial vaginosis (BV).
Results: About 60.7% of these women had at least one STI. The prevalence of STIs were as follows: BV 34%, C. albicans 17.6%, N. gonorrhoea 12.7%, T. vaginalis 10.3%, Chlamydia 5.9%, and syphilis 3.9%. Of these, 51.9% had multiple infections. Genitourinary tract symptoms were common: vaginal discharge 33.3%, pelvic pain 33.3%, dyspareunia 19.6%, pruritus 18%, dysuria 8%, and cervical muco-pus 20%. However, 53% of the 77 asymptomatic women also had at least one STI and 34% of the 127 symptomatic women were infection free.
Conclusions: The high prevalence of treatable STIs among antenatal clinic attendants in urban Cameroon reflects a similarly high prevalence in the general population, which is likely fuelling the nation's HIV epidemic.
Implications for Programs: These data should be considered in the development of a comprehensive STD component of the national HIV/AIDS control plan. The identification and treatment of STIs in pregnant women.
Implications for Research: The development of simple tests for detection of STIs in pregnant women in resource-poor settings where over 70% of them attend.
Contact Information:
Peter Ndumbe: pndumbe@yahoo.com
Barriers to Screening Adolescents for Chlamydia During Health Supervision Pediatric Visits in a Large HMO
S Brown1, R Pantell1, K Tebb1, M Shafer1, J Kaplan1, A Gyamfi1, S Cruz1, C Wibbelsman2
1University of California, San Francisco, CA; 2Kaiser Permanente Medical Group Northern California, CA
Background: HEDIS guidelines recommend universal annual chlamydia (CT) screening of sexually active adolescent females. Even with new urine tests only a minority are screened.
Objective: To identify barriers to CT screening of teens during pediatric health supervision visits.
Methods: As part of a larger study to improve CT screening, five pediatric clinics participated in a systems-level quality improvement model (QIM). Provider and systems-level screening barriers were identified using an anonymous provider survey and qualitative data gathered by research associates (RA's). Fifty-five pediatric providers (79%) responded to anonymous surveys about CT screening during pediatric visits. A Likert scale was applied to rate the frequency of barriers occurring using a scale from four (very frequently) to one (very rarely). At the time of the survey providers were unaware of teen self-reported sexual activity rates of 25% and 7.5% CT prevalence by urine screening. Mean scores are reported.
Results: Providers identified barriers to screening: belief of a low sexual activity rate in practice (3.7); difficulty in rooming teens without parents (3.5); teens unable to provide urine sample (3.4); belief of low CT prevalence in practice (3.0); unsure how to get teen to disclose (2.5); unsure about follow-up of CT(+) (2.3); discomfort in taking sex history (2.0); can't assure confidentiality (1.9); and inappropriate to ask about sex (1.0). RA's identified the lack of provider "buy-in" for screening needs, lack of visit time, and frequent clinic support staff changes as significant barriers.
Conclusions: Both provider and health-care system barriers need to be addressed before universal CT screening in teens can be accomplished.
Implications for Program/Policy: Interventions need to address barriers at the provider and systems level to achieve universal CT screening of teens during pediatric-visits.
Implications for Research: Successful interventions are needed that will be effective in overcoming barriers to screening sexually active adolescents for chlamydia.
Characterizing High School Males and Their Sex Partners
N Willard1, A Joffe1, C Gaydos1, G Waterfield2, J Ellen1
1Johns Hopkins University School of Medicine, Baltimore, MD; 2Baltimore City Health Department, Baltimore, MD
Background: Understanding where and how high school boys meet their sex partners can assist in targeting prevention and intervention efforts.
Objective: To describe characteristics of male adolescent high school students and their sex partners including where and how they met.
Methods: Longitudinal study of adolescent males ages 15-18 who tested positive for chlamydia and/or gonorrhea in a urine-based asymptomatic screening project being conducted in eight Baltimore City high schools and a teen clinic. Participants were asked the following for each main and casual sex partner in past three months: age, gender, and where and how they met. Preliminary results on 19 males are presented.
Results: Thirteen participants had at least one main sex partner, and 17 had at least one casual sex partner in past three months. Mean age difference between participants and their most recent main partner was 0.5 years; the age difference was 0.6 years for casual partners. Fifty-five percent of main and 55% of casual partners attended the same school as the respondent. Respondents met their most recent main partner in the following locations: 54% in school, 15% at work, 8% at a club, and 23 % at another location. Respondent met their most recent casual partner in the following locations: 30% in school, 24% met on the bus, playground, or club, and 46% at another location. They met their most recent main partners in the following ways: 62% met on their own, 15% through relatives, 15% through close friends, and 7% through associates. They met their most recent casual partners in the following ways: 30% met on their own, 18% through relatives, 47% through close friends, and 6% through associates.
Conclusions: Many high school boys meet their sex partners at locations other than their school, especially their casual partners. However, many meet their sex partners through relatives or friends.
Implications for Programs/Policy: Social network-based control interventions may be appropriate for finding sex partners of high school boys.
Implications for Research: Continued research should examine re-infection rates and sexual networks within this population.
Measurable Learning Objectives: By the end of this session participants will be able to identify key factors in helping them determine ways to target intervention and prevention efforts with high school adolescents.
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