title: Screening injecting drug users for sexually transmitted infections and blood borne viruses using street outreach and self collected sampling.
abstract: BACKGROUND
  Injecting drug users (IDUs) are a marginalised population, who infrequently access health services for screening for sexually transmitted infections (STIs) and blood borne viruses (BBVs), and are at high risk of these infections.
  
  
  OBJECTIVE
  To use street outreach and self collection of samples for STI screening, to establish the prevalence of BBVs and STIs, and to identify risk behaviours among a group of culturally diverse street based IDUs.
  
  
  METHODS
  This was a cross sectional study of 314 IDUs in the central business district of Melbourne, Australia, conducted over 3 years (1999-2002). We used street outreach as the recruitment strategy with staff "on foot" in injecting and dealing locations, as well as self collected genital sampling to increase acceptance of screening for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis by polymerase chain reaction (PCR). Individuals were screened for hepatitis A, B, and C, syphilis and HIV, and given the option of a self collected or clinician collected blood sample to increase acceptance of screening for BBVs.
  
  
  RESULTS
  Street outreach was highly effective and self directed STI sampling was more acceptable than practitioner directed sampling (76% versus 9% acceptance, p<0.001). There was a high prevalence of hepatitis C (74%, 95% CI 69 to 79), STIs (8% (5 to 13)), and chlamydia (6% (3 to 10)), and past exposure to hepatitis A and B was common. High rates of recent sharing of injecting equipment, unprotected sex and casual sexual partners, together with low levels of awareness of current hepatitis C infection were identified.
  
  
  CONCLUSIONS
  Street outreach and self collected genital samples facilitate screening for STIs and BBVs in IDUs and revealed a high prevalence of infections and risk behaviours.
authors.affiliation: Melbourne Sexual Health Centre, The Alfred Hospital, 580 Swanston Street, Carlton, 3053, Victoria, Australia. cbradshaw@mshc.org.au
authors.forename: C S
authors.initials: CS
authors.lastname: Bradshaw
authors.forename: L I
authors.initials: LI
authors.lastname: Pierce
authors.forename: S N
authors.initials: SN
authors.lastname: Tabrizi
authors.forename: C K
authors.initials: CK
authors.lastname: Fairley
authors.forename: S M
authors.initials: SM
authors.lastname: Garland
mesh_terms: D000293:Adolescent; D000328:Adult; D017848:Blood-Borne Pathogens; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D013048:Specimen Handling; D015819:Substance Abuse, Intravenous / Q000517:prevention & control*; D014739:Victoria / Q000453:epidemiology