Street-based STD testing and treatment of homeless youth are feasible, acceptable and effective.
OBJECTIVE
Current Centers for Disease Control (CDC) guidelines recommend that sexually transmitted disease (STD) screening measures for high-risk populations such as homeless youth prioritize testing in out-of-clinic settings and incorporate new approaches to STD eradication, such as field-delivered testing and treatment and patient-delivered partner therapy (PDPT). Our non-medically trained research staff offered field-based STI testing, field-delivered therapy, and PDPT to homeless youth in the context of a longitudinal study.


METHODS
A total of 218 ethnically diverse (34% female) 15-24-year-old homeless youth recruited from street sites in San Francisco completed an audio computer-administered self-interview survey and provided a first-void urine sample for testing for chlamydia (CT) and gonorrhea (GC). Youth testing positive were offered field-delivered therapy and PDPT. A random subset of 157 youth was followed prospectively, of whom 110 (70%) were interviewed and 87 (55%) retested at six months.


RESULTS
At baseline, 99% of youth in the study consented to STI testing, of whom 6.9% and .9% tested positive for CT and GC, respectively. Ninety-four percent of positive youth were treated, 50% within one week. The incidence rate for CT was 6.3 per 100 person-years (95% confidence interval [CI]: 1.3-18.4) and for GC was 4.2 per 100 person-years (95% CI: .5-15.2). None of the youth treated by study staff and tested six months later (n = 6) had CT or GC on follow-up testing (95% CI: 0-131.3).


CONCLUSIONS
Field-delivered testing and field-delivered therapy are feasible, acceptable and effective interventions for the diagnosis and treatment of STDs in homeless youth. These measures along with PDPT may decrease rates of subsequent reinfection.
Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, California 94143-0503, USA. auerswaldc@peds.ucsf.edu
Colette L
CL
Auerswald
Eiko
E
Sugano
Jonathan M
JM
Ellen
Jeffrey D
JD
Klausner
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006306:Health Surveys; D018453:Homeless Youth; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening; D010045:Outpatients; D016896:Treatment Outcome; D014505:Urban Population; D016482:Urinalysis