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Screening males for chlamydial infection in detention settings

Screening males for chlamydial infection in detention settings. Charlotte K. Kent, MPH. Screening in detention Developing a collaboration. How can programs identify detention settings for collaboration? Choose health jurisdictions with moderate to high rates of disease

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Screening males for chlamydial infection in detention settings

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  1. Screening males for chlamydial infection in detention settings Charlotte K. Kent, MPH

  2. Screening in detention Developing a collaboration • How can programs identify detention settings for collaboration? • Choose health jurisdictions with moderate to high rates of disease • Determine relationship between detention (or other correctional services) and state or local public health department • Determine whether any detention facilities have existing female screening programs • Who should be approached to explore collaboration? • Department of Health • Detention facilities - opinion leaders among administrators & providers of health care • Regional infertility project committee

  3. Screening in detention • Sustaining the collaboration • Funding • Provide something to detention/medical staff – pregnancy testing • Familiarity increases acceptance by detention staff • Communication • Distinctions between adult and juvenile detention settings

  4. Detention screeningIntegrating screening into existing services, activities • Baltimore model • Adult detention • DOH staff offer at intake unit, weekly via PA system • Offer CT, GC syphilis, and HIV • No age criteria for screening

  5. Detention screeningIntegrating screening into existing services, activities • Denver model • Juvenile detention • Medical staff at initial processing (75%) • STD staff weekly – inmates sign up for screening (25%) • Offer CT & GC, every 3 months • Adult detention • Medical staff at initial processing (25%) • STD staff twice weekly – inmates sign up for screening (75%) • Offer CT, GC, syphilis, HIV, HCV, HAV vaccine, HBV vaccine, every 3 months • No age criteria

  6. Detention screeningIntegrating screening into existing services, activities • San Francisco model • Juvenile detention • Medical staff at initial processing before shower • Offer CT • Adult detention • STD staff at processing (50%) • Medical staff after processing (50%) • Offer CT, GC and syphilis • Screen 18-30 years, every 2 months

  7. Detention screeningIntegrating screening into existing services, activities • Seattle model • Juvenile detention • Screening offered at STD class taught 1/month by assigned DOH staff (attendance mandatory) • Offer CT & GC

  8. Detention screeningDelivering treatment & partner services • Who performs treatment follow-up & partner services? • Baltimore—DOH DIS • Denver—Project staff • San Francisco—DOH DIS • Seattle—DOH DIS • Confidentiality

  9. Detention screeningMeasures of effectiveness I • Acceptance rate – varies widely in how measured • No. of eligible males • No. offered screening • No. accepting screening • Contrast to no. of eligible males

  10. Number of males CT screened in detention facilities by site

  11. Percentage of males CT positive screened in detention facilities by site N tested 1641 164 52 1262 1628 7214 Baltimore Denver San Francisco Seattle

  12. Percentage of CT positive males treated in or out of detention facilities by site N CT + 96 171 22 55 258 3 Baltimore Denver San Francisco Seattle

  13. Sentinel Surveillance in the San Francisco County Jail, Subjects by residence 1998-2000 Central Jail Female chlamydia rates by neighborhood for San Francisco, 2000 Southeast HC

  14. San Francisco: Decline in CT prevalence among women at Southeast HC and men at the city jail n tested % CT +

  15. Detention Screening:San Francisco • Venue rank for identifying CT & GC • Males • Jails 2nd for CT & GC (following STD clinic) • Youth detention 3rd for CT • Females • Jails 1st for CT & GC • Youth detention 3rd for CT & GC

  16. Detention screeningChallenges and obstacles • Public health not priority to detention staff nor medical staff • Limited resources – space, staff, cost of urine tests • Many settings difficult to access inmates • Difficult environment – personnel problems

  17. Detention screeningAdvantages, opportunities • Large population with moderate to high prevalence across all sites • Adult detention may one of few ways to access men 20-24 years at greatest risk for CT • In moderate prevalence communities may be most effective way to screen large volume of men at risk for CT

  18. Female chlamydia rates by neighborhood for San Francisco, 2000 Southeast HC

  19. Sentinel Surveillance in the San Francisco County Jail, Subjects by residence 1998-2000 Central Jail

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