Street-based STD testing and treatment of homeless youth are feasible, acceptable and effective

Purpose: 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 nonmedically 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 [Cl]: 1.3-18.4) and for GC was 4.2 per 100 person-years (95% Cl:.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% Cl: 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. (c) 2006 Society for Adolescent Medicine. All rights reserved.