Background:
Homeless youth engage in high-risk behaviors, suffer from disproportionate rates of STIs and HIV, and have limited access to medical care. Urine-based methods for STI screening and rapid tests for HIV have made it possible to screen youth in non-clinic settings. Street START (Street Testing and Rapid Testing) is a collaborative project of non-profit, governmental, and academic partners for street-based STI and HIV screening, treatment, and linkage to care for homeless youth.

Objective:
The objective of Phase I of the project is to train outreach workers to test homeless youth for chlamydia (CT) and gonorrhea (GC), and dispense field-delivered therapy (FDT) and patient-delivered partner therapy (PDPT).

Method:
Staff members received training in STI testing, FDT, and research principles. Street-based STI testing began as a joint activity between outreach and research staff and has now been integrated into outreach activities. Youth who are STI-positive are treated with FDT/PDPT.
Implementation has required ongoing communication between UCSF, LSYS, and the Department of Public Health. Field notes from each outreach session document the challenges and progress of testing in the different neighborhoods.

Result:
Since May 2005, 86 street-based youth have been recruited. STI prevalence was 8.1% (95% CI: 3.3, 16.1). All STI-positive youth were treated.
Research staff transferred skills to outreach staff to prepare them to take the lead for testing. Challenges that were addressed include insuring confidentiality in the field, the impact of testing on staffing patterns, and the impact tracking STI-positive youth has on other outreach activities.


Conclusion:
Outreach workers have been trained to provide street-based STI testing and treatment in the outreach setting without compromising core outreach services.

Implications:
The integration of STI screening and treatment into street outreach is a plausible model for increasing access to STI testing and care by homeless street youth.