Background:
Duval County is Florida's 5th largest county with a comparatively young demographic mix and disproportionately high rates of Chlamydia (Ch) and Gonorrhea (GC) infections. The infection rates per 100,000 women aged 15-19 during 2004 was 4216 for Ch and 1220 for GC, despite the availability of a traditional health department STD program with centralized clinical services, field based epidemiologic investigation and clinic referral of epidemiologically identified contacts and aggressive outreach programs.

Objective:
Based on the TB DOT (directly observed therapy) model, a program was developed utilizing field based health care worker delivered therapy, diagnostic testing, epidemiological contact investigation and prevention counseling targeting the high risk population of reported cases and contacts of Ch or GC in patients aged 15 – 24.


Method:
Field based activities were conducted by trained field workers under protocol with physician oversight. Patients were given oral therapy for GC and/or Ch as diagnostically or epidemiologically indicated. Field interview included eliciting risk factors for STD and HIV, prevention counseling, STD and HIV history, pregnancy screening and counseling and sexual contact information. Rapid HIV testing was performed with patient consent.

Result:
Comparing the first 6 months of 2005 with a pre-program period of Jan –
June 2003, we were able to increase the number of Chlamydia cases treated and interviewed in the target population from 380 to 833 cases (a 119% increase) and increase the number of sexual contacts of those cases treated from 266 to 724 cases (an increase of 172%).
Field administered medications were well tolerated and well accepted under the protocol with no adverse reactions.


Conclusion:
Field based worker treatment and contact interview is an effective strategy for bringing a larger number of infected individuals and their partners into therapy and prevention counseling.


Implications:
Further development, evaluation and utilization of this DOT model for STDs appears warranted.