Background:
Local health departments; utilizing the authority and autonomy of local county health officers to offer EPT through local Disease Intervention Specialists (DIS) assigned to their respective counties provide a manageable substitute for current EPT barriers.

Objective:
Provide Disease Intervention Specialist Directly Observed Therapy (DIS DOT) to clients who do not promptly present to a provider or the public health STD clinic.

Method:
DIS performed DOT criteria from a policy and procedure written and agreed upon by Health Department administration, nurses, DIS, and Health Officer of that county.

Result:
DIS DOT in Sedgwick County began in the second half of 2006. Since inception DIS have provided 99 DOT's to individuals who qualified for services. Of those patients, 70 (70.7%) were male and 29 (29.2%) female. 73 (73.7%) DOT's were done in the clinics and 26 (26.2%) DOT's were performed in the field. 1 (.01%) was positive for gonorrhea and 40 (40.4%) positive for chlamydia. There were a total of 57 (57.5%) partners given DOT, 4 (.04%) gonorrhea, 51 (51.5%) chlamydia and 2 (.02%) preventatively treated for both infections. 6 (14.2%) of the 42 individuals positive for gonorrhea and/or chlamydia were from private providers.

Conclusion:
DIS observed very little difficulty with the DOT process. DIS discovered DOT could be used as an effective tool to supplement the local county health clinic upon nurse shortage, or if a full schedule is observed. Additionally, DIS found that in a given timeframe patients were treated anywhere from 2-3 days sooner possibly preventing complications and further transmission. Finally, DIS have the opportunity to offer and provide DIS DOT to patients from private providers offices and area emergency rooms.

Implications:
Programs that find a state run (or mandated) EPT program impractical may find viable alternatives by collaborating with local county or municipal health officers.