An Adolescent Screening Project in Michigan's School Clinics

Background:
14 school clinics participate in a std and reproductive health screening project throughout Michigan; resulting in 8000 adolescents screened.

Objective:
Access adolescents; provide screening for early detection, prompt treatment, partner referral and risk reduction messaging

Method:
Students accessing school-based clinics are offered urine-base screening for chlamydia and gonorrhea, regardless of reason for clinic visit. Additional reproductive health testing is provided when applicable. Students are interviewed using computerized sexual questionnaire. Sites have capability to sync and upload data for analysis.

Result:
Michigan Department of Community Health (MDCH) STD/IPP and Division of Family and Community Health have collaborated to expand to 14 school clinics (urban, suburban and rural) as a result of a county pilot screening project. Over 8000 adolescents have been screened since 2000. Sexual questionnaire reveals high number of lifetime partners (5), 27% report a history of STD, 18% of females have a history of pregnancy. Clinics have gradually shifted from model of testing by “risk assessment” to offering screening to all students accessing clinic. More than 50% of infections would have been missed if testing only STD requests. Vast majority of chlamydial infections are asymptomatic ( 54%-females; 70%-males) Disparity noted in the AA student population; 72% of total number of students screened, but accounting for 83% (chlamydia) and 94% (gonorrhea) cases. Partners of positive students had >50% positivity, although mostly asymptomatic (71%).

Conclusion:
By screening adolescents at school clinics, asymptomatic infections can be detected, treated, partners notified, decreasing costly complications and spread of infections into broader community. Data collected has led to expansion into more school clinics and presented to local communities to inform/educate about silent epidemic of adolescent stds.

Implications:
Explore other non-traditional settings to offer screening to adolescents who rarely seek health care and are asymptomatic. Expand targeted screening, utilizing school data, into more schools and within local communities.