Incarcerated Juveniles and Chlamydia: Are We Making a Difference?

Background: From 2003 through 2008, the STD Control Branch funded 18 county STD or probation departments to provide chlamydia (CT) screening and treatment for females entering juvenile detention facilities.  In 2005, performance-based contracting was instituted. 

Objectives: To evaluate whether performance-based contracting improves screening coverage, timeliness of testing, and treatment.

Methods: Booking data reported through quarterly communication reports and line-listed data received from counties from 2003 through 2008 were analyzed.  Only those records with complete data for booking date and specimen collection date were used for the cross-sectional analysis of the timing of CT testing, positivity, and treatment outcomes.  All data were analyzed with the use of Statistical Analysis System (SAS).

Results: Overall screening coverage improved from 54 percent in 2003 to 74 percent in 2008.  Among the 44,085 females tested in the six years, 75.7 percent were tested within one day from booking.  Testing within one day from booking improved from 69.9 percent in 2003 to 87.2 percent in 2008.  Chlamydia positivity declined from 13.6 percent in 2003 to 10.5 percent in 2008.  Of the 5,280 cases found, 84.9 percent were treated.  While the percent treated overall remained the same over the six-year period, treatment within seven days improved from 78.2 percent in 2005 to 81.0 percent in 2008. 

Conclusions: Substantial improvement in programmatic outcomes was achieved through the use of performance-based contracting.

Implications for Programs, Policy, and/or Research: The largest challenge in providing screening for youth in detention is the identification of funding.  If these programs continue to be funded through STD programs, cost-efficiency and program outcomes can be enhanced by the use of performance-based contracting.