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Background: The Republic of Palau has a population of 20,000. In such remote populations, sexually transmitted infection (STI) screening is performed primarily in public health facilities and is not delivered in a comprehensive manner. This is due in part to limited resources, various procurement issues and test technologies requiring clinic visits. Therefore, little outreach is done to reach individuals unable or unwilling to access STI services at a healthcare facilities.
Objectives: Provide gonorrhea and chlamydia screening to the general population of the Republic of Palau and assess the disease burden.
Methods: Screen individuals 14 years of age and older for gonorrhea and chlamydia using donated vaginal and urine test kits and laboratory processing services. Outreach venues were identified by geographic area, convenience of location, and populations at risk. Specimens were shipped to the CDC for testing with the GenProbe Aptima Combo2 assay. Results were electronically sent to local staff for patient management according to CDC recommendations.
Results: Of the 1243 specimens collected and tested from October 2008 to September 2009, 143 (11.5%) were positive for chlamydia and 2 (0.2%) were positive for gonorrhea. The majority of cases were asymptomatic. Approximately 2/3 of the chlamydia cases were from the public sector while 1/3 were from outreach activities and private sector. The overall prevalence of chlamydia from outreach activities was 8.1% (38/464). During this period, 27 outreach venues were accessed including various communities in many of the states and several high risk populations.
Conclusions: In remote areas, outreach screening activities provide an opportunity to identify a significant portion of individuals infected with STIs that would not access STI services.
Implications for Programs, Policy, and/or Research: Eliminating barriers for STI screening in remote populations can promote the expansion of services to an important population at risk for STIs.