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Background: Reducing inequities in chlamydia (CT) and gonorrhea (GC) screening and positivity among youth ages 15-25 is a San Francisco Department of Public Health (DPH) priority. In 2014, the CT and GC rates were 3 times and 1.5 times greater, respectively, for youth than adults >25 years. Among Black/African-American youth, the CT rate was 5.9 times greater than for white youth; the GC rate was 6.5 times greater. We sought to increase screening with self-collection express visits.
Methods: The 3rd Street Youth Center and Clinic (YCC) is a community-based provider in a historically African-American neighborhood with the highest adolescent/young adult STD rates in SF. SFDPH and YCC staff developed an express visit protocol addressing clinic workflow, patient eligibility, supplies, and evaluation. Eligible patients, identified with a brief screener, were asymptomatic females who did not require or request other health services; they were given vaginal, oral, and pharyngeal test kits. Swabs were self-collected in the bathroom and placed in a bag given to a staff person who asked them to complete an evaluation. Patient-visits were registered daily. Results notification followed standard protocols.
Results: Screening patients for express visits began in February 2016. By 4/7/2016, of 82 CT/GC tests ordered, 8 were among patients eligible for an express visit; 5 were provided by self-collection through an express visit. All express-visit patients were previously positive, seeking their 3-month rescreening; all re-tested negative. Post-visit questionnaires verified patients’ understanding of their tests and results follow-up.
Conclusions: Express visits provide an efficient and acceptable screening option for youth. YCC staff input during development was integral, addressing their concerns to maximize acceptance. Additional evaluation metrics will include changes in patient and test volume, positivity, and missed clinical opportunities. Express visit evaluation will be extended to males and other youth clinics before best practices are identified for higher volume primary care clinics.