Improving STD testing behavior among high-risk young adults by offering STD testing at a vocational school

<p>Abstract</p> <p>Background</p> <p>Chlamydia trachomatis infection (CT) is the most prevalent bacterial STD. Sexually active adolescents and young adults are the main risk group for CT. However, STD testing rates in this group are low since exposed individuals may not feel at risk, owing-at least in part-to the infection's largely asymptomatic nature. Designing new testing environments that are more appealing to young people who are most at risk of acquiring chlamydia can be an important strategy to improve overall testing rates. Here we evaluate the effect of a school-based sexual health program conducted among vocational school students, aiming to obtain better access for counseling and enhance students' STD testing behavior.</p> <p>Methods</p> <p>Adolescents (median age 19 years) attending a large vocational school were provided with sexual health education. Students filled in a questionnaire measuring CT risk and were offered STD testing. Using univariate and multivariate analysis, we assessed differences between men and women in STD-related risk behavior, sexual problems, CT testing behavior and determinants of CT testing behavior.</p> <p>Results</p> <p>Of 345 participants, 70% were female. Of the 287 sexually active students, 75% were at high risk for CT; one third of women reported sexual problems. Of sexually active participants, 61% provided a self-administered specimen for STD testing. Independent determinants for testing included STD related symptoms and no condom use. All CT diagnoses were in the high-CT-risk group. In the high-risk group, STD testing showed an increased uptake, from 27% (previous self-reported test) to 65% (current test). CT prevalence was 5.7%.</p> <p>Conclusions</p> <p>Vocational school students are a target population for versatile sexual health prevention. When provided with CT testing facilities and education, self selection mechanisms seemed to increase CT testing rate dramatically in this high-CT-risk population expressing sexual problems. Considering the relative ease of testing and treating large numbers of young adults, offering tests at a vocational school is feasible in reaching adolescents for STD screening. Although cost-effectiveness remains an issue counseling is effective in increasing test rates.</p

Detecção de doenças sexualmente transmissíveis em ambientes clínicos e não clínicos na Cidade de Salvador, Bahia, Brasil Screening of sexually transmitted diseases in clinical and non-clinical settings in Salvador, Bahia, Brazil

O objetivo deste trabalho foi avaliar (1) a aceitação de rastreamento para DST em ambientes não clínicos por indivíduos assintomáticos, (2) os fatores de risco e prevalência de DST em ambientes não clínicos e clínicos e (3) o rastreamento não clínico de populações assintomáticas como um método viável para controle das DST. Recrutamos 139 participantes masculinos e 486 femininos entre 18 e 30 anos em clínica de planejamento familiar, escolas e comunidades de baixa renda. Inquirimos os recrutados sobre sintomas de DST e comportamentos de risco para DST/HIV e os testamos para gonorréia, clamídia, sífilis e HIV. Exceto pelo HIV, as mulheres recrutadas diretamente da comunidade apresentavam maior prevalência de DST do que as que procuravam a clínica. O rastreamento das DST em ambientes não clínicos no Brasil é aceitável e vantajoso para jovens em comunidades de baixa renda. Participantes infectados provavelmente nunca teriam procurado assistência, sido testados ou tratados. Medidas para o controle das DST podem ser implementadas em qualquer lugar onde se alcancem as populações de risco e transformadas em rotina nos serviços de saúde, mesmo entre indivíduos com problemas não relacionados com DST.<br>The objectives were to study: (1) acceptance of STD screening in non-clinical settings for asymptomatic individuals; (2) risk factors and STD prevalence among individuals in non-clinical and clinical settings; and (3) non-clinical screening of asymptomatic populations as a feasible method for STD control. We recruited 139 males and 486 females between 18 and 30 years of age from a family planning clinic, schools, and community centers in low-income neighborhoods. We asked about STD symptoms and STD/HIV risk behaviors and tested the individuals for gonorrhea, Chlamydia, syphilis, and HIV. Except for HIV, women recruited directly from the community had higher STD rates than those who came in for care at the clinic. Screening in non-clinical settings in Brazil is feasible and has a high yield among young adults in low-income communities. Infected participants would likely never have otherwise sought care or been tested or treated. STD control efforts could be implemented in any site that can reach populations at risk and become a routine procedure in health care settings where people report for problems unrelated to STDs