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Program Details


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Practice Type: Model
Program Name: High-School Based Screening for Chlamydia and Gonorrhea
Organization: Division of Disease Control, Philadelphia Dept. of Public Health
Web site:
Overview: The High School-Based Screening for Chlamydia and Gonorrhea program targets Philadelphia public high school students in Grades 9-12. The goal of the program is to educated high school students regarding the risks of STDs, prevention methods, and the need for testing if sexually active. Approximately 30,000 students have been provided with Sexually Transmitted Disease educational presentations annually (2002-2003 & 2003-2004 school years) and approximately 60% have been tested.

Outcomes of the program include:

  • In the 2002-2003 school year: 19,713 students tested; 1,052 were found to be infected and 1,051 (99.9%) were treated.

  • In the 2003-2004 school year: 17,019 students tested; 813 infected and 807 (99.3%) treated.

  • In the 2004-2005 school year: testing is in progress with more than 10,000 students tested mid-way through the school year.
In summary, the Philadelphia Department of Public Health STD Control Program, in collaboration with the School District of Philadelphia, implemented a citywide high-school based screening program to address epidemic levels of chlamydia and gonorrhea infections in this age group. In its third year of operation, this program has demonstrated that a large scale initiative such as this can be implemented and sustained, with substantial impact on the problem.

Year Submitted: 2005
Responsiveness and Innovation: In calendar year 2000, the case rate for reported Chlamydia infections among 15-19 year old females was 8,224/100,000, more than 6 times the rate among females (all ages) citywide and 3.5 times the national rate for females this age group. In addition, the case rate among males in Philadelphia in this age group was 1,645/100,000, only 20% of the rate among females in this age group. This screening program was implemented in high schools to reach these affected populations; testing of females was designed to identify infected individuals so that treatment could be provided and Pelvic Inflammatory Disease (PID) prevented. Testing of males was designed to identify asymptomatic individuals and to provide treatment to avoid sequelae and reduce infection/reinfection of females. Testing of both groups was also intended to reduce the reservoir of infection with asymptomatic infection in the community. Educational presentations were provided in an effort to educate students regarding the asymptomatic nature of many STDs, encourage those who were already sexually active to modify their behavior and to reinforce decisions to abstain from sex among other students.

This program was innovative in its scope and in its effort to test males. It was implemented on a citywide basis and included 54 high schools with an overall enrollment of more than 50,000 students. Each year, it successfully reached more than 30,000 students in small groups (approx. 60 students) with an STD presentation and the offer of urine-based, non-invasive screening immediately following the presentation; more than 60% of the students offered testing volunteered to be tested.

It represents an unprecedented collaboration between a Public Health Department and a Major School District to address the epidemic of sexually transmitted diseases prevalent among adolescents in major cities in the United States. It demonstrated that such a program could be implemented and would be accepted by parents, students and school faculty, and could be done while protecting the confidentiality of those seeking testing and those who tested positive.

In addition, this program targeted males as well as females in an effort to reduce the reservoir of asymptomatic infection among males in this at risk population.

Agency and Community Roles: The Philadelphia Department of Public Health initiated this program with the full collaboration of the School District of Philadelphia. The Health Department has provided the programmatic elements of this project while the School District has coordinated the scheduling of students for testing, the availability of space within the schools and access to students after testing, as necessary. During 2004, the Medicaid Managed Care Providers in Philadelphia agreed to reimburse the Department of Health for tests provided to students who were enrolled as members in their plans. To date, they have provided over $100,000 in reimbursements for this program.

Costs and Expenditures: This program costs approximately $900,000/year for all Health Department and laboratory costs. It is funded through a combination of Federal STD Grant, City of Philadelphia Department of Public Health and Medicaid Managed Care reimbursement programs. Approximately 70% of the cost is attributable to staff, the balance is associated with laboratory testing and treatment costs. Sustainability relies on continued support from these sources.

Implementation: In calendar year 2000, the case rate for reported Chlamydia infections among 15-19 year old females was 8,224/100,000, more than 6 times the rate among females (all ages) citywide and 3.5 times the national rate for females this age group. In addition, the case rate among males in Philadelphia in this age group was 1,645/100,000, only 20% of the rate among females in this age group. This screening program was implemented in high schools to reach these affected populations; testing of females was designed to identify infected individuals so that treatment could be provided and Pelvic Inflammatory Disease (PID) prevented. Testing of males was designed to identify asymptomatic individuals and to provide treatment to avoid sequelae and reduce infection/reinfection of females. Testing of both groups was also intended to reduce the reservoir of infection with asymptomatic infection in the community. Educational presentations were provided in an effort to educate students regarding the asymptomatic nature of many STDs, encourage those who were already sexually active to modify their behavior and to reinforce decisions to abstain from sex among other students.

This program was innovative in its scope and in its effort to test males. It was implemented on a citywide basis and included 54 high schools with an overall enrollment of more than 50,000 students. Each year, it successfully reached more than 30,000 students in small groups (approx. 60 students) with an STD presentation and the offer of urine-based, non-invasive screening immediately following the presentation; more than 60% of the students offered testing volunteered to be tested.

It represents an unprecedented collaboration between a Public Health Department and a Major School District to address the epidemic of sexually transmitted diseases prevalent among adolescents in major cities in the United States. It demonstrated that such a program could be implemented and would be accepted by parents, students and school faculty, and could be done while protecting the confidentiality of those seeking testing and those who tested positive.

In addition, this program targeted males as well as females in an effort to reduce the reservoir of asymptomatic infection among males in this at risk population.

Sustainability:
Lessons Learned:

 

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