Evaluation of Chlamydia and Gonorrhea

Field Delivered Therapy

San Francisco Dept. of Public Health STD Prevention and Control Services

V Davila, CK Kent, L Fischer, J Chaw, J Klausner

Background

• Single dose therapy available Cefixime 400 mg – Gonorrhea Azithromycin 1 g – Chlamydia

• Precedent Directly observed therapy in the field

for tuberculosis (TB)

Background (cont.)• Gonorrhea (GC) and Chlamydia (CT)

cases identified through STD screening at youth and adult detention centers and STD clinic

• Disease Intervention Specialists (DIS) assigned cases for follow-up

• Of cases assigned, high proportion (43%) not treated

Background (cont.)

• Screening expanded in jails (1999) Increase in GC and CT cases

assigned

• Field Delivered Therapy (FDT) protocol implemented to help reach the growing number of clients and improve treatment

Objectives

1. Offer treatment to individuals with uncomplicated GC and CT infection who are unlikely, unable or unwilling to come to STD clinic

2. Evaluate FDT by measuring the number of individuals accepting medication in the field and the proportion of persons treated

Protocol Development

• Enable DIS to treat clients in the field

Acting under the medical license of the STD Controller

• Design portable field pack for DIS to take into the field

Field Pack

Staff Training

• Two 1-hour training sessions Allergic reactions Concurrent medications Behavior assessment Direct observations Documentation

DIS Field Activities

• Follows standard confidentiality practices

• Educates client about infection and medication

• Obtains consent to treat• Observes client taking medication• Counsels client about STDs and

partner notification• Documents treatment

Percentage Receiving Treatmentof Persons Assigned for Treatment Follow-Up

01020304050607080

1998 1999 2000

Per

cen

t T

reat

ed

Clinic Rx Field Rx

57%

14%10%

61%60%

(N=460) (N=620) (N=641)

Results

• 39% increase in number of cases assigned for treatment follow-up from 1998 – 2000

• 27% increase in proportion of cases treated after FDT was implemented

Conclusions• FDT increases the

number of clients treated

• Field Delivered Therapy is: Feasible Effective Beneficial

Implications

• Program FDT may assist other programs in

increasing treatment follow-up of difficult to motivate individuals

• Research FDT should be evaluated in other

communities

Acknowledgments

• Anna Branzuela

• Felipe Acosta

• Sharon Penn

• Terrance Sha

• Ilene Zolt

• Bettye Spears

• Kate Steiner