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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