OPPORTUNISTIC SCREENING FOR STD IN EMERGENCY DEPARTMENTS

在急诊室接受治疗的青少年是一个不经常从提供预防性生殖健康筛查的设施寻求保健的群体，但他们的无症状性传播疾病和未被识别的性传播疾病的发病率很高。在本项目中，将研究通过外展（而不是基于临床的）活动提供的淋病奈瑟菌和沙眼衣原体尿液LCR筛查，并在社交网络的指导下，对急诊室就诊时发现的感染个体进行知情的筛查方案。本项目的具体目标是：1）确定未检出N的患病率; gonorrhoeae和C.在一个大型城市急诊室接受治疗的青少年中，除了可能与性病有关的投诉外，还有沙眼; 2）以探索性的方式描述寻求健康的行为，社会（和性）网络，和其他流行病学和行为特征的青少年与性病和风险，参加急诊室; 3）进行一项随机临床试验，将传统的卫生部门合作伙伴通知活动与社交网络知情的筛查干预进行比较，以使用LCR测试识别和测试细菌性性病; 4）与我们当地的卫生部门合作，制定新的战略，在高流行社区识别和治疗性病，以及通过在急诊室就诊时进行的机会性筛查来预防青少年未来感染的机会。结果测量将包括对在急诊室就诊的青少年的生殖健康护理寻求行为的描述性分析、在急诊室就诊的青少年中未被发现的细菌性性病的患病率、以及通过网络通知的外展和每单位卫生部门疾病预防活动时间的筛查确定的感染者人数。该项目有可能提供一个最随机的临床试验，以评价传统的伴侣通知活动，与其他外展机制相比，以确定患有性病和有性病风险的个人，以及为性病发病率最高的青少年提供一个新的性病干预战略。

Adolescents who have received care in Emergency Departments represent a group who do not regularly seek health care from facilities providing preventative reproductive health screening yet who have a high prevalence of asymptomatic and a unrecognized STDS. In this project urine LCR screening for Neisseria gonorrhoeae and Chlamydia trachomatis provided through outreach (as opposed to clinic-based) activity and guided by a social network informed screening protocols originating with infected individuals identified at the time of emergency room attendance will be studied. The specific aims of this project are: 1) To define the prevalence of undetected N. gonorrhoeae and C. trachomatis in adolescents receiving care for reasons other than possible STD-related complaints at a large urban emergency room; 2) To characterize in an exploratory fashion, the health seeking behaviors, social (and sexual) networks, and other epidemiologic and behavioral characteristics of adolescents with and at risk for STDs attending the emergency room; 3) To conduct a randomized clinical trial comparing traditional health department partner notification activities to a social network-informed screening intervention for identifying and testing bacterial STDs using LCR tests; 4) To d4evelop, in partnership with our local health department, new strategies for identifying and treating STDs in a high prevalence community as well as opportunities for preventing future infection in adolescents identified through opportunistic screening performed at the time of emergency room attendance. Outcome measures will include descriptive analyses of reproductive health care seeking behaviors in adolescents seen in the emergency room, the prevalence of otherwise undetected bacterial STDs in adolescents seen in emergency room, and the numbers of infected persons identified through netowrk- informed outreach and screening per unit of Health Department Disease Int4rvention Activity time. The project has the potential to provide one of the most randomized clinical trials for evaluating traditional partner notification activities as compared to other outreach mechanisms for identifying individuals with and at risk for STDs, as well as providing a new strategy for STD intervention in adolescents, the group with highest STD morbidity.