Enhancing Delivery of Confidential Care and STI Screening in Urban Health Centers

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DESCRIPTION (provided by applicant): Adolescents residing in impoverished urban environments are at considerable risk for pregnancy and sexually transmitted infections (STIs), including HIV, yet these health care needs are often not addressed. Delivery of recommended preventive services is inconsistent across practice settings, with sexual health services especially variable. Confidential health care is essential if adolescents' health care concerns are to be met. Despite the urgent need for confidential care, many youth report they have not spent time alone with health care providers, and few are aware of the right to confidential care. In preparation for a larger randomized controlled trial, our primary objective is to develop, implement and evaluate a practice-based pilot intervention to increase rates and timeliness of STI screening for sexually active urban adolescents by improved access to confidential services in urban primary care settings. In Phase I, we will gather formative data to complete development of the pilot intervention, through 1) meetings with a community advisory board to obtain input from the target community, 2) focus groups of adolescent boys and their parents (augmenting our previous qualitative work with adolescent girls and their parents), and 3) a prospective card study completed after visits with adolescents (male and female) followed by in-depth interviews of providers who treat adolescents in urban primary care. In Phase II, we will implement the intervention in urban practices, consisting of 3 components: 1) increasing adolescents' and parents' awareness of the need for and availability of confidential care; 2) training physicians to routinely and consistently provide confidential care and assess sexual health, while overcoming barriers associated with decisions to omit this service; and 3) implementing clinic level improvements in appointment, reception and billing procedures to create environments more conducive to confidential care. We will obtain preliminary estimates of the efficacy of the intervention to enhance exposure to confidential care, yield more thorough risk assessment (including adolescent disclosure of sexual activity to health care providers) and improve screening for STIs among sexually active youth. In addition, we will assess the feasibility of the intervention and barriers to adoption in different settings, as well as its acceptability to health care providers, staff, parents and adolescents. While our primary outcome is ultimately STI screening, we anticipate that increased exposure to confidential care will result in enhanced opportunities to address not only reproductive health but other sensitive health concerns of adolescents.Narrative Adolescents residing in impoverished urban environments are at considerable risk for pregnancy and sexually transmitted infections (STIs), including HIV, yet these health care needs are often not addressed. The overall goal of this project is to develop, implement and evaluate a practice-based intervention to improve urban adolescents' access to confidential care in urban primary care settings. We will obtain preliminary estimates of the effect of the intervention on adolescent risk assessment (including disclosure of sexual activity to health care providers) and screening for sexually transmitted infections among sexually active youth.