OPPORTUNISTIC SCREENING FOR STD IN EMERGENCY DEPARTMENTS

在急诊科接受护理的青少年是指不定期从提供预防性生殖健康检查的机构寻求保健的一群人，他们的无症状和未被识别的性传播疾病的流行率很高。在这个项目中，将研究通过外展活动(而不是以诊所为基础)提供的尿液淋球菌和沙眼衣原体的LCR筛查，并在社会网络的指导下，对急诊室就诊时发现的感染者进行知情筛查。该项目的具体目标是：1)确定在大型城市急诊室接受治疗的青少年中未被检测到的淋球菌和沙眼衣原体的流行率；2)以探索性的方式描述急诊室就诊的青少年的求医行为、社会(和性)网络以及其他有性病风险的青少年的流行病学和行为特征；3)进行一项随机临床试验，将传统的卫生部门伙伴通知活动与社会网络知情筛查干预相比较，以使用LCR测试来识别和检测细菌性STD；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传播疾病，并通过在急诊室就诊时进行机会性筛查，确定预防青少年未来感染的机会。结果措施将包括对在急诊室看到的青少年的生殖保健寻求行为的描述性分析，在急诊室看到的其他未被检测到的细菌性传播疾病在青少年中的流行情况，以及通过网络信息外展和每单位卫生部疾病预防活动时间筛查确定的感染者数量。该项目有可能为评估传统的伴侣通知活动提供最随机的临床试验之一，而不是与识别患有和处于性传播疾病风险的个人的其他外联机制相比，并为青少年--性传播疾病发病率最高的群体--提供一种新的性病干预战略。

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.