Meeting homeless youth where they're at: Integrating STI testing and treatment into a street outreach program Dina Wilderson, PhD (Larkin Street Youth Services) Eiko Sugano, MPH (UCSF Division of Adolescent Medicine) Jeffrey Klausner, MD, MPH (SFDPH, STD Prevention & Control) Colette Auerswald, MD, MS (UCSF Division of Adolescent Medicine)

Background Homeless youth:  Engage in high-risk behaviors  Have disproportionate rates of STIs and HIV  Have limited access to health care

Street START (STI Testing And Rapid Testing) Collaborative project designed to create a model program for street-based STI and HIV screening, treatment, and linkage to care for homeless youth

Project Goals  To train outreach workers to conduct street-based CT/GC screening and to dispense field-based therapy and partner- delivered therapy for those who test positive for an STI  To train outreach workers to conduct street-based rapid HIV testing

Collaborative Partners  Larkin Street Youth Services  Outreach activities  UCSF Division of Adolescent Medicine  Research activities  Community Health Programs for Youth  Medical care for homeless youth  Recruitment of comparison group (clinic based)  STD Prevention and Control, SFDPH  Training, supplies, and technical support  HIV Prevention Section, SFDPH  Training, supplies, and technical support

Trainings  Outreach staff trainings  Introduction to STIs  STI testing and treatment  Principles of research  Research staff trainings  Outreach skills

Methods  UCSF-Larkin joint outreach sessions  Recruitment of youth  Data collection  Testing  Tracking of STI positive youth  Field-delivered therapy  Patient-delivered partner therapy  Linkage to services

Areas of Recruitment

Gender

Ethnicity * Categories are not mutually exclusive

Age

STI Prevalence STI (CT or GC)107.3% Chlamydia96.5% Gonorrhea32.2% 138 street recruited youth were tested for CT and GC

Treatment  10 youth (100%) were treated:  7 - field based  3 - clinic based  Patient-delivered partner therapy  4 – given partner packs  1 – did not take partner pack (no contact with sex partner)  2 – sex partners (treated individually)

Challenges  Impact of testing and tracking on outreach activities  Integrating researchers into outreach  Balancing research and outreach roles  Logistics of sample collection  Staff time  Neighborhood differences

Strengths/Key Factors  Availability of FDT and PDPT protocols  Incremental implementation  Ongoing communication  Consistency of testing shifts  PDA’s for data collection  Documentation – use of field notes  Referrals and linkages to services  Collaborators working toward common goal

Street START Project Coordinator: Eiko Sugano, MPH (UCSF Division of Adolescent Medicine) Co-Principal Investigators: Dina Wilderson, PhD (Larkin Street Youth Services) Colette Auerswald, MD, MS (UCSF Division of Adolescent Medicine) Collaborators: Jeffrey Klausner, MD, MPH (SFDPH, STD Prevention & Control) Teri Dowling, MA, MPH (SFDPH, AIDS Office) Susan Obata, MD (SFDPH, Community Health Programs for Youth

Acknowledgements  Ed Melendez (LSYS Outreach Manager) and Chandra Sivakumar (LSYS HIV Prevention Manager)  Outreach/HSRC staff: Kelley Cutler, Lochlan McHale, Vinh Nguyen, Tamara Thomas, Jasmin Serim, John Pirkopf  Research assistants: Adrienne Schroeder, Arturo Durazo, Jacob Laurent, Jen Hecht  AIDS Office: Shelley Facente  STD Control and Prevention: Kate Scott, Ameera Snell, Lesly Soto, Monica Lee  Michael Baxter, Cielita Bess and CHPY clinic staff  SFDPH laboratory staff