Urine testing for Chlamydia trachomatis and hassle-free follow-up is acceptable to street youth

OBJECTIVE:

To evaluate whether street youth would use a sexually transmitted disease (STD) screening program involving non-nominal, noninvasive testing of urine for Chlamydia trachomatis with hassle-free follow-up and partner self-notification.

DESIGN:

Cross-sectional pilot study in six centres frequented by street youth 13 to 25 years of age in the Regional Municipality of Ottawa-Carleton.

INTERVENTIONS:

A structured, non-nominal face-to-face interview using an 88-item questionnaire was administered by a trained research assistant. Immediate feedback was provided to participants about specific individual risk reduction strategies for high risk life styles. Each street youth provided a urine sample that was tested non-nominally for C trachomatis by polymerase chain reaction (PCR). A single dose of azithromycin therapy was provided to participants who tested positive, each of whom was requested to encourage recent sexual partners to come forward for testing and treatment.

RESULTS:

One hundred and sixty-three street youth were recruited (98 males and 65 females male to female ratio 1.5:1]) over the four months of the study. The mean ages of participants were males 18.3±2.50 years and females 16.7±2.02 years. Ninety-two per cent (146) of all participants were sexually active and 99% of the sexually active youth (145 of 146) submitted urine samples. Urine samples were positive in 12 (8.2%) participants (seven males, five females), all of whom were asymptomatic. All those who tested positive were recruited from a single site (site specific rate 13.6%). Overall, only 25% of those tested returned spontaneously for test results; however, nine of 12 participants with positive results were treated due to investigator vigilance in locating the youth. Street youth partner self-notification resulted in five additional street youth requesting testing and treatment.

CONCLUSIONS:

Street youth participated in a STD testing program when a street friendly program and noninvasive methods were used. Although more expensive, urine PCR testing increased program acceptance by street youth compared with previous local results. Detection of C trachomatis was high in this hard-to-reach population. There is a need to address further the problem of poor return rates for results and treatment, as well as low rates of partner notification.