Asymptomatic Men's Preferences for Chlamydia Screening

Trustees Of Indiana University, Bloomington IN

Investigators

Linked publications, trials & patents

Abstract

DESCRIPTION (provided by applicant): This application describes an innovative project designed to use behavioral research to develop strategies that can be immediately applied to public health efforts to reduce the prevalence of C. trachomatis, the most prevalent bacterial sexually transmitted infection (STI), in a predominately urban, Black population. Using modified snowball sampling that starts with seed members identified as infected, or highly likely to be infected, based on findings during visits to a local STI clinic, we hope to access those men in high prevalence social networks who may have asymptomatic infection. In order to provide optimal STI screening services in the future, we will take advantage of this population recruited from the community in order to understand the features of a program that would facilitate screening of men without overt signs of disease. In order to accomplish this goal, we will interview participants regarding the screening program features that would encourage routine screening in men without symptoms. Current chlamydia control efforts have had insufficient impact in Marion County, Indiana to reduce the burden of disease which affects Black men and women disproportionately. Despite low-cost STI screening services available through the Bell Flower STI clinic and no-cost screening in non-traditional settings, the numbers of cases continue to rise. The recommendations for screening young, sexually active women annually during routine healthcare visits have been responsible for identifying asymptomatic women with C. trachomatis. Therefore, the major gap in our chlamydia control efforts is accessing the other half of the equation: asymptomatic men. This is a daunting task given that asymptomatic infections (the majority of cases in men as well as women) do not provide a cue for seeking services and that men do not utilize healthcare services on a regular basis, specifically reproductive healthcare. These facts are particularly relevant for under-insured men living in poor, urban settings. Therefore, it is essential to find novel methods for accessing men who may be in high prevalence settings within the general population. Use of incentivized peer referral has been shown to be a very useful tool for reaching hidden populations and has been applied to syphilis and HIV control efforts. However, this approach has not yet been fully explored for other STIs. Even if this method for reaching men in high prevalence social networks does not prove feasible for future application in a broad- based screening program, use of qualitative data gathered as part of this application can inform development of new strategies. Too often screening innovations are imposed on target populations with little, or no, acceptability analysis. There is little data about preferences for alternative screening strategies, particularly from persons not recruited from a clinical setting. This research will prove useful in defining the prevalence of infection in social networks of men at high risk for C. trachomatis and help us to understand the features of screening programs that would encourage asymptomatic men to seek STI-related services.