Leveraging Technology as a Clinician Extender to Screen Culturally Diverse Young Women for Chlamydia

Chlamydia trachomatis (CT) remains epidemic among sexually young adult and adolescent
females especially ethnic minority women. Despite recommendations for at least annual
screening of all sexually active women up to age 25, CT screening rates remain low. Most
young women do not regularly attend primary care clinics where preventive care such as CT
screening should be done; and clinicians lack time and comfort to address CT screening
during the context of an urgent care or emergency department visit. This proposed study
takes advantage of a "missed opportunity" for screening these at-risk young women for CT
when they come in contact with the health care system during an urgent care or emergency
department visit. The purpose of this study is to conduct a quality improvement
intervention, to improve the ability of health care providers to deliver an important
preventive health service (CT screening) in order to meet the goal of universal CT screening
recommended by virtually all major health organizations. CT screening should be done as a
routine part of health care but currently is not. In this study, we will help providers do
what they should already be doing using this novel health care delivery approach. In this
study, we created and are evaluating a bilingual (English-Spanish) computer kiosk module to
increase CT screening among at risk English and Spanish speaking women (18-25 yo) attending
urgent care clinics and emergency departments (ED). This computer technology will be able to
conduct many of the steps necessary for CT screening including assessing clients' CT risk
and prompting the client and health care professionals for CT urine specimen collection.
This study will also examine the extent to which this computer kiosk module intervention use
is acceptable and feasible among both English and Spanish speaking young women, and health
care professionals who care for them in urgent care and ED settings. This type of
intervention to improve CT screening is potentially translatable to a wide variety of health
delivery settings as it is not dependent on staff time, motivation or skill to assess sexual
history in the busy urgent care setting. This project also supports current recommendations
of Healthy People 2010, the U.S. Preventive Services Task Force and other professional
organizations to screen all sexually active young adult females at least annually for CT to
address this important public health problem especially among our young ethnic minority
women who carry the largest STI disease burden. Early detection through routine CT
screening coupled with appropriate treatment of CT infections can eliminate widespread
infection and prevent such major reproductive morbidity.

Inclusion Criteria:

- English or Spanish speaking

- Medically Stable

- Sexually active

- Female

- 18-25 years old

- Seeking health services in participating urgent care clinics and ED in San
Francisco/Bay Area, California.

Exclusion Criteria:

- Clients who do not speak English or Spanish will not be eligible to participate.

- Males of any age because there is no CDC recommendation to universally screen this
group.

- Women who have never had sexual intercourse are not eligible as this is a study of
how to increase screening for chlamydia, a sexually transmitted infection.

- For Kiosk, clients with moderate and major trauma or illness requiring immediate
medical intervention, as assessed by triage nurse as part of routine protocol, will
be excluded from participation.

- Anyone who chooses not to participate (as this is voluntary) will be excluded from
participation.