Chlamydia in urban adolescents: Implementation of an on-demand school screening program in Boston, MA

Schools provide an underutilized, yet promising setting for screening and treatment programs to reduce the burden of chlamydia among urban adolescents. The Centers for Disease Control and Prevention recommends yearly screening, yet outpatient clinics continue to have low rates among at-risk youth. The Boston Public Health Commission (BPHC) has developed an on-demand screening and treatment program within the Boston Public Schools to address the disproportionately high chlamydia rates among Boston teens age 15-19 (4,362 per 100,000 versus 1,310 per 100,000 for the state as a whole). The BPHC pilot program builds upon the experience of other urban health departments that have begun large scale universal screening efforts in high schools, and addresses their limited capacity to screen only once or twice per year. The pilot has integrated screening into the services available in the BPHC Health Resource Centers, previously established to provide health education within the schools. Students are able to request a screening test from a known and trusted health educator at any point throughout the school year. Treatment and further counseling are provided by an experienced BPHC nurse practitioner. A description of the model and lessons learned during the implementation phase demonstrates the potential to meaningfully expand sexual health services to at-risk youth in other urban communities.