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BACKGROUND: Twenty million new sexually transmitted infections (STIs) occur annually in the United States (US) and the two most commonly reported are Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Screening and treatment of high-risk groups is essential to limit long-term health consequences of untreated CT and NG infections and control the epidemic. Douglas County, Nebraska has CT and NG infection rates that are consistently above the US national average, with disparities observed by age, race, and geographic area. Literature suggests confidentiality, lack of insurance, and limited testing locations are important concerns for high-risk groups. To address these barriers, the Douglas County Health Department (DCHD) developed a novel community-based CT and NG screening program in public library branches. The primary aim of this study was to evaluate the effectiveness of public libraries as STI screening sites that target high-risk populations not captured by traditional clinics. The second aim was to identify demographic and clinical factors associated with CT and NG infection in both settings.
METHODS: A retrospective review was done of surveys of library patrons and DCHD Midtown STI clinic clients who submitted urine tests for CT and NG from June 2010 through April 2014. Chi-square, Fisher exact and student’s t- tests were conducted using SAS v9.3.
RESULTS: Records of 977 library program participants and 4,871 DCHD clinic clients were reviewed. Library participants were significantly younger than DCHD clinic clients (p<0.0001); 66.7% of library participants were 24 years and younger compared to 39.1% of clinic clients. Blacks used the library significantly more than the clinic site (65.8% vs. 37.0%, p = 0.0003). The percent positives for CT (9.9% vs. 11.2%) and NG (2.74% vs. 5.3%) were significantly lower among library participants than the clinic clients (p = 0.0393 and p = 0.0004 respectively). The percentage of symptomatic DCHD clients was significantly higher than the symptomatic library participants, regardless of test outcome (p < 0.0001).
CONCLUSIONS: When compared to the DCHD Midtown STI clinic, the library screening captures a young, predominantly Black population living in a high-risk area within the county. Most clients of the DCHD clinic went for STI testing when symptomatic while library patrons were mostly asymptomatic. The library group had CT and NG infection rates that were significantly lower than the DCHD site but higher than the national average, which underscores the importance of routine screening as part of sexual health maintenance.