Screening for sexually transmitted diseases in female arrestees upon intake at the Los Angeles County Twin Towers II correctional facility: An evaluation of test acceptance, disease burden and cost-effectiveness

This dissertation examines an innovative project to provide urine-based chlamydia and gonorrhea screening at intake to female arrestees at Los Angeles County Twin Towers II Correctional Facility. It evaluates the feasibility of this project by considering the level of test acceptance, the level of disease detected and the cost-effectiveness of the screening project.; During the pilot study in 1999, 3,174 women were offered the test. 81.7% accepted. Women who were pregnant, charged with prostitution, or reported being symptomatic for a sexually transmitted disease (STD) were the most likely to accept. Women under the age of thirty were the least likely. The chlamydia prevalence was 5.7%. The gonorrhea prevalence was 1.3%.; The following risk factors for chlamydia were identified: women under the age of thirty, women charged with prostitution-related offenses and pregnant women. 80% of the women testing positive for chlamydia or gonorrhea received treatment. A reevaluation of the project was conducted in 2000, when only women with the identified risk factors were offered chlamydia screening. Women testing positive for chlamydia were reflexively screened for gonorrhea. Of the 3,042 women tested, 11.8% tested positive for chlamydia, and 10% were coinfected with gonorrhea. Treatment rates during the reevaluation decreased to 55%.; A decision analytic model was created to compare the cost-effectiveness of the following three chlamydia screening strategies: no screening; selectively screening by identified risk factors; and universal screening. Using baseline estimates, the outcomes for universal and selective screening strategies had fewer cases of Pelvic Inflammatory Disease (PID), but neither was cost-saving.; A one-way sensitivity analysis found the model to be sensitive to chlamydia prevalence, probability of PID, and treatment rate. When these variables were increased to the following values, selective screening became cost-saving over no screening: chlamydia prevalence (9%), probability of PID (28%) and treatment rate (71%). Overall, screening for STDs at intake using a urine-based test was found to be feasible, acceptable and identified a large number of infected women. When treatment levels are increased, selectively screening this population is cost-saving.