Gonorrhea Community Action Project (GCAP)
Funded by the Centers for Disease Control and Prevention (CDC) and the National Institute of Mental Health (NIMH), the goal of this multi-site project was to better understand factors related to extremely high gonorrhea (and other bacterial sexually transmitted infection) rates in seven communities (Phase 1), and develop interventions to reduce those rates in three communities (Phase 2). Our local study used a community-based approach to address gonorrhea infection among youth and young adults in the Southwest health district of Los Angeles County. Phase I, the formative research phase, involved qualitative data collection to: 1) investigate contributing factors to the high incidence of gonorrhea, 2) identify factors that influence the health-seeking behaviors of populations at risk of acquiring and transmitting gonorrhea, and 3) investigate the knowledge and use of health services by these individuals. The findings from Phase 1 were used to develop the community, client, and provider interventions implemented in Phase 2. The GCAP Community Advisory Board, established with health and social service providers, community-based organizations, and other entities serving youth and young adults in the target area, played an integral role in successful implementation of study activities.
The Phase 2 interventions were an individual level intervention directed at STI clinic patients to encourage return for re-testing after treatment for gonorrhea or chlamydia, training of community health care providers to elicit sexual histories from adolescents and test sexually active adolescents and young adults under the age of 25, and a community-level intervention using outreach with peer health leaders and social marketing to increase seeking care for physical examinations (including STI testing) by adolescents, the creation of a community health outreach facility, called “The Positive Source” that provided urine screening for gonorrhea and chlamydia among other services. Evaluation of the community awareness campaign indicated increased awareness of campaign materials and the need for STI testing even in absence of symptoms in the target community compared to a comparison community. Results of the client intervention found that a monetary incentive did not increase return rates compared with a brief recommendation. A reminder phone call seemed to be the most effective method to increase return.