摘要：In 1998, treatment completion was low among chlamydia and gonorrhea cases reported to the San Francisco Department of Public Health and assigned for treatment follow-up. To improve treatment completion among growing numbers of chlamydia and gonorrhea cases, the department implemented field-delivered therapy (FDT), a single-dose, directly observed therapy protocol for uncomplicated chlamydial and gonococcal infections. After the protocol was implemented in March 1999, the proportion of cases completing treatment increased significantly, from 61.8% in 1998 to 81.0% in 2000. The greatest increases in treatment completion were observed for females and individuals younger than 20 years old. FDT is an effective, feasible, and convenient way to reach and treat individuals who are unlikely to return for chlamydia and gonorrhea treatment. CHLAMYDIA AND GONORRHEA are the most commonly reported diseases in the United States. 1 In women, these sexually transmitted diseases (STDs) have common and severe consequences if left untreated: pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain. 2, 3 In both men and women, chlamydia and gonorrhea are associated with a two- to fivefold increase in risk for HIV infection. 4 While these infections may cause symptoms of discharge and dysuria, most chlamydial and gonococcal infections are asymptomatic. 5 Screening programs are therefore critical for their detection and control. However, a proportion of detected, asymptomatic infections remain untreated either because people cannot be found after their initial screening for treatment follow-up or because some people are not motivated to make a clinical treatment visit for asymptomatic infection. During 1998, 38% (165 of 432) of people assigned for chlamydia and gonorrhea treatment follow-up by the STD program staff of the San Francisco Department of Public Health were not treated. In addition, new noninvasive urine-based nucleic acid amplification tests allowed us to expand screening in nonclinical settings in 1999, further increasing the number of chlamydial and gonococcal infections detected and needing treatment follow-up. Given the high proportion of untreated cases and increased case detection, innovative approaches to increasing treatment were needed. Field delivery of medication was an integral part of directly observed therapy for tuberculosis 6 but no similar protocol was in place for STD treatment. Because single-dose, orally administered treatments were available for chlamydia and gonorrhea and because directly observed therapy had been successful in ensuring treatment for tuberculosis, 6 the San Francisco Department of Public Health’s STD program implemented a similar protocol in March 1999. We called our program fielddelivered therapy (FDT). The objective of FDT was to allow STD program field staff, under the medical license of the STD controller, to treat uncomplicated chlamydial and gonococcal infections in persons who were unable, unwilling, or unlikely to come into the municipal STD clinic for treatment. We evaluated the FDT protocol by measuring the number of individuals accepting medication in the field, determining the proportion of individuals treated, and characterizing the population receiving field treatment.
