Chlamydia trachomatis (Ct) is the most common reportable sexually transmitted infection in the United States
that causes severe and costly morbidity. Black youth are disproportionately impacted, with Ct rates 7.5 times
higher than the rates among non-Black youth. In over two decades of Ct screening in young women,
population-based rates of Ct have declined for White youth but not for Black youth, and clinic-based Ct
screening is accessed less frequently than recommended by Black women, indicating that a different approach
is needed, particularly when considering structural racism and medical mistrust. We posit that a community-
based, seek, test, and treat approach is required. Check It (NICHD/NIAID R01HD086794) was a seek, test,
and treat bundled network approach to reducing chlamydia disparities that was designed for young Black men.
In 33.5 months of recruitment, we screened 1907 men and found a 10.6% Ct positivity rate. We found that
screening men reduced the rate in women by an average of 2.1 percentage points compared to synthetic
control sites; for every 5 men screened, 1 infection in women was averted; and that the program costs were
$5,468 per QALY gained. The study goal is to further adapt and refine Check It, a seek, test, and treat
community-based Ct prevention program aimed to reduce disparities among Black youth in the United
States. We will achieve this in three aims: Aim 1. To adapt and refine Check It – Using the ADAPT-ITT
framework47 and in collaboration with our intended population, content experts, and community partners, we
will make five adaptations to the program: inclusion of women, use of doxycycline, addition of a home
collection option, refinement of incentivized peer referral, and extragenital self-collection in the first year and
then readapt as needed in the third year. We will conduct interrupted time series analysis & hypothesize that
these adaptations will increase enrollment. Aim 2. To determine efficacy and cost-effectiveness of the
adapted Check it– After adaptations and implementation among Black youth in New Orleans (N=2322), using
Medicaid data, we will compare New Orleans (intervention) to synthetic controls to examine the adapted
program's impact on women's Ct rates.48 We will also use time-motion analysis to examine the cost-
effectiveness,34 hypothesizing that inclusion of both men and women is cost effective and will logarithmically
reduce the rates of Ct infection in women. Aim 3. To examine the feasibility/utility of Ct/GC extragenital
and syphilis/HIV testing – Participants will be offered extragenital specimen self-collection & syphilis/HIV
testing. We hypothesize that >80% will accept to do extragenital testing and that syphilis/HIV rates will exceed
the national average. To break down health disparities, it is essential to go to the communities of those
impacted. If successful, Check It II can serve as a model for other sites ultimately reducing Ct disparities on a
broader basis. Check It II could also serve as a model for other STI interventions in this population such as
doxy PrEP or vaccines.
