• be preserved at the regional level and strengthened where regional capabilities are lacking. Outsourcing and collaboration with private or university-based STD reference laboratories should be considered in sustaining and developing public sector reference laboratory capabilities.

Collaborating To Improve Services

In this section, the committee describes potential models for how the various providers of clinical services can work together to improve access to, and quality of, clinical services. In examining potential models for delivering services, the committee considered the many ongoing programs that they visited and heard about during the course of the study. The committee believes that the programs summarized in Appendix I serve as valuable models for agencies and organizations that are planning to develop collaborative activities. Because most of these programs have not been systematically evaluated for effectiveness, the committee does not necessarily endorse these specific programs, but rather encourages agencies and organizations to use these examples as the basis for developing collaborations to improve services.

Collaborating with Other Public Sector Health Programs

As in the case of community-based and private sector clinics, local health departments that provide STD-related clinical services should ensure that such services are provided in primary care settings, including reproductive health programs. The DeKalb County health department in Georgia, for example, has integrated STD and HIV screening and counseling services and is beginning to provide both services in family planning and primary care clinics. Some of the most promising efforts to provide STD-related services along with other public health services are focused on high-risk populations. For example, the Teen Services Program, sponsored by Emory University at Grady Memorial Hospital in Atlanta, and the Young Adult Clinic, operated by the Chicago Health Department with Vida/Sida, a community outreach program, target high-risk adolescents and young adults in inner-city communities. These projects focus on the comprehensive health and social needs of populations and individuals within the community, not just STDs. They bring together high-priority services for adolescents and young adults, such as STD screening and treatment, HIV testing and counseling, and contraceptive services and pregnancy testing, in a comprehensive health care setting. Although the Chicago project focuses on STDs, including HIV infection, and the Atlanta project focuses on pregnancy prevention, both emphasize education and behavior change related to sexuality. They are also both closely linked to schools; the Grady program is closely aligned with the Atlanta middle-school curriculum. Both programs also utilize ''peer experts" who provide outreach and education to other adolescents.

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