Three models to promote syphilis screening and treatment in a high risk population.

Three syphilis control models targeted at a high incidence area were implemented and evaluated over a 31-month period. These models consisted of (1) street-based outreach and referral to community health clinics for free sexually transmitted disease screening and treatment, (2) off-site syphilis screening at high risk locations and referral for free treatment, and (3) off-site syphilis screening and referral at high risk locations with monetary incentives offered for obtaining test results and seeking treatment if required. Off-site screening--conducted at homeless shelters, soup kitchens, drug treatment centers, and community fairs--was found to be significantly more effective in promoting syphilis screening than outreach and referral to community health centers. For the off-site screening models, monetary incentives were related to an increase in the proportion of individuals at homeless shelters and soup kitchens who agreed to be tested, and to an increase in the proportion of people at homeless shelters, soup kitchens and drug treatment centers who sought their test results and obtained treatment, if required.