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Background: Stratified care aims at matching the intensity and setting of mental health interventions to the needs of help-seeking Young People. In Australia, a 5-tiered system of mental health services is in operation. To aid patient triage to the most appropriate tier, a Decision Support Tool (DST) has been developed and is being rolled out nationally Methods: We analysed outcome data pre-and post-enrolment of about 1500 Young People (aged 16-25) referred to a Youth Mental Health Service delivering medium- and high intensity psychological treatment programs (tiers 3 and 4). We compared outcomes in both tiers during three 12-month periods: (a) in the inaugural phase of tier 4, prior to service saturation and stringent triaging, and prior to the COVID-19 pandemic (2019);(b) during the COVID-19 pandemic when all services were delivered remotely over phone- and video facilities, and when DST triaging was introduced (2020);(c) following return of face-to-face consultations, in a situation of service saturation and stringent DST triaging (2021) Findings: About 22% of Young People in the tier 3 program experienced reliable improvement according to their Kessler-10 (K-10) scale ratings, regardless of changing circumstances. In contrast, 40% of people in the tier 4 program reliably improved during the inaugural phase When circumstances and service delivery changed (COVID-19 restrictions service saturation, DST triaging), the rate of reliable improvement halved to about 20% Conclusion(s): Access to higher intensity psychological programs improves treatment outcomes for help-seeking Young People. However high-intensity services are more sensitive to external and service factors than less intense treatment models.
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Background: Published clinical and epidemiological data on individuals undergoing anonymous testing for sexually transmitted diseases (STI) in Germany are sparse. Here we report annual results of STI screenings and survey data from a large community based STI testing Checkpoint in Cologne, Germany in light of increased PrEP roll-out and the COVID-19 pandemic. Methods: From January 2017 to December 2020, data on STI screening, clinical, demographic, sexual information was anonymously recorded for individuals attending the Checkpoint in Cologne. Visitors were screened for HIV, syphilis, chlamydia, gonorrhea and hepatitis C using point of care testing kits. Positive tests were validated. Results: Overall, screening was performed on 15,153 visitors aged 16 to 85 years. Three main reasons were identified: recent HIV risk situation (40%), routine testing (23%), new relationship (21%). The largest visitor group represented MSM with a mean frequency of 40% across all years, followed by MSW (28%) and WSM (22%). Annual visitor numbers increased from 3,838 in 2017 by +3% and +6% for years 2018 and 2019, respectively. However, these figures declined by 40% in 2020 (COVID-19 lockdown). Frequency of MSM visitors declined from 46% in 2017 to 42%, 38%, and 35% in 2018 to 2020, respectively. In contrast, visitor numbers increased for all other groups from 2017 to 2020, with the highest relative change observed for WSW (+94%), followed by MSW (+25%) and MSW (+16%). Annual number of visitors screened for HIV declined from 55% in 2017 to 42% in 2020, with increasing test frequencies for chlamydia and gonorrhoea (17% in 2017 to 29% in 2020) and for HCV (4% in 2017 to 9% in 2020). Syphilis screening frequency remained constant at approximately 19% annually. MSM had the highest disease frequency but MSW and WSM showed a continuous increase in chlamydia infections from 2017 to 2020 (from 20% to 30% and 13% to 22%, respectively). Number of MSM visitors on PrEP increased from 2017 onwards, with +46% and +52% for years 2018 and 2019, and 7% for 2020 (COVID-19 lockdown). Conclusion: Checkpoint was able to detect relevant STIs in 5% of all visitors thereby underling the importance of community-based testing sites particularly with increased PrEP roll-out and despite COVID-19 lockdown restrictions. Still, MSM remain at highest risk for contracting HIV highlighting the continuous need for educational activities as well as low-threshold and cost-free STI screening capacities.