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STD Testing Protocols, STD Testing, and Discussion of Sexual Behaviors in HIV Clinics in Los Angeles County. Melanie M. Taylor MD, MPH Los Angeles County STD Program. Acknowledgements. Tracie McClain MD, MPH Bessie Brown Getahun Aynalem MD, MPH Lisa Smith DrPH Peter Kerndt MD, MPH

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Melanie M. Taylor MD, MPH Los Angeles County STD Program

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Melanie m taylor md mph los angeles county std program

STD Testing Protocols, STD Testing, and Discussion of Sexual Behaviors in HIV Clinics in Los Angeles County

Melanie M. Taylor MD, MPH

Los Angeles County STD Program


Acknowledgements

Acknowledgements

  • Tracie McClain MD, MPH

  • Bessie Brown

  • Getahun Aynalem MD, MPH

  • Lisa Smith DrPH

  • Peter Kerndt MD, MPH

  • Tom Peterman MD, MSc


Early syphilis los angeles county

Early Syphilis Los Angeles County


Hiv seropositivity among early syphilis cases 2001 2003

HIV Seropositivity Among Early Syphilis Cases, 2001-2003


Hiv in los angeles

HIV In Los Angeles

  • 45,000 persons living with AIDS or HIV aware of status*

  • An estimated additional 9,000 persons with AIDS or HIV that are unaware of status*

    *Office of AIDS Programs and Policy. Los Angeles County Department of Health Services. HIV Prevention Plan Addendum. 2003


Objectives

Objectives

  • To evaluate knowledge of syphilis epidemic among HIV care providers

  • To determine STD screening practices in HIV care clinics

  • To quantify use of STD screening/testing protocols in HIV care clinics

  • To evaluate the frequency and nature of discussion of sexual behaviors in HIV clinics


Study design methods

Study Design/Methods

In-person or phone interview performed by one interviewer

17 Question Survey

Results analyzed using SPSS

Clinics received:

Patient information cards for 6 STDs,

CA STD treatment guidelines,

MMWR: Prevention for Positives,

Posters of primary and secondary syphilis symptoms,

STD reporting forms


Sample summary

Sample Summary

  • Survey Respondents: N = 36*

  • Represented Clinics: N = 48

  • Represented HIV Care Providers: N = 184

  • Represented Patients: N = 28,119

  • *Medical Directors allowed to complete surveys for multiple sites under their direction


Survey of clinical care representatives from 48 clinics enrolling 50 hiv patients

Survey of Clinical Care Representatives from 48 Clinics Enrolling >50 HIV Patients

Clinician Type% of Sample

Medical Directors31

Clinic Directors 3

HIV/AIDS Program Coordinators11

Physicians 33

Nurse Practitioners17

Physician’s Assistants 3

Medical Assistant 3


Types of clinics

Types of Clinics

  • Public

  • Private

  • HMO

  • Hospital/University

  • Community Based Organization


Clinic types

Clinic Types

Public 20%

Community Based Organization

31%

Hospital/

University 10%

Private/HMO

38%

Source: LAC DHS STD Program; N=44,205


Knowledge of syphilis epidemic

Knowledge of Syphilis Epidemic

When asked about LA syphilis rates,

100% spontaneously reported they were higher.

97% thought they were higher than the national average.


Clinics performing std testing at the first visit

Clinics Performing STD Testing at the First Visit

STD TestNumber (%)

Syphilis48 (100)

Chlamydia32 (67)

Gonorrhea32 (67)

Herpes0 (0)

HPV (Pap Smears)7 (15)

Trichomoniasis3 (6)

Hepatitis screen (A, B, C)48 (100)


Use of a written std protocol

Use of a Written STD Protocol

Clinical PracticeNumber (%)

Use of STD testing protocol 24 (50)

Protocol Based on:

CDC Guidelines3 (13)

LAC STD Program

Screening Recommendations 4 (17)

Standardized Electronic

Sexual Risk Assessment 9 (38)

Other3 (13)

Unknown5 (21)


Activities of clinics reporting use of written protocols wp for std testing

Activities of Clinics Reporting Use of Written Protocols (WP) for STD Testing

ActivityWP Use WP Non-UseOR(95%CI)P Value

Asymptomatic Testing

Every 3-6 months:

Syphilis 20 (83)14 (58)3.6 (0.9-13.7)0.055

GC/CT 7 (79)6 (25)1.2 (0.3-4.4)0.5

Patients asked about unsafe sex behavior at each visit

24 (100)0 (0)2.2 (1.4-3.4)<0.001


Written protocol use by clinic type

Written Protocol Use by Clinic Type

Clinic Type WP UseWP Non-UseOR (95% CI)P Value

Early Intervention

Program** 22 (92) 11 (46)13.0 (2.5-68.1)0.001

CBO15 (63) 0 (0)2.7 (1.6-4.5)<0.001

HMO0 (0) 7 (29)0.7 (0.5-0.9)0.009

Hosp/Univ2 (8) 3 (13)0.6 (0.1-4.2)1.0

Private2 (8) 9 (38)0.2 (0.03-0.8)0.04

Public5 (21) 5 (21)1.0 (0.2-4.0)0.6


Questions frequently included in sexual risk assessments

Questions Frequently Included in Sexual Risk Assessments

-Have you practiced unsafe/unprotected (without a condom) sex since your last visit?

-Have you have unprotected oral, anal, or vaginal sex since your last visit?

-Do/did you use a condom when you have/had sex?

-If unsafe sex, what was the HIV status of your partner(s)?


Questions frequently included in sexual risk assessments1

Questions Frequently Included in Sexual Risk Assessments

-If unsafe sex, was your partner(s) aware of your HIV status?

-Have you used any recreational drugs that were linked to your sexual activity?

-Was your sexual interaction with an anonymous partner(s)? If anonymous, where did the sexual interaction take place? (bathhouse, sex club, via internet contact, other)

-What type of sex practices do/did you engage in?

-Have you had sex with men, women or both?


Conclusions

Conclusions

  • Written protocols for STD testing may promote sexual risk assessment questioning among HIV providers

  • These written protocols may insure STD testing per CDC/IDSA guidelines for HIV positive persons at sexual risk


Limitations

Limitations

  • Actual experience of the patients was not evaluated

  • Sample size limited some analyses

  • Unable to determine the values of sexual risk questions in predicting disease

  • 9/48 (19%) clinics operated by one organization and may have skewed the results.


La county recommendations for std screening among hiv positive persons

LA County Recommendations for STD Screening among HIV Positive Persons


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