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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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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 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 Directors 31

Clinic Directors 3

HIV/AIDS Program Coordinators 11

Physicians 33

Nurse Practitioners 17

Physician’s Assistants 3

Medical Assistant 3


Types of clinics
Types of Clinics Enrolling >50 HIV Patients

  • Public

  • Private

  • HMO

  • Hospital/University

  • Community Based Organization


Clinic types
Clinic Types Enrolling >50 HIV Patients

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 Enrolling >50 HIV Patients

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 Enrolling >50 HIV Patients

STD Test Number (%)

Syphilis 48 (100)

Chlamydia 32 (67)

Gonorrhea 32 (67)

Herpes 0 (0)

HPV (Pap Smears) 7 (15)

Trichomoniasis 3 (6)

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


Use of a written std protocol
Use of a Written STD Protocol Enrolling >50 HIV Patients

Clinical Practice Number (%)

Use of STD testing protocol 24 (50)

Protocol Based on:

CDC Guidelines 3 (13)

LAC STD Program

Screening Recommendations 4 (17)

Standardized Electronic

Sexual Risk Assessment 9 (38)

Other 3 (13)

Unknown 5 (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

Activity WP Use WP Non-Use OR(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 (WP) for STD Testing

Clinic Type WP Use WP Non-Use OR (95% CI) P Value

Early Intervention

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

CBO 15 (63) 0 (0) 2.7 (1.6-4.5) <0.001

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

Hosp/Univ 2 (8) 3 (13) 0.6 (0.1-4.2) 1.0

Private 2 (8) 9 (38) 0.2 (0.03-0.8) 0.04

Public 5 (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 (WP) for STD Testing

-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 (WP) for STD TestingSexual 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 (WP) for STD Testing

  • 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 (WP) for STD Testing

  • 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.



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