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Improving STD Screening Rates in the HIV Clinics

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  1. Improving STD Screening Rates in the HIV Clinics C. Lynn Besch, MD for the LSUHSC HIV Disease Management Team

  2. STD Screening - Rationale • STD’s – dangerous for individuals and their communities • Complications from infection • Cost of treatment • Interaction with HIV transmission • USA – high rates of STD’s • LA – high, high, high rates of STD’s • Periodic STD screening recommended in HIV clinics

  3. Chlamydia—Rates by State, United States and Outlying Areas, 2009 NOTE: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 406.3 per 100,000 population. 327 VT NH MA RI CT NJ DE MD DC 191 160 297 344 346 276 540 422 1,107 185 309 305 272 303 372 252 472 375 Guam 352 457 369 346 313 305 386 420 469 341 225 405 199 399 398 375 311 438 445 478 Rate per 100,000 population 413 400 503 595 478 411 803 556 <300.0 (n = 10) 626 435 300.1–400.0 (n = 21) 753 >400.0 (n = 23) Virgin Islands 444 398 Puerto Rico 185 468

  4. Gonorrhea—Rates by State, United States and Outlying Areas, 2009 NOTE: The total rate of gonorrhea for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 97.8 per 100,000 population. 34.9 VT NH MA RI CT NJ DE MD DC 8.0 8.6 30.4 30.6 73.1 54.8 111.2 113.5 432.7 8.3 10.9 23.5 44.1 29.4 92.4 7.2 42.8 87.2 Guam 33.5 147.0 13.9 81.4 55.2 77.2 66.4 139.2 154.7 12.5 107.2 57.2 63.2 26.2 100.3 89.4 89.6 109.8 150.4 127.5 Rate per 100,000 population 128.3 50.0 156.2 185.7 54.5 246.4 141.3 160.8 <19.0 (n = 8) 120.4 19.1–100.0 (n = 24) 113.9 204.0 144.3 >100.0 (n = 22) Virgin Islands 104.7 Puerto Rico 5.8 49.0

  5. Primary and Secondary Syphilis—Rates by State, United States and Outlying Areas, 2009 NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.6 per 100,000 population. 2.1 VT NH MA RI CT NJ DE MD DC 0.0 1.1 3.7 1.9 1.9 2.4 3.1 5.6 27.5 0.4 0.3 0.6 1.4 1.5 0.8 0.2 0.0 6.1 Guam 1.1 0.6 2.3 0.8 2.7 0.3 3.5 3.1 5.8 1.1 2.5 2.1 5.2 0.4 3.8 1.1 2.9 2.2 6.3 6.5 2.7 3.6 Rate per 100,000 population 9.6 3.1 2.7 9.8 8.1 8.9 <0.2 (n = 5) 16.8 6.8 0.21–2.2 (n = 19) 0.0 5.7 >2.2 (n = 30) Virgin Islands 0.0 Puerto Rico 5.7 2.6

  6. STD Screening in the LSU HIV Clinics • Objective: • Increase STD screening rates to 85% • Baseline data 3rd Q 2007: • 7 HIV clinics (as a group) screening rate – • GC 10% • Chlamydia (CT) 18% • Syphilis 68%

  7. Diversity of HCSD HIV Clinics size range from 200->2000 dedicated MD’s – house staff on site subspecialties or not depth of support services

  8. STD screening – Issues • Barriers / problems common to all: • Identification of patients for screening • Reminders for clinicians to order screening • Problems with specimen collection • Tracking progress • Providing feedback to clinicians

  9. STD Screening - Methods • Educational programs for staff • Screening charts • Revision of lab ordering slips • Development of standing orders or protocols • Collection kits placed in clinic • Giving patients specimen cups early in the clinic visit (plenty of time for collection)

  10. CT screening – Q1 2008 to Q4 2009

  11. CT Screening Q1 2009 to Q2 2011

  12. GC screening –Q1 2008 to 4Q 2009

  13. GC screening - Q1 ‘10 to Q2 ‘11

  14. Syphilis Screening 2008 to 2009

  15. Syphilis Screening: Q1‘10 - Q2 ‘11

  16. STD Screening: Results • All clinics dramatically improved screening rates, especially for GC and CT • Methods included educational efforts and programmatic changes • Group effort with shared responsibility for improvement • Success belongs to the entire clinic staff