improving std screening rates in the hiv clinics
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Improving STD Screening Rates in the HIV Clinics. C. Lynn Besch, MD for the LSUHSC HIV Disease Management Team. STD Screening - Rationale. STD’s – dangerous for individuals and their communities Complications from infection Cost of treatment Interaction with HIV transmission - PowerPoint PPT PresentationTRANSCRIPT
Improving STD Screening Rates in the HIV Clinics
C. Lynn Besch, MDfor the LSUHSC HIV Disease Management Team
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
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.
VT
NH
MA
RI
CT
NJ
DE
MD
DC
<300.0 (n = 10)
300.1–400.0 (n = 21)
>400.0 (n = 23)
327
303
399
386
309
753
305 185
472
346
595
435
252
225
478
369375
305
272
372
803556
411
398
445
398
420
457
341
478
438
413
626
503
469
311199405
400
468
313
375
Puerto Rico185
Guam352
Rate per 100,000population
VirginIslands
444
191
160
297
344
346
276
540
422
1,107
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
29.4
63.2
66.4
8.3
144.3
Puerto Rico5.8
Guam33.5
23.5 10.9
87.2
81.4
185.7
120.4
7.2
12.5
54.5
13.942.8
77.2
44.1
92.4
246.4160.8
141.3
113.9
150.4
100.3
139.2
147.0
107.2
127.5
109.8
128.3
204.0
156.2
154.7
89.626.257.2
50.0
55.2
89.4
<19.0 (n = 8)
Rate per 100,000population
19.1–100.0 (n = 24)
>100.0 (n = 22)
49.0
VirginIslands104.7
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
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.
<0.2 (n = 5)
0.21–2.2 (n = 19)
>2.2 (n = 30)
2.1
1.5
5.2
3.5
0.4
0.0
0.6 0.3
6.1
2.7
2.7
6.8
0.2
1.1
3.1
0.60.0
0.3
1.4
0.8
8.18.9
9.8
5.7
6.3
3.8
3.1
2.3
2.5
6.5
2.9
2.7
16.8
9.6
5.8
2.20.42.1
3.6
2.6
0.8
1.1
Puerto Rico5.7
Guam1.1
Rate per 100,000population
VirginIslands
0.0
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
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%
Diversity of HCSD HIV Clinics
size range from 200->2000
dedicated MD’s – house staff
on site subspecialties or not
depth of support services
STD screening – Issues Barriers / problems common to all:
Identification of patients for screeningReminders for clinicians to order
screeningProblems with specimen collectionTracking progressProviding feedback to clinicians
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)
CT screening – Q1 2008 to Q4 2009
CT Screening Q1 2009 to Q2 2011
GC screening –Q1 2008 to 4Q 2009
GC screening - Q1 ‘10 to Q2 ‘11
Syphilis Screening 2008 to 2009
Syphilis Screening: Q1‘10 - Q2 ‘11
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