2002 National STD Conference - Poster Abstracts 76-100
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Comparison of Cytological Cervical Figures in Women with or without Infection from HIV
C Pavia1, P Piselli1, M Peroni2, M L Schiavone4, N Orchi1, G Pontani4, S Calcaterra3, P Pietrobattista5, S Zaniratti3, A Spanó4, D Serraino1, MR Capobianchi3, G Ippolito1
1Dipartimento di Epidemiologia, 2Ambulatorio di Patologia Cervico-Vaginale, and 3Laboratorio di Virologia, Istituto Nazionale per le Malattie Infettive (INMI) “L. Spallanzani” IRCCS, Rome, Italy; 4Servizio di Microbiologia, Ospedale “Sandro Pertini”, Rome, Italy; 5Consultorio di Tor Cervara, Rome, Italy.
Background: Co-infection with HPV is more frequently found in HIV-positive women, and it is associated with a higher risk of precancerous lesions of the cervix.
Objective: To estimate frequency and type of cervical cytological pictures and infections from human papillomavirus (HPV) in HIV-positive and HIV-negative women.
Methods: One hundred seventeen HIV-positive women (HIVpos) cared for by the INMI “L. Spallanzani” of Rome, and 117 HIV-negative women (HIVneg) attending a gynecologic outpatient Clinic in Rome, have been considered. Age distribution in the two groups was similar (median age 35 in HIVpos, and 32 in HIVneg). Colpo-cytological examinations were carried out; cervical scraping samples were taken to identify HPV positivity and type of strain by specific PCR.
Results: We found seven (6% of the total) cases of atypical squamous cells of uncertain significance (ASCUS) in the HIVpos women against no case in the HIVneg. Squamous Intraepitelial Lesions (SILs) of low degree were found in 26 (22.2%) HIVpos, compared to four cases (3.4%) in HIVneg (P<.001). No high-grade SILs were found in HIVneg, while nine cases (7.7%) were found in HIVpos; seven out of these cases (77.8%) had a cytological diagnosis of carcinoma in situ. Cervical scrapings samples found to be HPV-positive were 21 (17.8%) in HIVneg vs 60 (51.3%) in HIVpos (P<.001). No statistically significant difference in the frequency of infection from high-risk HPV strains in the two groups was observed (83% in HIVpos and 71.4% in the HIVneg).
Conclusions: Our study confirms the known association between HIV-associated immunodepression, SIL, and HPV infection. Although no differences were observed in the susceptibility of infection by high-risk HPV strains, HIVpos women are more likely to be infected with HPV, and must be considered at higher risk to develop cervical neoplasia.
Strain Typing of Neisseria gonorrhoeae Isolates by Pulsed-Field Gel Electrophoresis and Automated Ribotyping
S Rolando, M Whelan, J Fontana, A Foley, H George
Massachusetts Department of Public Health, Boston, MA
Background: The incidence of Neisseria gonorrhoeae (GC) in Massachusetts has increased for the past two years. Molecular typing can help delineate epidemiological trends in infectious diseases. Pulsed-field gel electrophoresis (PFGE) effectively types strains of GC, while automated ribotyping (AR) has been less utilized for this purpose.
Objective: To evaluate the discriminatory power of PFGE and AR when applied to GC isolates collected from state-contracted STD clinics between December 2000 and June 2001.
Methods: The PFGE protocol followed CDC guidelines and utilized the enzyme NheI. Gels were analyzed with Molecular Analyst software. AR was performed on the Qualicon RiboPrinter‚ System using the enzyme PvuII.
Results: The 143 isolates tested generated 55 different PFGE types, comprised of 27 single isolates, 13 pairs, 5 sets of 3, and 11 groups containing 4, 6, 7, 8, 12, or 16 isolates respectively. AR generated 17 different ribotypes, comprised of 6 single isolates, 2 pairs, 1 set of 52, and 8 groups containing 3, 4, 6, 8, 20, or 28 isolates respectively. One group containing 6 isolates was common to both methods. Pairs of isolates associated with concurrent dual infections (7 patients) were indistinguishable by PFGE, while AR showed differences between 2/7 pairs. Isolate pairs from 3 additional patients with repeat infections (>2 months apart) showed differences by both methods, whereas 2 isolates from a 4th patient collected 19 days apart were indistinguishable by both methods.
Conclusions: Both AR and PFGE can differentiate strains of GC, with PFGE demonstrating greater resolving power. However, the epidemiological significance of this resolution needs to be clarified.
Implications for Programs/Policy: Molecular typing results combined with epidemiological data could aid in following GC through a community, serving to guide programs towards high-risk populations and to confirm self-reported sexual partner data.
Implications for Research: The addition of epidemiological data to these results should elucidate the degree of discriminatory power that is most suitable for tracking sexual networks.
Comparison of Two Nucleic Acid Amplification Tests to Culture for the Detection of Pharyngeal Neisseria gonorrhoeae
D Campbell, M Ishida, C Madayag, A Soohoo, V Zapitz, S Liska
San Francisco Department of Public Health Microbiology Laboratory, San Francisco, CA
Background: Nucleic acid amplification tests (NAATs) are commonly used to diagnose such sexually transmitted diseases (STDs) as chlamydia and gonorrhea. These tests are more sensitive than culture, the gold standard, and since these methods also utilize non-invasive specimens (urine), their use allows for expansion of routine STD screening outside of traditional clinical settings. In certain high-risk populations, however, there is often a need for routine screening for extra-genital STDs (pharyngeal gonorrhea, for example), but NAATs are not cleared for use with such specimens, which often leaves culture as the only testing option.
Objective: To compare Becton Dickinson’s (BD) ProbeTec ET System Strand Displacement Amplification assay (SDA) and Abbott’s LCx Probe System Ligase Chain Reaction (LCR) assay to culture for the detection of pharyngeal gonorrhea.
Methods: Three pharyngeal swab samples were collected from each study participant. One swab was inoculated to selective media for the isolation of Neisseria gonorrhoeae. An Abbott LCx Probe System Uriprobe Specimen Collection and Transport system was used to collect a specimen for LCR testing. A BDProbeTec Culturette Direct Collection and Transport System was used to collect a specimen for SDA testing. Culture was performed according to standard protocols. Abbott and Becton Dickinson manufacturers’ instructions were modified for collection of pharyngeal swab specimens. Manufacturers’ instructions were followed for performance of LCR and SDA testing.
Results: A modified gold standard was used to determine true positive results. All culture positive specimens were viewed as true positives. All culture negative specimens that were positive by both LCR and SDA were viewed as true positives. The sensitivity of culture was 57% and the sensitivity of both LCR and SDA was 93%. Culture specificity was 100%, and LCR and SDA specificity were 98% and 97%, respectively.
Discussion: According to the data, LCR and SDA appear to be more sensitive than culture for the detection of pharyngeal gonorrhea. Thus, in populations where the prevalence of extra-genital STDs is high enough to warrant routine screening, nucleic acid amplification tests can serve as valuable diagnostic tools when properly validated for such use.
Implications for Programs: These data indicate nucleic acid amplified tests may not only be options but preferable to culture for the detection of N. gonorrhoeae in pharyngeal/throat specimens.
Implications for Research: Further studies are warranted to determine if nucleic acid amplified tests would also provide a more sensitive method for detecting N. gonorrhoeae from other anatomical sites (e.g. rectal) for which they are not FDA approved.
Contact Information: Sally Liska / 415-554-2800 / sally_liska@dph.sf.ca.us
Implications of Chlamydia Test Specificity for Screening Guidelines for Older Women
C Kent1, J Chow2, H Bauer2, M Brammeier2, M Funabiki3, G Bolan2, P Blackburn 4
1STD Prevention and Control, San Francisco Department of Public Health, CA; 2California Department of Health Services, Sexually Transmitted Disease Control, Berkeley, CA; 3California Family Health Council, Berkeley, CA; 4Center for Health Training, Oakland, CA
Background: Chlamydia screening guidelines for women over age 25 have focused on identifying criteria, such as symptoms or behavioral factors, to maximize case detection. However, the dual effect of low chlamydia prevalence in this age group and chlamydia test specificity has usually not been considered in the development and evaluation of screening guidelines.
Objective: To determine the effect of test specificity on observed prevalence and positive predictive value among older women tested for chlamydia.
Methods: We analyzed 2,000 California Infertility Prevention Project data from family planning sites of chlamydia nucleic acid amplified testing of women over 25 years, for a range of specificity estimates that correspond to previous research findings. We estimated positive predictive value (PPV) and true prevalence based on specificity, observed prevalence, and symptom status.
Results: The observed chlamydia prevalence among women over 25 years was 2.1% (137/6,372). Chlamydia positivity was 1.9% among asymptomatic women (n = 4412) and 2.7% among symptomatic women (n = 1960). With an observed prevalence of 1.9%, and assuming use of a test with 95.0% sensitivity, and specificity set at 98.0%, 99.0%, and 99.5%, the PPV was 0. 0%, 49.0%, and 74.3%, and the corresponding true prevalence was 0.0%, 1.0%, and 1.5%. The corresponding PPV for an observed prevalence of 2.7% was 27.7%, 63.5%, and 81.7%, with a corresponding true prevalence of 0.8%, 1.8%, and 2.3%.
Conclusions: Even at high levels of specificity, the observed prevalence may significantly overestimate the true prevalence in low-prevalence settings. Screening guidelines should consider prevalence and test specificity.
Implications for Program/Policy: Low PPVs imply that a high proportion of older women may be falsely diagnosed with chlamydia. Routine confirmatory testing should be considered in low-prevalence populations.
Implications for Research: Small changes in test specificity are likely to have much more dramatic effects on observed prevalence than improved sensitivity. Interpretation of trends in prevalence should take these effects into account.
Measurable Learning Objectives: The participant will be able to describe the effect of test specificity upon observed chlamydia prevalence and PPV.
Comparison of Specimen-Processing Procedures and Preliminary Data on Performance of the ROCHE COBAS PCR to Detect Chlamydia trachomatis (CT) in Rectal Specimens
MR Golden, SG Astete, CW Celum, WHL Whittington, KK Holmes, WE Stamm, PA Totten
Background: Some STD programs recommend screening men who have sex with men (MSM) for rectal infection with CT. Experience doing so has been restricted to culture, which is not available in many locations and may be insensitive. The best method for processing rectal specimens for CT testing using PCR, and the utility of PCR for detecting rectal CT is unknown.
Objectives: To compare different methods of processing rectal specimens for CT PCR and to investigate the potential use of PCR for detecting rectal infections with CT.
Methods: Frozen rectal specimens from 109 Peruvian MSM were tested for CT using PCR. Three different specimen-processing procedures were compared for detection of CT by PCR: direct lysis using the ROCHE lysis buffer and diluent; centrifugation before lysis using the “urine” treatment reagents from Roche; and DNA purification using the Epicentre purification system. All specimens testing positive for CT by PCR, as well as ten randomly-selected specimens negative by PCR were also tested by LCR.
Results: At least one PCR for CT was positive in 11 (10%) of the 109 specimens. PCR was positive by all three sample preparation methods in ten (91%) of 11 specimens, and all ten of these specimens were also positive by LCR. No specimens were positive by LCR but not PCR.
Conclusion: PCR appears to be specific for detecting rectal CT infections.
Implications for Programs: STD control programs may be able to use PCR to detect CT.
Implications for Research: Further research is needed to confirm these preliminary findings and to better define the operating characteristics of PCR relative to culture in the detection of rectal chlamydial infections.
Comparison of Confirmatory Methods for Syphilis: EIA, TP-PA, and FTA
S Crowe1, D Willis1, Z Mulla2, S Terry1
Florida Department of Health: 1Bureau of Laboratories-Jacksonville and 2Bureau of Epidemiology
Background: The Florida Department of Health, Bureau of Laboratories screens for syphilis with the Rapid Plasma Reagin (RPR) assay; confirmatory assay(s) are performed upon request. The Captia Syphilis-G enzyme immunoassay (EIA) is the-first line confirmatory test. The fluorescent antibody absorption double-staining test (FTA) is used for specimens with RPR titers 1:8 or greater or upon provider request. The availability of the Serodia Treponema pallidum Passive Particle Agglutination (TP-PA) assay raises questions relative to the EIA and FTA performance for syphilis confirmation.
Objectives: Determination of performance differences between EIA, TP-PA, and FTA procedures for syphilis confirmation.
Methods: Specimens were tested by RPR, EIA, TP-PA and FTA. The SAS System Version 8.2 was used to calculate kappa coefficients between the EIA and FTA results, the FTA and TP-PA results, and the EIA and TP-PA results.
Results: Preliminary data displayed excellent agreement between the EIA and TPPA tests (n = 236, k = 0.84, 95% CI: 0.77–0.90), and moderate agreement between the EIA and FTA tests (n = 291), and the FTA and TP-PA tests (n = 236).
Conclusions: Both the EIA and the TP-PA are acceptable confirmatory tests for syphilis. However, the performance of the FTA procedure suggests that this assay be used to test specimens yielding a negative EIA or TP-PA result with an RPR titer of 1:8 or greater or in cases where exposure and/or symptoms suggest syphilis.
Implications for Programs/Policy: EIA and TP-PA results can be considered comparable, however, an FTA should be ordered when syphilis is suspected and the EIA or TP-PA is negative.
Implications for Research: Analysis of this data should include an evaluation of the RPR titer and patient disease status.
¡ Qué Siga la Tradición!
Incorporating Cultural Values in Latino Youth STD Education
L Shapiro1, M Stalker1, Y Polanco2, K Scanlon1
1American Social Health Association (ASHA), Research Triangle Park, NC; 2El Centro Hispano, Durham, NC
Background: Latino adolescents are at higher risk for STD infection than teenagers in general. Studies have shown that STD/HIV prevention programs tailored to Latino populations are effective in reducing STDs, including HIV, particularly when they incorporate broader issues of relationships, family, and culture.
Objectives: To meet the demand for culturally appropriate STD/HIV prevention education materials and increase STD prevention awareness and knowledge among Latino adolescents in North Carolina.
Methods: American Social Health Association (ASHA) partnered with youth from local Latino organizations to create, pilot-test, and distribute a bilingual, culturally appropriate STD prevention comic-novella. The youth and project staff jointly guided the development of the novella’s key themes, story, and artwork. Project staff used methods such as role plays, ice-breakers, and staged readings to engage youth in all stages of development and ensure a realistic and appealing product. The team incorporated traditional Latino values such as machismo and familismo and used them to reinforce healthy communication and sexual practices.
Results: ASHA produced 25,000 copies of “Calenturas,” a bilingual, culturally appropriate STD prevention novella, for distribution to adolescent Latinos in North Carolina via peer educator networks, collaborating agencies, local festivals, and other channels.
Implications for Programs: Prevention programs for Latinos, if they are to make a difference, must take into account cultural values. They must attempt to break the traditional silence about sexuality and incorporate specific cultural aspects to reinforce healthy behaviors.
Measurable Learning Objectives: At the end of this session, participants will be able to:
1. Explain the importance of involving the priority population in program development.
2. Describe three methods to involve youth in program development.
3. List four traditional Latino cultural values and discuss ways to use them to support healthy sexual communication and practices.
Contact Information: Lanya Shapiro / 919-361-4821 / lansha@ashastd.org
Internet as Health Educator: What Do Teens Wanna Know About STDs?
J Temby, L Gilbert, and J Short
American Social Health Association, RTP, NC
Background: Because teens are at increased risk for STDs, a Web site, www.iwannaknow.org, was developed to provide targeted STD prevention information.
Objectives: Specifically, to identify topics being discussed and questions being asked by site users, and to assess how well site content covered these topics. Overall, to develop evaluation methods for teen STD prevention web sites.
Methods: Five hundred and seven randomly selected e-mail/chat transcripts from the site were content analyzed. The codebook was derived from 30 randomly sampled transcripts, resulting in 14 individual code categories. Transcripts were multi-thematic; thus, the unit of analysis was a unique topic within a sentence or paragraph. Codes were assigned to appropriate text, resulting in 1,200 individually coded sentences and phrases. Prominent themes were then compared to existing content.
Results: Most e-mail/chat room users were teens (83%) and females (62%). The top ten discussion topics: sexual mechanics, symptoms, pregnancy, STDs, sexual transmission, puberty, virginity/first intercourse, non-sexual transmission, emotions, and “stats/facts.” Of the 507 transcripts analyzed, 48% of the questions’ topics were not within the site’s mission and should not be covered by site content. The remaining 52% (264) of topics did fall within the site’s mission. Of these, 71% were completely explained and 22% were mentioned in the site’s content. Only 7% of the topics were absent from site content.
Conclusions: More resources are needed to address general sexual health questions that fall beyond the site’s mission. Trained responders are needed to answer e-mail and mediate chats.
Implications for Programs/Policy: Web site creators can use this method to assess the degree to which site content is meeting users’ needs and identify areas for improvement.
Implications for Research: Results will help guide hypotheses formation in later phases of research, including an online user survey.
Presenting Author Contact Information: Julie Rae E. Temby / Project/Research Manager, Health Promotion and Evaluation, American Social Health Association / Phone 919-361-8420.
Of Mice and Mail: Starting a Regional STD E-mail Newsletter
J Fitch, J Douglas, T Anderson, T Lee
Denver STD/HIV Prevention Training Center, Denver Public Health Department, Denver, CO
Background: While there are many list servers providing information for STD/HIV clinicians and programs, locally pertinent information may often travel through a traditional "grapevine" line of communication that may be erratic or quickly out-of-date. This program examines the obstacles and costs to setting up and implementing a regional STD newsletter.
Objective: To determine the obstacles and local program costs to setting up a regional STD/HIV e-mail newsletter.
Methods: The Denver STD/HIV Prevention Training Center (PTC) began a six state STD e-mail newsletter in June 2001. The Denver PTC had been soliciting e-mail addresses and contact information for the prior 16 months through its normal course of training. The PTC used Infacta Group Mail Pro 3.2 ($79.95) to personalize and mail the newsletters. New addresses were added by clinician request.
Results: A short e-mail newsletter was published one to two times a week. The newsletters contained short bullets on STD/HIV information, events and trainings in the six-state region. 256 contacts were on the initial mailing list. Of these 59 (23%) did not resolve, leaving 197 “good” contacts. The newsletter took approximately 1-2 hours a week for each mailing to gather and format information. An average of 17 people was added to the mailing list each week. A total of 5 people asked to be removed. Three months later there were 353 participants receiving the newsletter.
Conclusions: With its easy reproducibility and forwardability as well as its absence of postage and material costs, e-mail newsletters may be a cost-effective way to regularly distribute information. Time commitments and distribution costs are minimal if computer and Internet access are already available.
Implications for Programs: Programs that regularly distribute information to large e-mail accessible populations should consider implementing an e-mail newsletter.
Implications for Research: Additional studies on the effectiveness would be beneficial. Anecdotal reports describe a high level of usage but no research has been done.
Contact Information: John Fitch / Phone 303-436-7263 / Jfitch@dhha.org
Promoting Comprehensive Prevention Efforts Through Community Outreach
R Zimmerman1, C Finley1, D Durbin2
1Illinois Department of Public Health, Springfield, IL; 2Macon County Health Department (MCHD), Decatur, IL
Background: In January 2001, the Illinois Department of Public Health (IDPH) STD and Immunization Sections were funded to integrate viral hepatitis prevention services into existing prevention programs. Macon County Health Department was one of the grantees selected to integrate hepatitis prevention services into the existing STD/HIV clinic and outreach settings.
Objectives:
1) Promote hepatitis prevention services within the community.
2) Increase the number of men who have sex with men (MSM) and injecting drug users (IDUs) vaccinated for hepatitis A and B.
3) Test IDUs for hepatitis B and C.
Methods: Macon County Health Department (MCHD) staff created laminated posters with tear-off information that provided name, address, and phone number advertising the hepatitis prevention program at MCHD. Staff met with business owners to place posters at establishments frequented by at-risk clients. MCHD met with local gay/lesbian media groups to include advertisements promoting the viral hepatitis prevention program. MCHD developed strategies to motivate clients to complete vaccine series, including using vouchers/coupons for goods and services.
Results: MCHD obtained permission from management of local establishments frequented by at-risk clients to promote the hepatitis prevention services at MCHD. MCHD collaborated with the local Gay/Lesbian Association of Decatur (GLAD) to include a full-page advertisement for the hepatitis prevention program in the monthly newsletter (550 distributed). MCDH worked with the Prairie Flame, the central Illinois gay/lesbian newspaper distributed monthly to over 5,000 addresses/locations, to include an article advertising the hepatitis prevention program at MCHD. On-going evaluation of this effort will take place in the fourth quarter of 2001.
Conclusions: Targeted hepatitis prevention messages can be accomplished using community gatekeepers to promote prevention services to at-risk clients.
Implications for Programs: Programs that target MSM and IDUs should consider integrating targeted prevention services into existing STD/ HIV outreach programs.
Implication for Research: An evaluation of the community outreach initiative should be performed to determine if the target populations are seeking prevention services.
Learning Objective: Describe creative ways to utilize community resources to promote prevention services to at-risk clients in the community.
Contact Information: Rich Zimmerman / Phone 217-782-2747 / rzimmerm@idph.state.il.us
Using Visual Print Media to Modify Behavior of Communities Disproportionately Affected by Syphilis with a Message Testing Campaign
V Hartwell, E Cameron, M Allen, Y Holiday, C Perez-Espinoza, A Lomax, R Lewis-Hardy, A Troutman, D Daniels
Fulton County Department of Health and Wellness –Communicable Disease Prevention Branch, State of Georgia, Syphilis Elimination Project, Atlanta, GA
Background: A message testing study was conducted to pilot test sample health education posters. The pilot was implemented to determine which poster would be best received by communities that were disproportionately affected by syphilis.
Objectives: To identify health messages that were culturally competent; to identify health messages that were linguistically specified and presented in terminology consistent with the target populations; to ensure health messages were educationally appropriate; and to identify appropriate channels and methods of communication.
Methods: The study used two survey assessments. Assessment instrument one was a 7-item survey that asked each participant to review and identify which poster they liked “better and why”. Assessment instrument two was a 22-item inventory of words that described the participant’s feelings about each poster.
Results: A total of 345 participants were surveyed in 6 high-risk communities. The results revealed that 47% (162) of participants were African-Americans and 44.6% (154) Hispanic/Latino. The majority (73%) of participants indicated that the posters had all the information needed to encourage a person to get tested. Ninety percent reported that the messages would make them think about getting tested, and 82% reported that the messages would make them get tested.
Conclusions: These results indicated that when the target population is involved in developing health awareness messages to modify behavior toward testing for an STD, 90% would think about getting tested, and 82% would get tested.
Implications for Programs/Policy: The results of the message testing assessment should further warrant the use of data collected through action research to develop health programs and program policy.
Implications for Research: The results and the process can be a guide to future efforts in respect to social marketing campaigns or health education promotion.
Learning Objectives: To determine the effectiveness of message testing in communities disproportionately affected by sexually transmitted diseases especially communities of color.
Item Non-Response to A-CASI Sexual Health Interviews in a Primary Care Clinic
JD Fortenberry1, M McFarlane2
1Indiana University, Indianapolis, IN; 2Centers for Disease Control & Prevention, Atlanta, GA
Background: Many STDs are diagnosed in primary care settings. However, information sufficient to assess STD risk is obtained in only a fraction of primary care visits. A-CASI may be a useful clinical tool if patients are willing to provide sensitive information via this format.
Objectives: Assess use of audio computer-assisted self-interview (A-CASI) as a tool for sexual health interviews in a primary care setting.
Methods: Patients attending a multi-specialty primary care clinic (internal medicine, adolescent medicine, and gynecology) were recruited from the clinic waiting area. Items included demographics, menstrual and reproductive history (women only), STD history, sexual and contraceptive behaviors, sexual identity, substance use, and partner violence. Items were developed and initially evaluated in a sample of more than 500 STD clinic clients. Participants were allowed a “don’t want to answer” option for most items.
Results: Two hundred thirty-four female and 34 male subjects have participated (average age = 24.1 years; range 14–34). Eighty-seven percent of subjects are African-American or white. Items with 10% or more non-response include age (13.8%), times pregnant (14.9%), number of living children (10.9%), number of partners in past 2 months (18.4%), number of casual partners (10%), coital frequency in past 2 months (18.7%), condom use in past 2 months (17.2%), and sexual identity (17.9%). Few gender or ethnic group differences in non-response were noted although African-Americans were more likely to decline response to items about number of casual partners.
Conclusions: A-CASI is a useful format for STD risk assessment in primary care settings. However, many patients decline responses to key items when allowed to do so.
Implications for Programs/Policy: Clinical use of A-CASI to gather sensitive STD risk assessment data is limited by item non-response.
Implications for Research: Qualitative research may be useful to better understand patient perceptions of A-CASI and potential barriers to its use in clinical settings.
Learning Objectives: Participants will be able to describe response patterns to sensitive items in an A-CASI sexual health interview.
Contact Information: J. Dennis Fortenberry / Phone 317-274-8812 / jfortenb@iupui.edu
STD Education Needs on Campus: Opening the Door to Collaboration
C Burke, P Etkind
Division of Sexually Transmitted Disease Prevention,
Massachusetts Department of Public Health, Jamaica Plain, MA
Background: College students are at high risk for STDs. The Division of Sexually Transmitted Disease Prevention (DSTSP) seeks to collaborate with local college campuses to support the maintaining and developing of appropriate on-campus STD services.
Objectives: Identify if needed service is being delivered on campus, and if not, can the DSTDP assist in maintenance or development of appropriate services.
Method: Survey of Massachusetts colleges, including 14 state, 42 private, and 11 community colleges.
Results: Sixty-seven of 89 institutions responded. Ninety-one percent (61/67) reported a campus-based student health center. Of these, 87% (53/61) report STD-related services including diagnostic testing (83%), clinical screening (risk without symptoms [75%]), one-on-one counseling (94%), and STD treatment (74%). Most health centers also report collection of STD specimens and laboratory services (either on-site or outside). When these services are not provided on campus, students are being referred to local physicians, health centers, and state clinics.
Other clinical services were less likely to be reported. Most schools rely exclusively on urging students to notify partners. In addition, most health centers state that they do not report STDs to the Department of Public Health (65%). Those schools that responded reported a wide range of prevention and education activities. Only 44% of respondents (27/61) indicated a working relationship with the health department or community organizations. When asked how the Massachusetts Department of Public Health (MDPH) might help change, expand, or improve services, 90% (55/61) indicated a need for educational materials for students, 75% (46/61) for educational materials for staff, 64% (39/61) for in-service education, and 54% (33/61) for assistance with laboratory services.
Conclusions: Among needs identified on survey, schools felt that STD education for both students and staff would be of most assistance.
Implication for Programs/Policy: Requests for on-campus education can open the door for collaboration and a larger dialogue regarding STD division services including partner services and surveillance.
Learning Objectives:
1) Learner will be able to describe current campus-based STD services in Massachusetts.
2) Learner will be able to identify those STD service needs not being addressed on college campuses in Massachusetts.
3) Learner will be able to describe how responding to requests for education could open the door for collaboration and a larger dialogue regarding DSTSP services.
Involving all Sectors of the Society in Effective STD Educational Programs
IL George Jr
MOPACAS, Inc., Monrovia, Liberia
Background: Sex is one of the most basic activities millions of people worldwide are involved in 24 hours everyday. Some do it for pleasure, while others for financial gain. This makes millions of people vulnerable to STD’s and cannot be avoided easily. Though having sex makes any individual vulnerable, adequate and requisite health education would minimize or avert people from contracting STD’s. STD programs should design proper educational strategies in order to effectively reach vulnerable populations (rural dwellers, sex workers, people with many sexual partners, children in their puberty stage).
Objective: To make people know their vulnerabilities to different STD’s, and how they can prevent themselves coming in contact by practicing abstinence, single sex partnership, using condoms and going for proper treatment or check-up if some abnormal. Observation is notice in the body system.
Methods: School authorities, community leaders, youth groups, sex workers and traditional health practitioners were taught through workshops and seminars about prevalence of STD in their setting is detrimental consequences on how it could be prevented. The different groups were acknowledged of the financial constraints faced by society, parent or individuals if people were continue to be expose to STD. And approach title “EACH ONE TEACH ONE ABOUT STD” was put into effect.
Results: in the space of four to six months our offices in twelve different communities recorded an average of seventy-five (75) person coming for condoms a day, exceeding the previous five persons before the start of the program. Data recorded from communities, clinics show reduction in STD cases of about 45%.
Conclusion: STD educational programs don’t with the participation of all sectors of the societies, will optimistically help in minimizing or rather eradicating STD’s infections and complications.
Implication for Programs: STD program should include the participation of government officials and civil society especially youth groups.
Implication for Research: STD programs studies will need to extend to remote areas where traditions and cultures are highly practice to know how effective the program would be accepted in such settings.
Learning Objectives: Target population will be able to protect themselves from contacting STD and be able to educate others of the dangers STD’s pose and it preventive methods.
Initiatives to Encourage Individuals to Attend for STI Screening
P-A Mardh1, D Hellberg2
1Department of Obstetrics and Gynecology, University Hospital, Lund; 2Department of Obstetrics and Gynecology, Municipality Hospital, Falun, Sweden
Background: To book patients for consultations and to perform clinical examinations are costly, particularly in mass screening programs. Therefore, a pre-selection mechanism to focus on potential carriers of STI agents is likely to be cost-effective not at least if combined with partner-notification in cases being diagnosed to have contracted curable STIs.
Objective: To develop a score system to be used by women to provide them the statistical chance of being a carrier of one or more STI agents with the intention to encourage them to attend for STI screening.
Methods: One thousand women who all had attended for contraceptive advice and from whom altogether 900,000 data were available, e.g., concerning behavior, gynecological, obstetric, and sexual history. Of the women requested to participate, 93% accepted (approx. half of the 7% drop-outs were due to technical reasons, e.g., lost data, etc). All participating women answered all questions asked in the structured deep-interviews. The women were investigated for N. gonorrhoea, C. trachomatis, T. vaginalis, human papillomavirus, herpes virus, bacterial vaginosis, and vulvovaginal candidosis. HIV and hepatitis B and C had never been diagnosed in any of the women. To produce the score, questions that had the most power to distinguish STI agent carriers from non-carriers were selected. The statistical chance of having contracted a STI was provided with the score pamphlet. The statistical chance was related to age of respondees.
Results: The following items were selected that had the best power to identify those being carriers of STI agents to be included in the score system i.e., marital status, cohabitance, use of contraceptives, and certain genital hygiene products, obstetric history, smoking habits, alcohol- and drug abuse, length of acquaintance before and after first intercourse with first life-time as well as with current steady partner, number of sex partners last month and last six months as well as life-time, casual sex domestic and during travels, circumstances at intercourse at such latter events, and finally unfaithfulness during current relationship. For each of three age groups, i.e., 15–19, 20–29 and 30–44 years of age, the risk of being a STI agent carrier varied from 5–60% dependent on the score obtained.
Conclusion: The score system described can, e.g., be spread in tabloid press for female readers to encourage those with high section risk profile to consult for taking part in STI screening programs. The questions in the score should be simple to answer without specific medical knowledge. Development of this type of score system must be based on local/state/national conditions and cover behaviors in cohorts addressed.
Implications for Programs: To include the type of score pamphlet discussed in STI screening promotion programs.
Implications for Research: To evaluate the response rate of attendees after distribution of the score pamphlet to various cohorts.
Learning Objectives: Participants will be made aware of a new mean to encourage persons to take initiative to attend for STI screening.
Contact Information:peranders.mardh@simrishamn.se
Assessment of a Computer-Based Interactive STD Prevention Educational Intervention for Adolescents
KK Hsu1, DM Hoffman1, PQ Sheehan1, CM Zuckerman1, AJ Santana1, D Christiansen2, PG Braslins1
1Boston University Medical Center, Boston, MA; 2Boston University School of Public Health, Boston, MA
Background: To promote safe sex practices in adolescents, we developed a computerized sexually transmitted disease (STD) quiz focused on decision-making skills and common misperceptions.
Objective: To report our experience and assess predictors of participation and responses to a novel adolescent STD educational intervention.
Methods: From May 2000 to August 2001, interventions were offered to English-speaking patients of a medical center providing care to an under-served population with high prevalence of STDs and risk behavior (RB). Multiple choice and true-false answers were scored for correctness. Participation and scores were correlated with age, gender, race, referral reason, and referring clinic.
Results: In the first 6 months, 46/123 patients completed the offered intervention. Over the study period, 92 subjects completed the survey. Of participating patients, median age was 18 (range 13–23); 78% were female; 66% black, 11% Hispanic, and 2% white. 71% were referred from adolescent center (AC), and 26% pediatric emergency room (PER). Fifty percent were referred for a diagnosed STD, 33% reported RB, and 17% had STD symptoms. Subjects correctly answered 77% of questions (16.1/21, SD = 3.3). Least square adjusted means did not differ significantly by age (>18 yrs 16.6, <18 yrs 16.1; P=.79), gender (females 15.9, males 16.7; P=.72), race (blacks 15.3, Hispanics 17.4, whites 16.2; P=.87), referral site (PER 14.2, AC 18.5; P=.12), or referral reason (STD 15.2, RB 15.7, symptoms 18.1; P=.56).
Conclusions: In our preliminary sample, no significant predictors of correct answers existed, although referral site approached significance. Response structure to this intervention did not permit assessment of reliability or internal consistency.
Implications for Research: After answer choices are restructured to improve our ability to assess reliability and internal consistency, this intervention will be suitable for use in prospective studies aimed at reducing STD incidence in a population of under-served, high-risk adolescents. Further examination of high participation refusal rate is needed.
Learning Objectives: Participants will be able to view and comment upon a novel, computer-based, interactive STD prevention educational intervention for adolescents.
How Did We Get Here?: Formative Research for the Development of Health Communication Materials for National Plan to Eliminate Syphilis from the U.S.
S Hornston, D Anderson, H Shepeard
Centers for Disease Control and Prevention (CDC), Atlanta, GA
Background: Formative research is a critical component of any health communication effort with a social marketing focus. This is because it provides an understanding of target audience needs, knowledge, attitude, belief and practices (KABP). The results allow for developing targeted communication materials that are effective and well-received. The Syphilis Elimination Communication Plan, which was developed to support the National Plan to Eliminate Syphilis from the U.S., identified three main target audience segments: policymakers, health care providers and associations, and community representatives.
Objective: To summarize formative research activities and results which helped guide the development of concepts and messages for syphilis elimination materials that are being tested during this conference.
Methods: Upon literature review and environmental scan, syphilis HMAs were grouped into seven clusters based upon certain characteristics. To ensure regionally representative sampling, nine research sites were selected from these clusters for formative research. A total of 238 in-depth interviews were conducted with the target audience segments. The interview instrument explored the perceived severity of syphilis; barriers to recognition of syphilis as an important public health problem and how to overcome these barriers; suggested messages, tones and spokespersons; preferred methods of receiving information; and the relationship between HIV and syphilis.
Results: Important barriers include, lack of awareness that syphilis is still a problem today, lack of knowledge about syphilis signs and symptoms, lack of advocacy, difficulty of talking about sexual matters and STDs, and competition from other social and health issues. Fact-filled, culturally sensitive messages with a serious tone are preferred by all target audiences. Health care providers need clarification about the meaning of “syphilis elimination” and information on syphilis. CBOs emphasized the importance of African American clergy involvement.
Conclusions: Increasing awareness and knowledge about syphilis is crucial. Clergy need to be involved to accomplish this and to create community advocacy. Providing health care providers with practical information on syphilis is essential.
Implications for Program/Policy: These ongoing efforts indicate that the use of social marketing methodology (i.e. formative research and pre-testing of materials) is an important factor in helping to keep health communication efforts for such national programs on target.
Implications for Research: Concepts and messages, developed through formative research, need to be tested with target audiences to produce health communication materials that are acceptable, useful and well liked by target audiences.
Learning Objectives: Describe formative research involved to produce communication materials for syphilis elimination.
Contact Information: Sureyya E. Hornston / Phone 404-639-8532 / soh6@cdc.gov
Health Protective Sexual Communication Scale in STD Clinics
J Yasuda1, P Gorbach2, L Drumright1, KK Holmes3
1San Diego State University, San Diego, CA; 2University of California-Los Angeles, Los Angeles, CA; 3Center for AIDS and STD Research, University of Washington, Seattle, WA
Background: Sexual communication skills facilitate safe sex. The Health Protective Sexual Communication (HPSC) scale determines individuals’ abilities to discuss sexual histories, condom and contraceptive use, past injection drug use, and HIV testing with new sexual partners. Those with high HPSC scores discuss these subjects often. The utility of the HPSC scale in Sexually Transmitted Disease (STD) clinics has not been assessed.
Objective: To apply the HPSC Scale to high-risk heterosexual young adults aged 18-30 years from STD and family planning (FP) clinics, assessing reliability and identifying score predictors.
Methods: Ninety-six individuals and their new sexual partners presenting for care at STD and FP clinics in San Diego County (total n = 192) completed an audio computer-assisted interview and were tested for gonorrhea, chlamydial infection, and trichomoniasis.
Results: HPSC scale reliability for STD clinic males and females respectively was Cronbach’s a = 0.87 and 0.90; for FP clinic both males and females Cronbach’s a = 0.86. In multivariate analysis women were more likely to have a high HPSC score than men (odds ratio = 2.6), and African Americans were more likely to have a high HPSC score than Caucasians (OR = 3.8). In univariate analysis of males, the HPSC score was not predictive of condom use during first sexual intercourse with a partner (p=.42). However, for women, the HPSC score was predictive of condom use at first sexual encounter with a partner (p=.03). There were no differences in HPSC skills between those attending STD and FP clinics.
Conclusions: There are gender and ethnic differences in the ability to discuss sexual histories with new sexual partners.
Implications for Programs: STD/HIV prevention programs that teach sexual communication skills in STD or FP clinics should focus efforts on males and Caucasians.
Implications for Research: There is a need for additional research looking at psychosocial factors associated with low HPSC skills, and to incorporate these findings toward efforts to increase condom use.
Contact Information: Julie M. Yasuda / julieyasu-da@msn.com
Increase Access to STD Care Through Using Morbidity to Locate Clinical Services
N Burns1, B Farrell1, P Briggs2, W Dumas2
1Baystate Medical Center, Springfield, MA; 2Massachusetts Department of Public Health, Jamaica Plain, MA
Background: Developing innovative methods and alternate venues for STD prevention and clinical care for groups who are difficult to reach through traditional methods has always been challenging. The MA State Sexually Transmitted Disease Program in Springfield expanded clinical services in 1990 from a location on the periphery of the city to two community health centers in two ZIP Code areas with the highest morbidity. As trends change and morbidity moved, so did the STD program. The program remains within the original two community health centers but has expanded to three school-based health centers and a community health center in a neighboring city with similar characteristics and morbidity. The clinicians and the Disease Intervention Specialist travel to each of these sites allowing for continuity of care and disease intervention.
Objective: To determine if the Springfield, MA STD Program is providing clinical services in high morbidity areas.
Method: We collected ZIP Codes of patients that accessed STD services from July 1, 1996, to June 30, 2001. These were compared with morbidity reported by all providers to the state STD Prevention program from the same ZIP Code areas and time frame.
Results: We found a high level of agreement between the locations of our services and the geographic distribution of morbidity from Springfield, MA.
Conclusion: The MA State STD Program in Springfield is increasing access of STD services by ensuring location of services within high morbidity areas.
Implications for Programs/Policy: It is far easier to reach people at risk when programs utilize various venues for clinical services.
Implications for Research: Consistent data collection is needed to ensure that as trends change and morbidity moves within the community the STD program also moves.
An Evaluation of Reporting of Laboratory-Confirmed Gonorrheal and Chlamydial Infections by Providers Affiliated with Three Large Managed Care Organizations, 1995–1999
M Stiffman1, P Carr2, D Yokoe3, R Platt4, R Blair5, L Martino5, S Ratelle6, Y Tang6, M Whelan6, P Etkind6, D Magid7, E Lyons7, C Loftin8, G Tao9, K Irwin9
1HealthPartners, Minneapolis, MN; 2Minnesota Department of Health, Minneapolis, MN; 3Channing Laboratory, Brigham and Women’s Hospital, Boston, MA; 4Harvard Medical School, Harvard Vanguard Medical Associates, Harvard Pilgrim Health Care, Boston, MA; 5Harvard Pilgrim Health Care, Wellesley, MA; 6Massachusetts Department of Public Health, Jamaica Plain, MA; 7Kaiser Permanente Clinical Research Unit, Denver, CO; 8Colorado Department of Public Health and Environment, Denver, CO; 9Division of STD Prevention, CDC, Atlanta, GA
Background: Little is known about the case-reporting practices for laboratory-confirmed gonorrhea and chlamydia diagnosed by providers affiliated with managed care organizations (MCOs). One study of private providers found that no more than 72% of such cases were reported.
Objectives: We evaluated the completeness and timeliness of reporting of laboratory-confirmed chlamydia and gonorrhea cases in three large, staff, or group model MCOs that used different reporting methods.
Methods: All cases of laboratory-confirmed chlamydia or gonorrhea diagnosed from 1995–1999 in the three MCOs were matched to their respective state STD surveillance databases. Cases were considered as matched if the case’s name, date of birth, sex, specimen collection date, and/or disease pathogen matched exactly or if these variables did not match exactly due to minor typographic errors.
Results: From 64% to 84% of gonorrhea cases and 78% to 98% of chlamydia cases identified by MCO laboratories were matched to the state surveillance databases. Most mismatches were due to transposition of first and last name or different last names for women. The median interval between specimen collection and entry of case report into the state surveillance database was less than 19 days for cases from the two states where date of case report entry was available.
Conclusions: Several factors may have enhanced the completeness of reporting at these three MCOs: 1) a single, centralized laboratory reporting system; 2) the MCOs’ productive relationships with their state STD surveillance agencies; and 3) website and newsletter communication to MCO providers about trends in STD morbidity in the MCOs’ patients.
Implications for Programs/Policy: Use of manual methods and regular mail to transfer reports to state health departments may have resulted in non-reporting, and lost or delayed reports. Manual data entry on case reporting cards and the state surveillance databases may have resulted in errors that reduced reporting completeness. MCOs that wish to improve completeness and timeliness of reporting may consider confidential electronic systems that minimize case reporting and data entry errors and data transfer delays. Such systems are easiest to implement in MCOs that use a single, central laboratory reporting system.
Implications for Research: As MCOs insure more Americans at risk for STD and become central to STD control in the US, the impact of interventions to promote complete and timely STD reporting in MCOs merits continued evaluation.
Learning Objectives: By the end of this session, participants will be able to know how frequently chlamydia and gonorrhea cases were reported from managed care organizations to state surveillance agencies.
Contact Information: Guoyu Tao / Phone 404-639-8180 / gat3@cdc.gov
Leading Barriers to STD Care in Two Managed Care Organizations: Final Results of a Survey of Primary Care Clinicians
K Irwin1, L Anderson1, M Stiffman2, D Magid3, T DeFor2, AL Crain2
1Centers for Disease Control and Prevention, Atlanta, GA; 2HealthPartners, Minneapolis, MN; 3Kaiser Colorado, Denver, CO
Background: Although >80% of privately insured adults receive STD care in managed care organizations (MCOs), barriers to optimal STD care in MCOs are poorly understood.
Objective: To identify barriers to STD care at two large MCOs.
Methods: During 1999–2000, we mailed a survey to 1,000 randomly-selected physicians, advance-practice nurses, and physician’s assistants who practiced internal, family, emergency, or adolescent medicine or obstetrics/gynecology at Kaiser in Colorado and HealthPartners in Minnesota: 500 at Kaiser’s staff-model MCO, 250 at HealthPartners’ staff-model MCO, and 250 at HealthPartners’ network-model MCO. The survey addressed demographic characteristics, STD experience, and perceived barriers to STD care.
Results: Of the 906 clinicians still practicing, 82% responded. Most respondents were physicians (74%), practiced ambulatory care (87%), and had practiced >10 years. Twenty-seven percent had diagnosed >6 chlamydia cases in the past year. From 20%–45% of clinicians rated eight issues as “problematic” or “highly problematic”: limited staff to manage sex partners; managing high-risk patients; finding time for sexual histories; lack of MCO policies about notifying and treating sex partners; finding time to address STDs; limited staff to counsel patients; and the belief that infected patients do not practice safe sex during treatment or notify their partners. Clinicians with more STD experience were less likely to report these problems than less experienced clinicians.
Conclusion: These MCO clinicians consider risk assessment, managing high-risk patients, counseling, patient adherence to treatment advice, and partner services as major barriers to STD care. Many problems concern limited time or staffing.
Implications for Programs/Policy: Interventions to improve STD care in MCOs should focus on these barriers and address resource constraints.
Implications for Research: Interventions to overcome the barriers identified in these staff-model or mixed-model MCOs should be tested. Research on barriers to STD care in the >90% of MCOs that are exclusively network models is needed.
Learning Objectives: Participants will be able to identify barriers to STD care that can guide interventions in MCOs.
Contact Information: Kathleen Irwin / Phone 404-639-8979 / kli1@cdc.gov
Incidence of STDs Among Sex Workers and Their Partners: Testing in Non-Traditional Settings
L Nicholson
Genesis House, Chicago, IL
Background: Genesis House has provided hospitality, outreach, case management, prevention services, and residential treatment to women involved in the cycle of prostitution for almost twenty years. While we know the women we serve are at risk for or impacted by HIV and/or STDs based on statistics that place low income, homeless, and/or drug-affected African-American women with little education at higher risk for these diseases. We have no statistics specifically related to sex workers or their partners. Additionally, we know that it is unlikely that our clients will walk into a clinic to get a test because they face social stigma based upon their choice of “work.”
Objective: To determine the incidence of gonorrhea and/or chlamydia among sex workers and their partners.
Methods: In May of 2001 we began a mobile outreach program, and in partnership with the Chicago Department of Public Health (CDPH), the mobile outreach staff began a counseling and testing program. The mobile program operates during non-traditional hours, 9 pm until 7 am, 4 nights a week. We offer a service where our clients are and also come back to them to deliver the results.
Results: From May until August we have found a 30% incidence rate of chlamydia among our clients; we have yet to find a case of gonorrhea.
Conclusions: Non-traditional settings provide a unique opportunity to test sex workers and their partners for STDs. More infections may be found and treated early.
Implications for Programs/Policy: Programs that serve at-risk populations with low motivation to walk into clinics should consider non-traditional settings for testing.
Implications for Research: STD screenings of diverse, at-risk groups, like sex workers and their partners, should continue in Chicago and other urban areas to get a better picture of prevalence.
Learning Objectives: Participants will be able to discuss the benefits of bringing services to the clients as opposed to trying to bring clients in to the services. Additionally, participants will be able to identify sex work as a risk factor for obtaining and spreading S TD infections.
Contact Information:
Lisa Nicholson, Director of Outreach Services / Phone 773-533-8701 / Fax: 773-533-8705 / lisanick@yahoo.com
Expectations of STD Clinic Patients Regarding STD Screening
K Kroeger1, R Knaup2, M Williams2, B Stoner1
1Washington University School of Medicine, St. Louis, MO; 2Department of Health, St. Louis County, MO
Background: This survey examined reasons STD patients report to the clinic, expectations for testing and screening, and acceptance of new STD tests.
Objective: To assess and evaluate expectations STD clinic patients have of STD clinic services.
Methods: A 15-question, anonymous, self-administered, voluntary survey was given to 622 consecutive STD clinic patients at a public STD clinic. Participants completed surveys while waiting in the examination room and deposited them in a box as they left. No incentives were paid.
Results: Patients reported to the clinic “to get checked out” (38.4%) and because of symptoms (31.5%), suspicion of STD exposure (24.3%) and health department instructions (3.9%). Patients expected screening for gonorrhea (48.4%), chlamydia (47.4%), syphilis (37.6%), trichomonas (29.1%), genital warts (26.8%) and herpes (26.5%). Some women (23.5%) expected to be screened for pregnancy. Many (37.6%) respondents believed not getting medication meant they did not have an STD. Patients would accept free herpes testing (71.2%); 19.9% would pay $20. Women (78.9%) would accept free HPV screening; 35.7% would pay $20.
Conclusions: Patient expectations are often at odds with current clinic practice. Many patients visit the clinic just to be sure they do not have an STD and are unaware that they are not being screened for some STDs. Not getting medication is perceived by many patients to mean they do not have an STD. Most patients would accept new STD tests if they are free, but would not pay for them.
Implications for Programs: Educational messages should make it clear that certain STDs may be transmitted even though there are no symptoms. STD Clinic staff should inform patients when they do not receive a specific test for herpes, HPV or pregnancy.
Implications for Research: Research is needed to assess public awareness of asymptomatic STDs. Health-seeking behaviors of patients who come to "get checked out" should be examined to determine motivations for and frequency of clinic visits.
Measurable Learning Objectives: By the end of this session, participants will be able to identify the reasons that patients report to the STD clinic, and to discuss expectations patients have for screening and testing.
Contact Information: Karen Kroeger / kkroeger@im.wustl.edu
A Comparison of Community-Based Organizations’ Medical and Preventive Services for HIV/STDs to Morbidity Rates in Baltimore City
B. Glass1, G. Mitchell1, I. Chinea2, J. Michaud,1 J.Ellen1
1The Johns Hopkins University, School of Medicine, General Pediatrics; 2Centers for Disease Control, Atlanta, GA
Background: Throughout Baltimore City, funding from city, state, federal, and private sources provide financial support to community-based organizations (CBOs). Since funders operate independently, it is difficult to measure or evaluate how effective a program is in reaching its targeted population. An important question is whether there are at-risk groups being missed.
Objective: To determine if catchment areas of CBOs providing medical and prevention services for HIV/STD geographically overlap with disease morbidity.
Methods: A comprehensive catalogue of CBOs offering HIV/STD-related medical, psychosocial, and prevention services to residents in Baltimore City was compiled. Using the comprehensive catalogue, CBOs were contacted and invited to complete a survey listing services provided by and geographic definitions of catchment area. Morbidity rates for gon-orrhea were mapped to Baltimore City. CBO catchment areas were overlaid upon morbidity maps for evaluation.
Results: Two hundred twenty-five CBOs have been identified as meeting our criteria. To date 59 have completed the survey, 45 provided complete information. ZIP Codes were used to define catchment areas. There are 13 ZIP Codes with gonorrhea rates between 578/100,000 and 5,000/100,000. Twenty-one CBOs offered medical services (15 HIV and STDs) and 40 sites offered prevention/outreach services (35 HIV and STDs) which covered all these ZIP Codes.
Conclusions: At the ZIP Code level, it appears there is adequate medical and prevention service coverage in areas with significant morbidity.
Implications: While reported services appear to be providing adequate coverage, an evaluation of coverage falls short if intensity of that presence is not measured. The ratio of staff to geographic area served may provide a means of assessing adequacy of services. Ongoing analysis will attempt to measure intensity of services provided.
Measurable Learning Objectives: By the end of the session, participants will be better informed about utilizing geographic information systems to evaluate service provisions.
STD Screening and Diagnostic Testing Policies Among Primary Care Practices in Wake County, North Carolina
M Smurzynski1, T Moran2, TQ Nguyen1, TH Cohen1, K Irwin3, KK Fox3, R Barnes3, PA Leone2,4, WC Miller1,2
1University of North Carolina School of Public Health, Chapel Hill, NC; 2University of North Carolina School of Medicine, Chapel Hill, NC; 3Centers for Disease Control and Prevention, Atlanta, GA; 4North Carolina Department of Health and Human Services, Raleigh, NC
Background: Optimal STD control requires screening of at-risk asymptomatic persons and diagnostic testing for symptomatic persons/STD contacts.
Objectives: To assess current policies for STD screening and diagnostic testing of primary care medical practices in Wake County, NC.
Methods: Surveys were mailed to family medicine, internal medicine, pediatrics, and obstetrics/ gynecology (OB/Gyn) practices listed in the NC Physician Directory (n = 155). The survey addressed practice characteristics and screening and diagnostic testing policies and practices for chlamydia, gonorrhea, syphilis, trichomonas, genital herpes, and HIV. Of the 128 valid surveys for active practices that provided some STD care, 65 (51%) were returned.
Results: OB/Gyn practices were more likely than other practices to report formal or informal policies for screening and diagnostic testing of women. More practices had formal or informal policies on STD screening of women than men: chlamydia (50% vs 27%), gonorrhea (50% vs 30%), syphilis (47% vs 30%), trichomonas (41% vs 27%), genital herpes (42% vs 27%), and HIV (43% vs 27%). In addition, more practices had formal or informal policies on STD diagnostic testing of women than men: chlamydia (75% vs 69%), gonorrhea (75% vs 67%), syphilis (73% vs 65%), trichomonas (68% vs 62%), HSV (70% vs 62%), and HIV (67% vs 65%).
Conclusion: Except for OB/Gyn practices, fewer than half of primary care practices in Wake County had policies to screen women for STDs; only two-thirds had policies on diagnostic testing of women. Not as many practices reported policies for screening or diagnostic testing of men.
Implications for Programs/Policy: Establishing and implementing policies for STD screening and diagnostic testing in primary care practices may increase early detection and treatment of infections.
Implications for Research: Future research should examine barriers and facilitators to establishing and implementing policies on STD screening and the impact on testing practices.
- Page last reviewed: June 1, 2003 (archived document)
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