Implementation and Operational Research

Abstract

Background Rates of screening for bacterial sexually transmitted infections (STI) among men who have sex with men in HIV care settings remain low despite high prevalence of these infections. STI self-testing may help increase screening rates in clinical settings. Methods We implemented an STI self-testing program at a large, urban HIV care clinic, and evaluated its effectiveness and acceptability. We compared measures obtained during the first year of the STI Self-testing Program (Intervention Year, April 1, 2013 – March 31, 2014) to Baseline Year (January 1, 2012 – December 31, 2012) to determine: 1) overall clinic change in STI testing coverage and diagnostic yield and; 2) program-specific outcomes including appropriate anatomic site screening, and patient-reported acceptability. Results Overall, testing for gonorrhea and chlamydia increased significantly between Baseline and Intervention year, and 50% more gonococcal and 47% more chlamydial infections were detected. Syphilis testing coverage remained unchanged. Nearly 95% of 350 men who participated in the STI Self-testing program completed site-specific testing appropriately based on self-reported exposures, and 92% rated their self-testing experience as “good” or “very good”. Conclusions STI Self-testing in HIV care settings significantly increases testing coverage and detection of gonorrhea and chlamydia, and the program is acceptable to patients. Additional interventions to increase syphilis screening rates are needed.

Syphilis incidence in men who have sex with men with human immunodeficiency virus comorbidity and the importance of integrating sexually transmitted infection prevention into HIV care

“…Compared to pre-intervention, there was a 91.8% relative increase in complete testing (i.e. all three anatomical sites) after implementation of the self-testing program (16% vs. 31%, p<0.001) [50]. Although there were statistically significant increases in urethral, pharyngeal, and rectal screening when analyzed separately, screening for gonorrhea and chlamydia was still low with less than 50% of clinic patients tested for each anatomical site.…”

“…Although there were statistically significant increases in urethral, pharyngeal, and rectal screening when analyzed separately, screening for gonorrhea and chlamydia was still low with less than 50% of clinic patients tested for each anatomical site. Syphilis screening was above 50%, but there was no significant difference before and after intervention (63.3% vs. 64.6%, p=0.44) [50].…”

Health Care Provider Perceptions of a Sexually Transmitted Infection Self-testing Program in an HIV Care Clinic

“…8,9 Clinicians perceived that the self-testing program increased the likelihood of STI testing, and our quantitative effectiveness analysis found that STI testing of pharyngeal, rectal, and urethral NG/CT significantly increased post-intervention. 17 The timesaving benefit seemed to facilitate clinician referral to the self-testing process during a clinic visit and contributed to the increase in testing coverage. In a study by Richardson et al, most surveyed physicians reported that they would use vaginal swab self-testing in women for CT testing, but some providers who did not prefer self-testing were concerned about patients conducting self-testing incorrectly and the time required to instruct patients on self-testing.…”

“…The STI self-testing program was a multi-step project, which consisted of (1) identification of barriers to STI testing (May-June 2012) and baseline testing frequencies (March 2011 – September 2012); (2) program implementation (January – April 2013); and (3) program effectiveness (April 2013 – March 2014) and acceptability evaluation at Madison Clinic (December 2013 – January 2014). Step one 8 and parts of step two and three 17 have been previously described. Prior to implementation, we conducted five educational sessions to clinicians and nursing staff to allow all providers the opportunity to attend a session.…”

Global challenges in human immunodeficiency virus and syphilis coinfection among men who have sex with men

“…Despite that recommendation, there is evidence that MSM may not be offered quarterly screening as recommended [93]. A 2009 study in Ontario found that only 55% of HIV infected MSM received annual syphilis screening [94].…”