STI Screening Program Evaluation Callen Lorde Community Health Center. Anita Radix MD MPH

Transcription

1 STI Screening Program Evaluation Callen Lorde Community Health Center Anita Radix MD MPH

2 Introduction Callen-Lorde Community Health Center Michael Callen Audre Lorde

3 Callen-Lorde Lorde s s History Michael Callen-Audre Lorde Community Health Center (Callen-Lorde) was founded in 1983 as the Community Health Project (CHP) Merger of the St. Mark s s Community Clinic and the Gay Men s s Health Project two clinics providing STI screening and treatment.

4 Callen-Lorde Visit Volume Growth 60,000 54,838 50,000 40,000 37,965 41,633 44,706 46,327 30,000 29,088 30,483 20,000 13,907 18,707 10,000 9,

5 Engagement in Care HIV Primary Care Total HIV Primary Care Patients

6 Callen-Lorde and LGBT Health Patient Diversity In 2008, Callen-Lorde served 12,122 unique patients: Women....34% Men....66% Transgender. 9% Adolescent...13% HIV Positive 20% Seniors.. 3% HIV Positive Adolescents.129

7 Callen-Lorde and LGBT Health Services Primary Care Lesbian Health/ Gynecology Urgent Care Sexual Health Clinic HIV/AIDS Care Transgender Health Health Outreach to Teens (HOTT) Mental Mental Health Oral Health Clinic Support Support Services (Case Management, Education, Outreach) Mobile Mobile Medical Unit Outreach Program

8 Primary medical care Access to Care HIV Primary Care Psychiatric care /Mental Health Adherence nursing Oral/Dental Health Anal cancer screening Gynecological care STI screening/ sexual health clinic Adolescent Primary Care (HOTT) HOTT operates from a dedicated clinical suite and a mobile medical unit

9 Patients by Race/Ethnicity (FY08) Asian/PI 4% More than 1 7% Other 2% Hispanic 20% Caucasian 56% African American 16% All Others 80%

10 Visits by Insurance Status and Type Self-Pay 39% Commercial 34% Medicaid 14% Medicare 4% Medicaid/ADAP 9%

11 STI Screening Programs

12 Sexual Health Clinic Anatomic males,, mostly MSM 7 sessions per week (35 patients) screened for STIs 20 minutes counseling / risk reduction HIV testing Hep A & B immunizations Saturday SHC since 3/2007: 20 patients/wk

13 Sexual Health Clinic Screening and Assessment Template

14 Sexual Health Clinic STI Diagnoses 1/1/05-6/30/ SHC visits Hepatitis vaccinations Patients with Genital Herpes New Syphilis Cases Patients Treated for Genital Warts Gonorrhea/ Chlamydia Cases RPR s Sent 5607

15 Transgender Sexual Health Clinic If you have it, check it 1 session per week (5 patients screened) Equal numbers transmen & transwomen 20 minutes counseling / risk reduction/hiv testing Breast chest exam, pelvic, pap, testicular exam, STI screen Hep A & B immunizations

16 Misc Wart / HPV clinic, 4.5 session = 44 patients/wk Anal cancer screening program* All HIV providers perform anal paps HRAs/IRCs - approx 23 patients/week 5 providers trained to do HRAs *Mayer, G. AIDS AIDS 2008 Abstract no. THPE0224

17 Evaluation of Programs Quality management program (QMG): % eligible patients receiving routine testing % HIV+ persons tested for Hepatitis C % SHC attendees tested for syphilis Peer chart reviews Annual primary care chart reviews Annual HIV chart reviews Surveillance reports Hep C, Syphilis, GC, CT ; run as needed

18 QMG Routine Annual HIV testing (%) Routine annual HIV testing (%) Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 date Jul-08 Sep-08 % Eligible persons screened

19 QMG % screened Callen Lorde Sexual Health Clinic Annual Syphilis Screening (Men only) Annual syphilis screening (%)* Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 May-09 Jul-09 Sep-09 Date

20 QMG Annual Hepatitis C Screening (HIV-positive only) %Screened Jul-08 Sep-08 Nov-08 Jan-09 Mar-09 Date May-09 Jul-09 Sep-09 Annual hepatitis C screening (%)

21 Annual Peer Chart Review 2009 MSM focus MSM receiving annual STI screening (in process) Preliminary results: Anal GC screening 50% Anal CT screening 33% Urethral GC/CT screening 60% 3 anatomic site screening 33% * RPR 90% Anal pap (HIV+ MSM) 60% 52% - Mahle K National STD Prevention Conference

22 STI Surveillance

23 Callen Lorde HIV Screening 2008 TEST # Tests # Positive % Stand Alone testing Routine Testing (low risk) HIV prevalence for transgender women (MTF): 42%, African-American: 70%* *Radix A. AIDS 2008 Abstract no. WEPE0706

24 Callen Lorde STI Results 2007 TEST n # Tests # Positive % Urethral GC Urethral CT (NAAT) GC anal culture Chlamydia anal GC Pharyngeal culture Hep C

25 SHC Syphilis 2007 Stage No No with % HIV Primary secondary Early latent Late latent unspecified TOTAL

26 Issues High rates of STIs among MSM, especially HIV+ STI screening suboptimal time constraints patient limitations: cost, time, discomfort NAAT testing pharyngeal/rectal sites being Bioreference labs for rectal/pharyngeal specimens SHC counseling program -?effectiveness

27 Goals Improve STI testing at all exposed anatomic sites (?performance improvement project) Implementation DEBI: RESPECT Continued collaboration with Bioref. Labs for NAAT validation

28 Acknowledgements: Gal Mayer MD, Susan Weiss NP, Nicole Mylan LMSW, David Vincent MSW