STI Screening Program Evaluation Callen Lorde Community Health Center Anita Radix MD MPH
Introduction
Callen-Lorde Community Health Center
Michael Callen 1955 - 1993
Audre Lorde 1934 - 1992
Callen-Lorde’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 Community Clinic and the Gay Men’s Health Project – two clinics providing STI screening and treatment.
Callen-Lorde Visit Volume Growth 60,000
54,838
50,000
44,706
46,327
41,633 37,965
40,000
29,088
30,483
30,000
18,707 20,000
13,907 9,356 10,000
0 1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Engagement in Care HIV Primary Care Total HIV Primary Care Patients 2001-2007 3000
2486 2500
2020 2000
1747 1397
1500
1524
1136 952
1000
500
0
2001
2002
2003
2004
2005
2007
2008
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
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
Health Oral Health Clinic Support Services (Case Management, Education, Outreach) Mobile Medical Unit Outreach Program
Access to Care
HIV Primary Care
Primary medical 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
Patients by Race/Ethnicity (FY08)
Other 2% Asian/PI 4% More than 1 7%
African American 16%
Hispanic 20%
Caucasian 56%
All Others 80%
Visits by Insurance Status and Type
Self-Pay 39%
Commercial 34% Medicaid 14% Medicare 4%
Medicaid/ADAP 9%
STI Screening Programs
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
Sexual Health Clinic Screening and Assessment Template
Sexual Health Clinic STI Diagnoses 1/1/05-6/30/06 800
721
700 600
662
524
500 378
400 300 200
SHC visits
1058
Hepatitis vaccinations
2722
RPR’s Sent
5607
100 0
Patients with Genital Herpes
New Syphilis Cases
Patients Treated for Genital Warts
Gonorrhea/ Chlamydia Cases
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
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 2008 - AIDS 2008 Abstract no. THPE0224
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
QMG 50.0 40.0 30.0
Routine annual HIV testing (%)
20.0 10.0 0.0 Ju l-0 Se 8 p0 No 8 v0 Ja 8 n0 M 9 ar M 09 ay -0 9 Ju l-0 Se 9 p09
% Eligible persons screened
Routine Annual HIV testing (%)
date
QMG Callen Lorde Sexual Health Clinic Annual Syphilis Screening (Men only)
85.0 Annual syphilis screening (%)*
80.0 75.0
Date
09 p-
Se
l- 0 9 Ju
-0 9 ay
9 M
ar -0
M
n09 Ja
08
No
v-
08 p-
Se
l- 0 8
70.0 Ju
% s c re e n ed
90.0
QMG Annual Hepatitis C Screening (HIV-positive only) 92.0 88.0 Annual hepatitis C screening (%)
86.0 84.0 82.0
v08 Ja n0 M 9 ar -0 M 9 ay -0 9 Ju l-0 Se 9 p09
No
08 p-
Se
l-0
8
80.0
Ju
% S creened
90.0
Date
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. 2008. 2008 National STD Prevention Conference
STI Surveillance
Callen Lorde HIV Screening 2008 TEST
Stand Alone testing
# Tests
# Positive
%
4271
159
3.72
39
1.97
Routine Testing 1983 (low risk)
HIV prevalence for transgender women (MTF): 42%, African-American: 70%* *Radix A. AIDS 2008 Abstract no. WEPE0706
Callen Lorde STI Results 2007 TEST
n
# Tests
# Positive %
Urethral GC Urethral CT (NAAT)
1276
1415
133 92
9.4 6.5
GC anal culture
1098
1247
32
2.6
Chlamydia anal
-
-
-
-
GC Pharyngeal culture 1551
1776
31
1.7
Hep C
3149
137
4.3
2515
SHC Syphilis 2007 Stage
No
%
39
No with HIV 26
Primary secondary
69
46
67
Early latent 25
19
76
Late latent
27
20
74
unspecified 24
11
46
TOTAL
122
66
184
76
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 validated @ Bioreference labs for rectal/pharyngeal specimens
SHC counseling program - ?effectiveness
Goals
Improve STI testing at all exposed anatomic sites (?performance improvement project) Implementation DEBI: RESPECT Continued collaboration with Bioref. Labs for NAAT validation
Acknowledgements: Gal Mayer MD, Susan Weiss NP, Nicole Mylan LMSW, David Vincent MSW
[email protected]