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

STI Screening Program Evaluation Callen Lorde Community Health Center Anita Radix MD MPH Introduction Callen-Lorde Community Health Center Michael...
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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: ƒ Anal GC screening 50% ƒ Anal CT screening 33% ƒ Urethral GC/CT screening 60% ƒ 3 anatomic site screening 33% * ƒ RPR 90% ƒ 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]

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