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Enhanced STD Services in Resource-Limited Times<br>

Learn about the innovative programs including expedited partner therapy, express STD visits, embedded CDIs in HIV clinics, and Hepatitis B vaccination to improve STD services in Maricopa County. Contact Heather James for more details.<br>

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Enhanced STD Services in Resource-Limited Times<br>

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  1. Expanding and Improving STD Services during Resource Limited Times Heather James STD Field Services Supervisor Maricopa County STD Program

  2. Four Expanded Services • Express STD Visits • Expedited Partner Therapy • Embedded CDIs in HIV Clinics for partner interviews • Hepatitis B Vaccination in STD Clinic

  3. Express STD Visits • STD visits without a medical provider, physical examination or interview • Test only visit includes: • Syphilis serology • HIV test • Combined chlamydia and gonorrhea urine test

  4. ET Risk Factor Screening • Answering “Yes” to the following risk factors disqualifies the patient for ET: • Are you experiencing symptoms? • Did someone tell you to come here? • Have you traded sex for drugs or money? • Are you pregnant? • Have you engaged in receptive anal sex in last 3 months? • Have you recently been sexually assaulted?

  5. ET Risk Factor Screening STD Screening Triage Assessment Form Frequently Asked Question Form

  6. Express STD Visits • Since September of 2008, 2,464 patients have been tested through ET visits • Approximately 14% of STD clinic attendees are channeled through ET • Run by CDI; 2 per clinic • Follow-up results given per regular clinic protocols • No treatment provided at ET

  7. STD Clinic AttendanceJanuary – July 2009

  8. STD Express TestingClients Tested / Cases

  9. Benefits • Shorter wait times (average 1 hour shorter) • Increased number of patients seen during working hours • Projected increase in revenue as Express patients pay same fees ($20) • Many patients prefer this option to seeing a provider

  10. Potential Drawbacks • Fewer patients receive presumptive treatment thus, • Possible treatment delays (not yet evaluated) • Requires additional CDI’s in clinic • Some clinic flow changes necessary

  11. Expedited Partner Therapy • AZ State Statute (32-1401) allows for treatment of contacts of infectious diseases without a medical exam • Protocols developed for Maricopa County STD Program • Implemented June 2009

  12. Expedited Partner Therapy (EPT) • EPT protocol summary • Patients receive diagnosis and treatment for Chlamydia and/or gonorrhea • Patients receive a prescription(s) from the provider to fill at the Maricopa County pharmacy (adjacent to clinic) for partner medication • Patients receive information to give to partner about the medication • Partners are encouraged to seek care for testing

  13. Results • Since June 2009, 15 prescriptions have been filled at the Maricopa County pharmacy for EPT • 11 for azithromycin • 4 for cefixime • EPT Protocol has been shared with MIHS clinics

  14. EPT Benefits • Patient delivers medication to partner • Reduced re-infection rates • Reduced number of untreated partners (frequently male partners) • Reduces need to track partners for clinic referral for testing and treatment • Medication cost to patient for partner treatment • $7.75 for 1 gram of azithromycin • $9.94 for 400mg of cefixime

  15. EPT Potential Drawbacks • Partners do not receive testing • Small risk of adverse reaction to medication though written and verbal information provided through pharmacy

  16. Embedded CDIs in HIV Clinics • Rationale • 70% of Maricopa P and S cases are MSM • Approximately 50% are HIV infected • Top 3 syphilis reporting providers for 2007-08 were HIV clinics • Spectrum • McDowell • Pueblo Family

  17. Implementation • In early 2008, 2 CDIs identified to work ½ day/week in two clinics and 1 CDI identified to be “on call” in one clinic • CDIs deliver penicillin to 2 of 3 clinics • CDIs perform partner elicitation in the clinic following provider evaluation

  18. Evaluated Improvements • Improved time to interview • Higher number of completed interviews • Higher number of partners initiated • Fewer field attempts to locate partners • Higher number of partners brought to treatment • Visibility of public health in private offices

  19. Administration of HBV Vaccine in Maricopa STD Clinic • Rationale • Hepatitis B is an STD • Preventable with vaccination (3 shot series) • Highest risk population attending STD clinics • Physical proximity to Immunization Clinic • Staff sharing • Education/administration by immunization staff

  20. Implementation • Staff member from Immunization Clinic “solicits” potential vaccinees from the STD waiting area • First shot of series administered in STD Clinic by Immunization staff • Patient receives follow-up dates for remaining 2 injections • Follow-up 2 injections administered at the Immunization Clinic

  21. Summary • These four services have expanded care through the Maricopa STD Clinic • Protocols available for other programs • Site visits welcome

  22. Contact Information Heather James 602-506-5056 heatherjames@mail.maricopa.gov Questions?

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