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LB 2.59 Improving std screening in hiv care through implementation of self-collected extragenital swabs
  1. Ina Park1,
  2. Jeffrey Schapiro2,
  3. Leo Hurley3,
  4. C Brad Hare4,
  5. Sally Slome5,
  6. Jason Flamm6,
  7. Lauren Nelson7,
  8. Michael Allerton5
  1. 1University of California San Francisco, San Francisco, USA
  2. 2Kaiser Permanente Northern California Regional Laboratory, Berkeley, CA, USA
  3. 3Kaiser Permanente Division of Research, Oakland, CA, USA
  4. 4The Permanente Medical Group, San Francisco, USA
  5. 5The Permanente Medical Group, Oakland, CA, USA
  6. 6The Permanente Medical Group, Sacramento, CA, USA
  7. 7California Department of Public Health, STD Control Branch, Richmond, CA, USA

Abstract

Introduction Screening for syphilis, gonorrhoea (GC) and chlamydia (CT) is recommended at least annually for HIV-positive men who have sex with men (MSM) in the United States (US). Recent analyses from the US Medical Monitoring Project demonstrate that STD screening of HIV-positive MSM remains far below that recommended by guidelines; specific data on extragenital GC/CT screening is not reported. We implemented a quality improvement intervention to improve STD screening (syphilis, GC/CT) in a large managed care organisation (16 centres) including didactic training and implementation of self-collected swabs for GC/CT.

Methods We analysed data from the Kaiser Permanente Northern California HIV Registry to calculate the proportion of MSM tested for syphilis and GC/CT (any site, rectal/pharyngeal site) at least once in the prior year. Laboratory validation of self-collected swabs was completed by 1/2014, rolled out at five centres by 12/2014, and 11 centres by 11/2016. Screening data were finalised for analysis in 1/2017. Three time periods were examined: baseline (6/2012), 1 year (11/2015), and 2 years (11/2016) post initial implementation of self-collection. Cochran-Armitage was used to test for trends.

Results During the study period, the denominator of eligible HIV-positive MSM increased from n=4499 to 5866. Annual screening for GC/CT (any site) significantly increased from 45.2% to 58.3% (ptrend <0.0001); extragenital GC/CT (among those screened) increased from 48.4% to 58.1% (ptrend <0.0001). Medical centres that implemented self-collected swabs within the first year reported higher extragenital screening rates than those who did not (60.6% vs 20.2%, p<0.0001), this difference persisted into year 2. Syphilis screening also increased from 73.6% to 76.8% (ptrend=0.0002).

Conclusion Implementation of self-collected GC/CT swabs is an effective intervention to increase STD screening among MSM in a large US managed care organisation. This intervention should be disseminated to other settings to improve currently suboptimal STD screening rates among MSM.

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