The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Wednesday, May 10, 2006

Impact of a Pilot Fast-Track Screening Program for a High-Volume STD Clinic Chicago, Illinois

William Wong1, Jennifer Broad1, Tammy Rutledge1, Leah Quinn1, and Dawne Rekas2. (1) STD/HIV Prevention and Care Program, Division of STD/HIV/AIDS, Chicago Department of Public Health, 530 E 31st street, 2nd floor, Chicago, IL, USA, (2) Chicago Department of Public Health, STD/HIV Prevention and Care Program, Centers for Disease Control and Prevention, 530 E 31st street, 2nd floor, Chicago, IL, USA


Background:
The number of patients presenting to CDPH STD clinics exceeds the program capacity to deliver comprehensive services causing large numbers of patients being turned away from care. To reduce the number of patient turnaways, a fast-track STD screening program was piloted in 2005.

Objective:
To evaluate the impact of a fast-track STD screening program to increase the number of patients seen in an STD clinic.

Method:
Following registration, patients were assessed using nine questions about symptoms and behavioral risk. High-risk patients were offered a complete clinician examination, STD/HIV testing, and counseling. Low-risk patients were offered urine-based gonorrhea/chlamydia tests, syphilis serology, and an HIV antibody test. Patients returned for complete examination and treatment, if fast-track screening test results were positive. To obtain patient demographics and laboratory results, we reviewed clinic data.

Result:
Between November 2005 and January 2006, 1857 visitors presented to the STD clinic, of which 255(13.7%) were turned away. Of the 1602 visitors who received clinical services, 1548(96.6%) were identified as high-risk and received standard clinical care, and 54(3.4%) were low-risk and received fast-track screening services. Standard clinical services identified 590(38.1%) STD diagnoses compared with 7(13.0%) STDs in the fast-track services group. All 7 diagnoses were chlamydial infections.

Conclusion:
The majority of patients who presented to the STD clinic were high-risk, and required a complete clinical evaluation. Institution of a fast-track screening program expanded clinical services by 3.4% during the pilot period. Triage questions identified asymptomatic patients with a lower incidence of STDs compared to the patients who received standard clinical care (13.0% versus 38.1%).

Implications:
Fast-track STD screening programs are feasible, and expand patient access to drop-in STD/HIV testing services. Fast-track STD screening is an option for programs whose service demand exceeds program capacity. Analysis of the service impact of the program continues.