Missed Opportunities to Screen for HIV Among Persons Diagnosed with Gonorrhea (GC) in Non-STD Clinic Settings in Colorado

Background:
Despite statewide evidence that newly reported HIV cases among males are 3.0 times more likely to have had previous Gonorrhea or Syphilis infection prior to their HIV diagnosis, providers continue to miss opportunities for HIV screening when patients present with symptoms of an STD.

Objective:
To describe HIV screening practices of several non-STD clinic provider types when patients are diagnosed with gonorrhea.

Method:
A random sample of 532 gonorrhea cases, reported to the Colorado Department of Public Health and Environment (CDPHE) in 2006 from three counties in Metropolitan Denver, was selected for medical record review. Demographic, clinical, and behavioral variables were collected including HIV screening information.

Result:
A total of 532 medical records of GC cases reported to CDPHE in 2006 were reviewed from March 2007 - September 2007. These included 108 individual providers: 32% Emergency Departments (ED), 8% Urgent Care sites, 28% Primary Care providers, 11% Prenatal/OB providers and 21% representing other provider types. Females reported being symptomatic in 55.9% of cases; males reported symptoms in 81.5% of cases. Despite CDC recommendations to screen patients (79.1%) presenting with STD symptoms or a concern of STD infection, the majority of these patients (85.0%) were not screened as part of the visit. A sub-analysis of ED and Urgent Care sites was conducted. In this analysis, 93.9% did not have HIV screening ordered and only 14.0% had HIV status documented.

Conclusion:
Prior research indicates that HIV positivity rates are higher in some ED and Urgent Care sites than in HIV Counseling and Testing sites. This project demonstrates that HIV screening practices at these and other health care settings do not follow recommended CDC HIV screening guidelines. As a result, opportunities may be lost to diagnose HIV infections.

Implications:
This surveillance project may direct public health decision-making regarding the implementation of HIV screening recommendations in the Denver Metropolitan area.