Ensuring Access to STD Screening, Diagnosis, Treatment, and Partner Services

Background:
Secondary prevention of STDs includes early diagnosis and treatment of infected individuals; case reporting, follow-up, and partner services. The earlier secondary prevention is implemented; the sooner disease spread is likely to be controlled.

Objective:
Use public health practices to ensure timely access to STD prevention.

Method:
Multnomah County Health Department increased access to STD Clinic (medical, lab, disease intervention specialist services) and Partner Services, for individuals at greatest risk, by using public health practices outlined in CDC Program Operations Guidelines for STD Prevention, local epidemiology and input from two community collaboratives to eliminate STD disparities.

Result:
Services were streamlined to focus on reportable disease. Priority access to appointments was given to the following: reported actual or suspected cases and sex partners; individuals aged <25, and men who have sex with men (MSM). Consequently: Clinic productivity increased by 40%. Visits by MSM increased from 9% to 27%, visits by African Americans remained at 18%, and visits by people aged <25 decreased from 45% to 34% (utilization of School-Based Health Centers by people aged <22 increased concurrently). Clinic client satisfaction surveys: >90% respondents rated services excellent or good (no differences in response rates or satisfaction when analyzed by patient characteristics). Partner Services increased from 88% to 91% of cases of HIV, syphilis and gonorrhea receiving services. Locally, in 2004 a local syphilis outbreak was contained, and in 2006 gonorrhea cases and rates decreased overall and in all three priority groups. Annually, local information is reviewed and priorities adjusted. Quarterly, aggregate STD case report review occurs to identify possible outbreaks.

Conclusion:
Using local information and prioritizing access may influence STD case rates and persistent STD disparities. Identifying non-stigmatizing ways to increase access for African Americans aged >24 is needed.

Implications:
Evaluating prioritization of care might help eliminate disparities in STD rates.