The Impact of Introducing ″Express Visits″ for Asymptomatic Persons Seeking STD Services in a Busy Urban STD Clinic System, New York City, 2005-2006

Background:
The New York City Department of Health and Mental Hygiene's Bureau of STD Control's (BSTDC) 10 clinics provide free and confidential STD testing and treatment. With limited physician (MD) resources, it is difficult to provide clinical services to all patients seeking care. In January 2006 we introduced an ‘Express Visit' option- STD screening without examination - for asymptomatic persons denying contact to known STD cases and not requesting examination.

Objective:
Evaluate impact of express visits on Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (Ct) management.

Method:
Express visits were defined as clinic visits with a GC or Ct urine nucleic acid amplification test but without MD examination. We compared GC/Ct case management (diagnosis and treatment within 30 days) before (September 1 –December 31, 2005) and after (September 1- December 31, 2006) introducing express visits.

Result:
In 2005 there were 18,449 MD visits, 0 express visits; in 2006, 18,421 MD visits, 6,064 express visits. The proportion of symptomatic MD visits increased (73.6% vs. 85.6%; p<.0001) and GC-positivity at MD visits increased (before: 4.4%, after: 5.2%). Proportion cases treated by 30 days after MD visit increased from 92.1% to 95.9% with a median time to treatment of 14 days (before) vs. 10 days (after). Overall, more GC/Ct infections were detected (2,043 vs. 2,617) without decreasing proportion treated (92.1% vs. 93.0%) by 30 days.

Conclusion:
Express visits enabled GC/Ct screening of a large number of asymptomatic patients and MD resources directed to symptomatic patients. More GC/Ct was treated, and time-to-treatment improved. Only additional costs were related testing, treatment. Strategies to improve treatment rates and time-to- treatment are needed for both express and MD visits.

Implications:
Programs with limited clinician resources may benefit from offering screening visits which do not rely on clinician exam to specific patient groups.