Incorporating Sexually Transmitted Disease (STD) Screening and Partner Management Into the Routine Medical Care of American Indian/Alaska Native Populations

Background:  Sexually transmitted diseases (STDs) including chlamydia, gonorrhea impose a significant health burden on American Indian and Alaska Native (AI/AN) people as compared to other racial/ethnic groups.  

Objectives:  With the goal of expanding STD screening and treatment opportunities for AI/AN communities, the provision of these confidential services were incorporated into a clinical policy and protocol. The clinical policy and protocol were based on standard recommendations for chlamydia, gonorrhea, syphilis and HIV screening and treatment and partner management to ensure that patients and their sex partners receive care that follows national guidelines.

Methods:  National published guidelines and recommendations on STD and HIV screening, STD treatment, STD vaccination, and patient delivered partner therapy were compiled, excerpted, and formatted into clinical policy and protocol formats.  Materials were reviewed and branded by IHS and the Centers for Disease Control and Prevention. 

Results:  The policy content includes broad guidance for the following targets of STD/HIV prevention:  (1) STD/HIV screening in pregnant women, (2) STD and HIV screening and testing in general and high-risk populations, (3) treatment and referral of patients and sexual partners, (4) disease reporting, (5) vaccinations, and (6) question and resource referral. Supplemental materials include:  sexual risk assessment example, STD screening guidelines, and patient delivered partner therapy information for patients and partners.  

Conclusions:  These materials are now available for use within clinical settings serving AI/AN populations including:  IHS service units, remote or village-level clinics, regional IHS medical centers, tribal corporation medical facilities, IHS contracting facilities, and urban health centers.  Evaluation of these materials will provide information on STD/HIV screening rates and partner services.

Implications for Programs, Policy, and Research:  Standard clinical guidance incorporating national guidelines for STD/HIV screening and STD treatment and partner management can facilitate the integration of these services into routine clinical practice of other medical systems.