Screening for Gonorrhea and Chlamydia in HIV Care Settings in Tennessee

Background: HRSA pays for annual syphilis testing for persons in HIV care; however, there is no such coverage for other sexually transmitted diseases (STDs).  Although there are no accurate statistics on co-infection of HIV with gonorrhea and chlamydia, presence of these STDs increases the risk of HIV transmission 2-5 times.  STDs also can cause the person with HIV disease to have a reduced CD4 count and an increased viral load until adequately treated.  Tennessee has established seven Centers of Excellence in HIV Care located based on morbidity.

Objectives: To offer annual, opt-out gonorrhea and chlamydia testing to those receiving HIV care at Tennessee’s HIV Centers of Excellence.

Project Description: The TN Department of Health HIV/STD medical director issued a memorandum to all Centers of Excellence in December 2010 adding gonorrhea and chlamydia testing to the 2011 Performance Standards.  Gonorrhea and chlamydia testing were also added to the Ryan White Part B medical services fee schedule and the annual site review forms. 

Findings: Data was collected from several sources including direct contact with the COE, laboratory requisition and case management databases.  With no instructions on coding or specific database in which to enter the data, it was difficult to collect and analyze the data.  Even with the requirement, similar number of tests and positivity were seen in 2010 and thus far in 2011 with 4% chlamydia and 2% gonorrhea positivity. 

Conclusions: When requiring new tests, instructions must be given on how and where to record the information.  With many non-integrated databases, a plan for merging and linking data should be established prior to implementation.

Implications for Programs, Policy, and Research:  HIV and STD and HIV Care databases, as well as ELR and EMRs, should be interoperable.