SP9 Victims of Our Own Popularity: Screening Visits At New York City Sexually Transmitted Disease (NYC STD) Clinics

Tuesday, March 13, 2012
Hyatt Exhibit Hall
Kate Washburn, MPH, Bureau of Sexually Transmitted Disease Control, NYC Department of Health and Mental Hygiene, Long Island City, NY, Susan Blank, MD, MPH, Bureau of STD Control and Prevention, NYC Department of Health & Mental Hygiene, Long Island City, NY and Kimberly Johnson, MS, Bureau of STD Control and Prevention, New York City Department of Health and Mental Hygiene, Long Island City, NY

Background: In 2006, NYC Department of Health and Mental Hygiene Bureau of Sexually Transmitted Disease (STD) Control began screening visits for asymptomatic patients not needing exam, consisting of urine-based chlamydia/gonorrhea NAAT, RPR and rapid HIV antibody test. 

Objectives: To respond to budget shortfalls, we evaluated relative cost and yield of lab testing for STD and HIV screening.

Project Description: Using financial and electronic medical record (EMR) data we compared screening visit and provider visit yield and costs.

Findings: From 2006 to 2010, visits to NYC STD clinics increased from 111,473 to 123,430 ; screening visits as a proportion of all visits increased from 12% to 36%. From 7/1/09 – 6/30/10, 90% (36,408/40,926) of screening visits yielded NO STD diagnosis, versus 13% (7,338/56,283) of provider visits (Ct, GC and syphilis only). Screening visit Ct/GC positivity was 7.6% (3,126/40,916) and 1.2% (472/40,919) respectively, versus 13.3% (5,877/44,356) and 5.2% (2,332/44,644) among provider visits.  Screening visit costs per Ct/GC case was $118 versus $56 for provider visits.

Conclusions: Screening visits increased STD clinic volumes, without commensurate yield in morbidity. It cost twice as much to find one case of Ct/GC among screening visits as among provider visits. In weighing what to cut, we calculated that screening visits including a rapid HIV test cost BSTDC approximately $800,000 annually; and those without a rapid HIV test cost $413,000 annually. To cut costs and maintain priority services, as of March 2011, persons with no STD exposure or symptoms are offered HIV testing and a referral for screening/primary care services.  Since 3/2011 the number of visits without STD pathology has declined, allowing BSTDC to focus on persons most likely to have and spread disease.

Implications for Programs, Policy, and Research: Referring asymptomatic patients to primary care enables STD clinics to focus on mandated specialty services and appropriately encourages primary care to take on the burden of routine screening.