Routine Computer-Assisted Self-Interview Increased Sexual History Completeness Among MSM STD Clinic Patients

Background: In October 2010 we implemented a computer-assisted self-interview (CASI) for collection of patients’ sexual histories in the King County STD Clinic. Prior to implementation, we validated the accuracy of several CASI variables.

Objectives: To compare completeness of key data elements before and after CASI implementation.

Methods: We analyzed data from electronic STD Clinic records to determine the proportion of new problem visits at which key sexual history elements were documented in October 2010-September 2011 (post-CASI) compared to October 2005-September 2010 (pre-CASI).  When patients did not complete the CASI, clinicians documented histories in a structured medical record.  We compared data completeness with t-tests. 

Results: A total of 67,958 visits occurred during the analysis period. Patients completed the CASI at 76% of visits after CASI implementation. Among men who reported having a male partner in the past year (MSM), HIV status ascertainment increased from 96% to 98% (p<0.001), and among MSM not previously diagnosed with HIV, HIV testing history completeness increased from 92% to 96% (p<0.001).  Data from MSM visits indicating unprotected anal intercourse with nonconcordant HIV status partners increased from 83% to 94% complete (p<0.001). In patients with previously diagnosed HIV, ascertainment of antiretroviral use and HIV care receipt increased from 61% to 88% (p<0.001) and 79% to 88% (p<0.001), respectively.  Ascertainment of condom use with vaginal sex was the same pre- and post-CASI (80%; p=0.8).  The prevalence of transactional sex, same sex partners in the past year, heterosexual anal sex, and injection drug use in the CASI year varied <5% from the pre-CASI year.  

Conclusions: Complete ascertainment of key aspects of the MSM sexual history, receipt of HIV care, and antiretroviral use increased with CASI, providing additional evidence to support the use of CASI in STD care.

Implications for Programs, Policy, and Research: CASI implementation in STD Clinics is likely to improve data completeness and may improve patient care.