STD CHOICES: Integrating Alcohol-Exposed Pregnancy Prevention Into Routine Care for High-Risk Women Attending Urban STD Clinics in Baltimore MD, and Denver CO

Background: The CHOICES trial showed that a brief intervention can lower the risk of an alcohol-exposed pregnancy (AEP) in women.  The CDC is currently funding a demonstration project to determine the feasibility of providing the intervention to high-risk women attending urban STD clinics.

Objectives: To discuss successes and challenges encountered in implementing STD CHOICES in two divergent clinic systems.

Methods: Each site received identical training through the CDC in the motivational-interviewing-based intervention.  An Interventionist provides two sessions to eligible women who agree to participate:  aged 18 - 44, not using effective contraception, and drinking alcohol at high-risk levels (>4/occasion or >7/week).  A Patient Navigator assists with patient retention.  Follow-up assessments are done at 3 and 6 months after the first session.  In Baltimore women can receive contraception at a Title X Family Planning (FP) clinic in the same building, while in Denver the STD clinic already integrates FP with STD care.  In Baltimore screening is done by project staff, while in Denver screening is done by the STD/FP clinicians, with questions built into the clinic’s electronic medical record (EMR).  Both sites monitor performance and adjust their systems in response to identified problems.

Results: Baltimore has had more success in delivering sessions, but more difficulty in getting women to attend FP visits.  Not all women attending the Baltimore clinic receive screening due to staff availability.  In Denver, all women are screened, but eligible women are unlikely to enter the intervention if a direct hand-off to the Interventionist is not achieved, and lack of staff availability again means eligible women are missed at this step.

Conclusions: Baltimore and Denver have implemented the same intervention in differing systems. 

Implications for Programs, Policy, and Research: The CHOICES intervention can be successfully deployed in urban STD clinics, reaching a high-risk population.  Challenges can be addressed with ongoing adaptation.