TP 79 Chlamydia and Gonorrhea Diagnosis, Treatment, Personnel Cost Savings, and Service Delivery Improvements Following the Implementation of Express STD Testing in Maricopa County, Arizona

Tuesday, June 10, 2014
Exhibit Hall
Sana Rukh, Master of Public Health (MPH), Department of Sexually Transmitted Diseases and Human Immunodeficiency Viurs, Maricopa County Department of Public Health, Phoenix, AZ

Background:  The demand for low-cost STD services in Maricopa County (Phoenix area) is high.   Improved methods for STD/HIV testing are needed to increase the number of patients receiving testing. To evaluate an STD/HIV express testing option for patients identified as being at lower risk for infection. 

Methods: Clients reporting current STD symptoms, contact to an infected partner, or health department referral were identified via questionnaire and routed to a traditional provider visit (PV); those not reporting these situations were routed to express (lab-only) testing (ET).   Demographics, treatment completion, and treatment intervals were compared among patients diagnosed with chlamydia and gonorrhea through ET and PV encounters during September 2008 to July 2011.    Personnel costs were compared for each of the two visit types.   The number of clinic turn-aways for the two-month time interval prior to the start of the program was compared to the two-month interval at the end of the evaluation. 

Results:  Of the 36,946 clients seen at MCDPH, 7,466 (20.2%) were patients seen through express visits. Overall chlamydia and gonorrhea positivity was lower among express testing patients (527/7466, 7.1%) as compared to those tested through provider visits (6323/29,480, 21.4%). Treatment completion rates were comparable, but were higher among patients seen through provider visits (99%) as compared to express testing (94%). A savings of $2,936 per 1,000 patients seen was achieved when 20% of clients were routed through ET.  Clinic turn-aways decreased significantly, from 159 clients during the two months prior to implementation of ET to 6 patients during the last 2 months of evaluation (96% reduction).

Conclusions: This express testing system included an effective patient routing process which provided an efficient way to increase access to STD testing among persons at lower risk, at a reduced cost per patient, while maintaining high treatment coverage.