WP 138 Opportunities for Expanded HIV and STD Management in Federally Qualified Health Centers (FQHCs) North Carolina's Experience

Tuesday, June 10, 2014
International Ballroom
Cal Ham, MD, MPH, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, Aaron Fleischauer, PHD, MSPH, Epidemiology, Norht Carolina Division of Public Health, Raleigh, NC, Jacquelyn Clymore, MS, North Carolina Division of Public Health, Raleigh, NC and Peter Leone, MD, Division of Infectious Diseases, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC

Background:  FQHCs will play an increasing role in HIV and STD management following Medicaid expansion.  We describe the HIV and STD screening and treatment practices at four FQHCs in North Carolina (NC).

Methods:  Computer-assisted personal interview software was used during in-person interviews with physicians, clinic supervisors, and administrative executives.  Questions included services provided in 2011; additional data was collected from electronic health records and annual reports.

Results:  In 2011, 74,878 (mean= 18,720/ center) patients were seen at four FQHCs representing 17% of patients receiving care at 31 FQHCs in NC.  Of these, 45% were male, 28% were Caucasian, 41% were African America, and 28% were Hispanic.  Furthermore, 53% were uninsured, 28% used Medicaid, 11% used Medicare, and 7% had private insurance.  All four FQHC’s offered testing for HIV (ELISA), gonorrhea and chlamydia (NAATs), syphilis (non-treponemal and confirmatory treponemal tests), and serologic tests for herpes simplex virus (type 2), Hepatitis B and Hepatitis C.  Most (3 of 4) centers had protocols in place for HIV screening, but only 1 of 4 had STD screening protocols.   In 2011, 3,619 (mean=904.8/ center) HIV tests were performed and 22 new HIV diagnoses made.   Three of 4 centers offered management of HIV infection, and all 4 provided treatment for gonorrhea, chlamydia, and syphilis using CDC recommended regimens.  Of 3 centers offering HIV care, one was new and had not enrolled patients, one managed 50 HIV+ patients, and one was an HIV referral center, providing care for 625 HIV+ patients. None of the facilities had stand alone or walk in STD clinic services.

Conclusions:  FQHCs are important HIV testing and treatment sites in NC, and will become more critical following healthcare reform.   The coverage and quality of STD-related care can be improved through protocols and structural interventions which routinize STD screening in asymptomatic individuals.