TP 81 Low STD Screening Rates and High STD Prevalence Among HIV-Infected Patients in Primary Care in 5 US Centers

Tuesday, June 10, 2014
Exhibit Hall
Kenneth Mayer, MD1, Kerith Conron, ScD2, Heidi Crane, MD3, Richard Haubrich, MD4, Elvin Geng, MD5, Chris Grasso, MPH6, Stephen Boswell, MD7, Mari Kitahata, MD3 and Michael Saag, MD8, 1Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, 2The Fenway Institute, Fenway Health, Boston, MA, 3Department of Medicine, University of Washington, Seattle, WA, 4Department of Medicine, University of California, San Diego, CA, 5Department of Medicine, Univerisity of California, San Francisco, San Francisco, CA, 6The Fenway Institue, Fenway Health, Boston, MA, 7Fenway Health, Boston, MA, 8Department of Medicine, University of Alabama, Birmingham, AL

Background: STD screening and treatment is an important part of HIV care, but adherence to CDC guidelines is not well-characterized.

Methods: Data from sexually active HIV-infected adults (N=2,747) who completed at least one computer-assisted self-interview in 2011 at one of 5 sites participating in the CNICS cohort were analyzed to identify correlates of STD screening and infection. Logistic regression models were fit to examine socio-demographic and behavioral predictors of 6- and 12- month screening for Syphilis, Gonorrhea, Chlamydia, and Trichomonas among those who reported or high (unprotected sex with >1 partner) or low (1 sexual partner and/or consistent condom use) risk behavior, respectively.

Results: Most participants (87.3%) were male, and 49.1% were non-White. A minority (27.0%) of high-risk patients underwent 6-month STD screening. High-risk men (odds ratio [OR]=0.69; 95% CI 0.56, 0.87) and Latinos (OR=0.41; 95% CI 0.41, 0.76) were less likely to undergo 6-month screening than women and non-Latino whites, after adjusting for other characteristics. Few (17.9%) low-risk patients received 12-month STI screening. Low-risk 30-39 year olds (OR=1.46; 95% CI 1.10, 1.95) and those who reported recent cocaine, opiate or amphetamine use (OR=1.71; 95% CI 1.52, 1.92) were more likely to receive 12-month screening as compared to older (50+) patients and those who did not report drug use, adjusting for other characteristics. Screening rates varied greatly by site, after adjusting for patient characteristics. STDs were highly prevalent among those screened (32.4% of high and 15.2% of low risk patients.)

Conclusions: Most HIV-infected patients in primary care at five U.S. health centers were not routinely screened for STDs as advised by CDC. Common detection of STDs suggests that routine screening is warranted for low and high risk patients. Research to understand variability in screening patterns in different sites and under-screening of key populations may identify additional intervention opportunities.