Understanding STD Screening and Management in Indiana Community Health Centers

Background: STD rates in the United States have been reaching unprecedented levels over the past few years. Previous studies have determined that costs for treating STD infections were about 16 billion dollars in 2010 alone, with a substantial proportion of STD care being provided by community-based clinics/centers. The objective of this study was to assess and understand how Community Health Centers (CHCs) in Indiana identify and manage Chlamydia, Gonorrhea and Syphilis.  

Methods: Online survey was completed by 28 (32.9%) of Indiana CHCs between April and May 2013. Measures included reported STD services, testing expectations, barriers to screening and management and partner services. Covariates included clinic characteristics such as census designation, FQHC/RHC designation and years in current position. Reported practices were compared with current CDC guidelines for STD testing in clinical settings.

Results: Most CHCs reported onsite testing and counseling for Syphilis (75%), Chlamydia and Gonorrhea (85.7%). Testing expectations for Chlamydia, Gonorrhea and Syphilis were mainly based on clinic policy (50%) and CDC recommendations (46.4%). Most clinics reported testing generally at patients request or when the patient was symptomatic for adults under the age of 65 and gay/bisexual men while testing expectations for pregnant women and gay and bisexual men were also unknown for quite a few CHCs. Most CHCs (75%) reported notifying the health department in response to positive syphilis tests, but do not provide on-site partner counseling or services. STD screening and treatment guideline trainings were offered to clinicians at the CHCs, but only a few (28.6%) reported being likely to have received this training within the past 3 years.

Conclusions: CHCs in Indiana overall did not follow the CDC guidelines for screening of Chlamydia, Gonorrhea and Syphilis. CHCs may consider understanding national and state guidelines while also discussing challenges to implementation to help implement more standardized care across the state.