Will STD Screening Rates in Men Who Have Sex with Men Living with HIV Improve with the Implementation of a Standardized Risk Assessment Tool in an HMO Setting?

Background: Routine rectal and pharyngeal chlamydia and gonorrhea (CT/GC) screening is recommended for HIV-positive men who have sex with men (MSM) who report having receptive anal or oral sex.    However, performance of sexual risk assessment (RA) to assess which STD tests are indicated creates a barrier to routine STD screening.   Our objectives were 1) to facilitate routine and accurate RA, and 2) to increase STD screening rates in HIV-positive MSM men at Kaiser Permanente Northern California (KPNC), Oakland by the implementation of a paper-based RA tool.

Methods:From 5/25/13 to 9/25/13 a pilot quality improvement intervention was implemented at a single KPNC medical center, which included:  1) qualitative assessment of baseline RA practices among HIV providers 2) calculation of baseline STD screening rates for HIV-positive MSM 3) development of self-administered RA tool, and 4)  training and implementation support for the RA tool.  During analysis, patient responses to the RA were sorted into high-risk (screen today) and low-risk (screen annually) groups. 

Results: Qualitative assessment demonstrated an absence of standardized RA practices.  Among 606 HIV-positive MSM, 59.1% were screened for GC/CT in the 12 months before the intervention; 26% of this total were screened by urine only.  One hundred-ninety patients completed the standardized RA.  Responses indicated 39.5% needed pharyngeal screening, 28.4% needed rectal screening and 39.5% needed urethral screening on day of visit. Evaluation comparing pre-/ post- intervention data to measure changes in the proportions of patients receiving STD screening will be completed by March 2014.

Conclusions:A self-administered RA tool could provide consistent sexual health information to guide provider’s decision-making about STD testing.  Implementation includes: 1) relationship-building and problem-solving with the partner agency to tailor the quality improvement intervention 2) assessment of current RA and STD screening practices, 3) evaluating use of the tool and reporting back to partner agency.