WP 35 Developing and Implementing an Ipad-Based Sexual History Application to Increase Extra-Genital Gonorrhea (GC) and Chlamydia (CT) Testing in Men Who Have Sex with Men (MSM)

Tuesday, June 10, 2014
International Ballroom
Bradley Stoner, MD, PhD1, Mario Schootman, PhD2, Enbal Shacham, PhD2, Deloris Rother, MPH1 and Rachel Presti, MD, PhD1, 1Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 2College for Public Health and Social Justice, Saint Louis University, St. Louis, MO

Background: Men who have sex with men (MSM) represent an important population for targeting STD prevention and control efforts.  Asymptomatic carriage of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) in extra-genital sites is common, and risk-based screening of rectal and pharyngeal sites is currently recommended.  However, performance of extra-genital GC/CT testing among MSM is not routinely performed, particularly when ongoing risks are not adequately assessed by providers during screening examinations.  We describe efforts to develop and implement an iPad-based sexual history application to enhance identification of ongoing extra-genital site exposures and to encourage providers to screen for extra-genital GC/CT based elicited risks.

Methods: Current sexual history / risk assessment questions from several high-volume MSM clinic locations, as well as from published sources, were reviewed for accuracy, completeness, and ease of use.  Risk questions were consolidated to generate a comprehensive exposure-specific questionnaire, which was then programmed for patient self-administration using an iPad tablet device.  Responses were designed to integrate directly into the patient’s electronic health record (EHR).  Self-reports of rectal or pharyngeal exposure were programmed to generate provider prompts to order extra-genital GC/CT tests.  Pilot testing was performed to refine question wording and flow.

Results: Implementation of the iPad risk sexual history application is currently underway in three high-volume MSM clinic locations in Missouri, Illinois, and Wisconsin.  System-level challenges include (1) successful interfacing with EHR systems, which vary across sites, and (2) generating user-friendly summary reports which direct clinicians to order site-appropriate GC/CT tests.  Clinic locations will be evaluated at 3-months and 6-months to determine impact on appropriate site-specific extra-genital test utilization.

Conclusions: Use of an iPad-based sexual history application can contribute to STD prevention and control efforts by promoting appropriate use of site-specific extra-genital GC/CT testing, based on elicited exposures and provider prompts.