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)

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.