Increasing Extra-Genital STI Testing with NAAT: Public Health Detailing in High-Priority Settings

Background:  CDC has recommended use of nucleic acid amplification test (NAAT) for extra-genital STI testing in men who have sex with men (MSM) since 2010, but uptake outside of dedicated STD clinics has been minimal. In 2011, CDC funded an initiative to increase extra-genital STI screening among HIV-infected MSM. We describe public health detailing efforts to increase this practice through directed outreach, education and technical assistance to high priority clinic-based settings in the Pacific Northwest.

Methods:  From October 2012 –13, we identified clinics based on HIV care focus and high-risk patient population in Washington and Oregon States. We inquired clinics about current STI screening procedures, and developed individualized implementation plans for interested clinics, including education and technical assistance via email, phone, and in-person communication.

Results:  Seven clinics represented sites where the majority of urban HIV-infected persons seek care in WA and OR were contacted: three private practices in Seattle; university-affiliated clinic and a private provider in Spokane; FQHC in Portland; and the Tacoma-Pierce County Health Department (TPHD). Two of the private providers were already providing appropriate screening. Two clinics were not aware of recommended use of NAAT for extra-genital STI testing and switched to NAAT after appropriate education. We worked with TPHD to implement a rectal STI self-testing protocol through developing and delivering training on epidemiology of extra-genital STIs, efficacy of STI self-testing, and clinic procedures for the clinic’s staff. Despite our efforts, not all clinics participated; reasons included our inability to work directly with clinic staff due to mediation by the local health jurisdiction, and competing priorities for clinic staff time during efforts to implement countywide primary care initiatives.

Conclusions:  Public health detailing, that is the practice of directed outreach and education of providers, is a strategy that can be used to change clinical practice and increase STI screening.