Increases in Adherence to Gonorrhea Treatment Recommendations in Three California Local Health Jurisdictions Associated with a Targeted Provider Intervention

Background:  To counter emerging drug-resistant gonorrhea (GC) and reduce transmission, adherence to recommended treatment guidelines is essential.  Treatment monitoring in the California state surveillance system indicated that improved provider adherence and reporting were needed.  The California Department of Public Health partnered with local health jurisdictions (LHJs) to increase GC treatment adherence and reporting.

Methods:  Three LHJs (intervention group) were prioritized based on high GC morbidity, diverse geographic representation, baseline low GC data completeness and low treatment adherence.  From March–December 2015, intervention LHJs selected and contacted local providers that were incorrectly treating GC cases and/or were not reporting GC treatment using visits, phone calls, and/or letters.   Three non-intervention LHJs similar in morbidity, region, and GC reporting/adherence were also identified.  GC treatment adherence was compared for intervention and non-intervention groups across sex, age, race/ethnicity, and clinical setting.  Chi-square tests were used to compare the percent adherent in 2013 (pre-intervention) to 2015 (post-intervention).

Results:  All contact methods (visit, phone call, and letter) used by intervention LHJs had a positive impact on treatment adherence.  Calls and letters were most cost-efficient, using 15-30 minutes of staff time per contact.  Both intervention and non-intervention LHJs saw increases in GC treatment adherence; however, intervention LHJs saw an absolute change of 32.2% (p<.0001) compared to 8.7% (p<.0001) for non-intervention LHJs.  The treatment adherence improvements for intervention LHJs were consistently high and statistically significant across all strata (sex, age, race/ethnicity, and key clinical settings such as family planning, health department, private physician, hospital, and corrections), with in-strata absolute changes between 17-48%.  Improvements were also seen across most strata for the non-intervention group, but of a much smaller magnitude (1-26%).

Conclusions:  By prioritizing high volume, poorly adherent providers all three LHJs made significant improvements in GC treatment adherence.  Phone calls and letters were found to be the most cost-efficient use of local resources.