Location Matters: Distribution and Responsiveness of Governmental STD Clinics Across the Country

Background:  Studies of U.S. STD clinics are limited by non-representative sampling. We sought to identify the existence and distribution of STD clinics across the U.S. associated with governmental public health, and examined whether publicly available data would provide a basis of evaluating STD clinic “Community Responsiveness.”

Methods:  A multi-level internet-based search conducted from September 2014-March 2015, identified government-associated sexually transmitted disease (STD) clinics in all 50 states and the District of Columbia. Data included location, operating hours, clinic contact information and type. Hierarchical linear modeling (HLM) tested whether “community responsiveness:” an additive index of operating hours (nonstandard and weekend) and website presence (presences, website currency and contact information) was function of county STI rates (Level 1), geographic designation of the city (Level 2), or state population size (Level 3).

Results:  1,843 STD clinics were identified across the U.S. and organized into 7 classifications. Clinics were located in metropolitan (52.0%) and non-metropolitan areas (48.0%), and 221 STD clinics (12.0% of total) were in completely rural areas. The number of clinics within states ranged from 2-124 with (M=69.2), and the number of clinics per 100,000 population ranged from .05-4.06 (M= 0.89). Large states had more clinics in metro areas (β=0.6), while Clinics in Medium size states were in Rural areas (β=0.2), and Urban areas (β=0.4). For access, 21.6% of clinics operated beyond 8am-5pm. Rural clinics tended not to do so, and only 1.1% (8) of clinics offered weekend hours. “Community Responsiveness” was a function of county STI rates (β= 0.10) and City Location (β=0.32). STD clinics in large states were more responsive (β= 0.9).

Conclusions:  STD clinic location appears to matter most for responsiveness. Clinics should consider expanding operational hours. Future studies of STI service access and quality over time will be assisted by this clinic listing.