Higher yet suboptimal chlamydia testing rates at community health centers and outpatient clinics compared with physician offices
Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.American Journal of Public Health (Impact Factor: 4.55). 06/2012; 102(8):e26-9. DOI: 10.2105/AJPH.2012.300744
To assess chlamydia testing in women in community health centers, we analyzed data from national surveys of ambulatory health care. Women with chlamydial symptoms were tested at 16% of visits, and 65% of symptomatic women were tested if another reproductive health care service (pelvic examination, Papanicolaou test, or urinalysis) was performed. Community health centers serve populations with high sexually transmitted disease rates and fill gaps in the provision of sexual and reproductive health care services as health departments face budget cuts that threaten support of sexually transmitted disease clinics.
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ABSTRACT: Objective: To describe the trends in chlamydia positivity among New Orleans high school students tested in a schoolwide screening between 1996 and 2005, and to determine factors associated with chlamydia positivity among students during the 10-year period. Methods: Between school years 1995-1996 and 2004-2005, students in New Orleans public high schools were tested for chlamydia using nucleic acid amplification tests (NAAT) in urine specimens (LCx assay until 1999-2000; BD assay from 2000-2001 to 2004-2005). For each year, we calculated chlamydia positivity by dividing the number of students testing positive by the total number of students tested. Data were analyzed separately by gender. Logistic regressions were performed to determine independent predictors of chlamydia positivity during the 10-year period. Results: Between 1996 and 2005, the average chlamydia positivity was 7.0% (95% confidence interval 6.6-7.4) in boys and 13.1% (95% confidence interval 12.6-13.7) in girls (P < .001). Chlamydia detection increased with the switch from LCx to BD assay. In multivariate analyses, chlamydia positivity among boys and girls was significantly associated with age, black race, and gonorrhea coinfection. Additionally, positivity was significantly different by school year among boys (P = .03) and by NAAT used among girls (P = .008). Conclusions: The trends in chlamydia positivity observed between 1996 and 2005 more likely reflected a high and stable prevalence of chlamydia in the New Orleans school-age adolescent population. Any benefit of screening on individuals tested was likely to be mitigated by participants' uninterrupted social interactions with the dynamic forces that sustain the sexual transmission of chlamydia in the population.Academic pediatrics 03/2013; 13(4). DOI:10.1016/j.acap.2013.02.011 · 2.01 Impact Factor
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ABSTRACT: To describe recent trends in the receipt of sexually transmitted disease (STD) services among women (age, 15-44 years) from 2002 to 2006-2010 using the National Survey of Family Growth. We analyzed trends in demographics, health insurance, and visit-related variables of women reporting receipt of STD services (counseling, testing, or treatment) in the past 12 months. We also analyzed trends in the source of STD services and the payment method used. Receipt of STD services reported by women in the past 12 months increased from 2002 (12.6%) to 2006-2010 (16.0%; P < 0.001). Receipt of services did not increase among adolescents (P = 0.592). Among women receiving STD services from a private doctor/HMO, the percentage with private insurance decreased over time (74.6%-66.8%), whereas the percentage with Medicaid increased (12.8%-19.7%; P = 0.020). For women receiving STD services at a public clinic or nonprimary care facility, there were no statistically significant differences by demographics, except that fewer adolescents but more young adults reported using a public clinic over time (P = 0.038). Among women who reported using Medicaid as payment, receipt of STD services at a public clinic significantly decreased (36.8%-25.4%; P = 0.019). For women who paid for STD services with private insurance, the only significant difference was an increase in having a copay over time (61.3%-70.1%; P = 0.012). Despite a significant increase in receipt of STD services over time, many women at risk for STDs did not receive services including adolescents. In addition, we identified important shifts in payment methods during this time frame.Sexually transmitted diseases 01/2014; 41(1):67-73. DOI:10.1097/OLQ.0000000000000058 · 2.84 Impact Factor
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ABSTRACT: Prior to issuing formal HIV pre-exposure prophylaxis (PrEP) clinical practice guidelines in 2014, the U.S. Centers for Disease Control and Prevention (CDC) had released interim guidance for oral PrEP use among adults. Because oral PrEP may be used off-label for youth and may soon be indicated for minor adolescents, we examined the potential adoption of the interim guidance among clinicians who care for HIV-infected and at-risk youth. Individual, semi-structured interviews were conducted with 15 US clinicians who were recruited through an adolescent HIV research network. The theory-driven interview guide, consisting primarily of open-ended questions, assessed demographics, familiarity with the guidance, attitudes toward the guidance, and attitudes toward the use of the guidance for adult and adolescent patients. Transcripts were analyzed using framework analysis. Most clinicians (11/15) reported that the guidance was compatible with their practice, although several reported that some aspects, particularly frequency of follow-up visits, needed to be tailored to meet their patients' needs. We found variability in clinician reported characteristics of appropriate PrEP candidates (e.g., youth with substance use and mental health issues were noted to be both suitable and unsuitable PrEP candidates) and PrEP use in serodiscordant couples (e.g., whether PrEP would be recommended to a patient whose HIV-infected partner is virally suppressed). Clinician reported steps for initiation, monitoring, and discontinuing PrEP were largely consistent with the guidance. The observed variability in clinician practice with regard to oral PrEP may be reduced through interventions to educate clinicians about the content and rationale for guideline recommendations.AIDS PATIENT CARE and STDs 02/2015; 29(4). DOI:10.1089/apc.2014.0273 · 3.50 Impact Factor
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