Abstract
Bacterial sexually transmitted infections (STIs) continue to be a worsening public health concern in the United States (US). Though the national incidence of HIV infection has decreased over recent years, that of chlamydia, gonorrhea, and syphilis have not. Despite national recommendations on prevention, screening, and treatment of these STIs, these practices have not been standardized. Nine Health Resources and Services Administration Ryan White HIV/AIDS Program funded clinics across 3 US jurisdictions (Florida, Louisiana, and Washington, DC), were selected as clinical demonstration sites to be evaluated in this mixed method needs assessment to inform a multi-site, multi-level intervention to evaluate evidence-based interventions to improve STI screening and testing of bacterial STIs among people with or at risk for HIV. These 3 US jurisdictions were selected due to having higher than national average incidence rates of HIV and bacterial STIs. Descriptive statistics and deductive analysis were used to assess quantitative and qualitative needs assessment data. Results indicate the following needs across participating sites: inconsistent and irregular comprehensive sexual behavior history taking within and among sites, limited routine bacterial STI testing (once/year and if symptomatic) not in accordance with CDC recommendations, limited extragenital site gonorrhea/chlamydia testing, limited annual training on STI-related topics including LGBTQ health and adolescent/young adult sexual health, and limited efforts for making high-STI incidence individuals feel welcome in the clinic (primarily LGBTQ individuals and adolescents/young adults). These findings were used to identify interventions to be used to increase routine screenings and testing for bacterial STIs.
Highlights
Bacterial STIs continue to be a worsening public health concern in the United States (US)
The Clinical Team Member Interview and the 4 quantitative surveys were completed by each Change Champion, clinical prescriber, and clinical non-prescriber from each clinical demonstration sites (CDS)
There was a 100% response rate from 27 Change Champions, clinical prescribers, and/or clinical non-prescribers who completed the Clinical Team Member Process, Attitudes & Beliefs Survey and represented the 9 CDSs. This survey consisted of 5 components to include 1) sexual history taking, 2) STI testing, 3) STI treatment, 4) clinical barriers to STI testing and treatment, and 5) non-clinical barriers to STI testing and treatment
Summary
Bacterial STIs continue to be a worsening public health concern in the United States (US). Though the national incidence of HIV infection has decreased over recent years, this is not the case for common bacterial STIs (ie, chlamydia (CT), gonorrhea (GC), and syphilis) [1, 2]. Bacterial STIs have associated morbidities and mortalities [1] (eg, infertility, chronic inflammation and pain, congenital anomalies, neonatal death, and neurocognitive disease), increase the risk of HIV transmission from a non-virally suppressed person [3], and contribute to an everincreasing public health burden. Despite national recommendations on screening and treatment of STIs in people with HIV or at risk for HIV, disparities exist in the regular screening, treatment, and prevention of STIs among this population [5]. Addressing the many barriers across institutions, communities, providers, and patients associated with providing STI care in HIV care clinics is an integral step towards reducing STI incidence
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