Evidence-Based Interventions Implemented into HIV Primary Care Clinics to Make Sexually Transmitted Infection Screening and Testing Routine: Outcomes of a Multi-Site Study.

In response to rising rates of bacterial sexually transmitted infections (STIs) in the United States, this evaluative study of the implementation of four evidence-based interventions was developed and implemented. In three STI and HIV high-incidence jurisdictions of the United States, nine federally funded Health Resources and Services Administration Ryan White HIV/AIDS Program clinical demonstration sites implemented (1) audio computer-assisted self-interview sexual history taking, (2) patient self-collection of urogenital and extragenital site chlamydia/gonorrhea nucleic acid amplification test specimens, (3) sexual and gender minority welcoming indicators, and (4) provider training, to make STI screening, testing, and treatment routine in their HIV primary care clinics. The priority populations of young adults, men who have sex with men, and sexual and gender minority patients were found to have risk behaviors identified in the self-interview sexual history, to prefer to self-collect urogenital and extragenital site specimens for STI testing, and to notice and like the sexual and gender minority welcoming indicators. Testing positive for a bacterial STI was significantly associated with using alcohol or recreational drugs before sex, being younger than 50 years, and having two or more sexual partners with other concurrent sexual partners. Of 255 cases of chlamydia, gonorrhea, and syphilis infections, only 13.73% of patients reported related symptoms when screened and tested.

Automated Sexual History and Self-Collection of Extragenital Chlamydia and Gonorrhea Improve Detection of Bacterial Sexually Transmitted Infections in People with HIV.

With consistently rising rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) since 2014, the need for increased screening, testing, and treatment of bacterial sexually transmitted infections (STIs) in people at risk is clear. In this study, people with HIV were asked to complete a comprehensive audio computer-assisted self-interview sexual history at routine clinic-based laboratory visits every 3-6 months. The sexual health screening resulted in an automated summary of recommended bacterial STI tests. Self-collection of recommended extragenital CT/GC specimens was implemented to decrease the need for a provider to collect the specimen(s) and to give more control to the client. In total, extragenital CT/GC testing returned a 7.3% (n = 11) test positivity for CT and/or GC, with the highest test positivity of 14% (n = 7) among rectal swabs and 4% (n = 4) for pharyngeal swabs. Urogenital testing for combined CT/GC returned a 4.8% (n = 11) test positivity. All participants with extragenital CT/GC who underwent simultaneous urine testing returned discordant laboratory results, with urine collected at the same clinic visit resulting as negative. In addition, 7 of 11 (63.6%) of the positive extragenital GC/CT cases were asymptomatic. Therefore, extragenital site-specific testing was essential in appropriately diagnosing and treating CT and GC among participants. When extragenital STI testing was recommended, participants needing extragenital CT/GC specimens primarily chose self-collection after a brief demonstration. Error rates between self- versus provider-collected samples did not differ, and participants provided positive feedback on the intervention and self-collection process in satisfaction surveys taken at the end of each visit.

Differences in Selected HIV Care Continuum Outcomes Among People Residing in Rural, Urban, and Metropolitan Areas-28 US Jurisdictions.

PURPOSE: The HIV care continuum is used to monitor success in HIV diagnosis and treatment among persons living with HIV in the United States. Significant differences exist along the HIV care continuum between subpopulations of people living with HIV; however, differences that may exist between residents of rural and nonrural areas have not been reported. METHODS: We analyzed the Centers for Disease Control and Prevention's National HIV Surveillance System data on adults and adolescents (≥13 years) with HIV diagnosed in 28 jurisdictions with complete reporting of HIV-related lab results. Lab data were used to assess linkage to care (≥1 CD4 or viral load test ≤3 months of diagnosis), retention in care (≥2 CD4 and/or viral load tests ≥3 months apart), and viral suppression (viral load <200 copies/mL) among persons living with HIV. Residence at diagnosis was grouped into rural (<50,000 population), urban (50,000-499,999 population), and metropolitan (≥500,000 population) categories for statistical comparison. Prevalence ratios and 95% CI were calculated to assess significant differences in linkage, retention, and viral suppression. FINDINGS: Although greater linkage to care was found for rural residents (84.3%) compared to urban residents (83.3%) and metropolitan residents (81.9%), significantly lower levels of retention in care and viral suppression were found for residents of rural (46.2% and 50.0%, respectively) and urban (50.2% and 47.2%) areas compared to residents of metropolitan areas (54.5% and 50.8%). CONCLUSIONS: Interventions are needed to increase retention in care and viral suppression among people with HIV in nonmetropolitan areas of the United States.