SSuN: MSM prevalence monitoring and HIV Testing in STD Clinics

1. SSuN: MSM prevalence monitoring and HIV Testing in STD Clinics Kristen Mahle & Lori Newman SSuN Call #3 Oct 30, 2008

2. Oct. 30 - Call Agenda • Conference Call Schedule • Comments/questions re: SSuN Operational Guidelines • Activity #2: MSM prevalence monitoring in STD clinics • Activity #3: HIV testing coverage in STD clinics

3. Conference Call Schedule • Nov. 6th: Diagnostic coding & other core STD clinic data element revisions • Nov. 13th: Population level GC surveillance • Nov. 20th: Trich resistance monitoring – laboratory component • Nov. 27th: Thanksgiving

4. SSuN Operational Guidelines Questions or comments?

5. Core STD clinic data collection Activity #2: MSM prevalence monitoring in STD clinics

6. MSM Prevalence Monitoring Project – Brief History • Sexual behavior data usually not available • Implemented in 1999 in state and local health departments and community clinics • Integrated surveillance funding from National Center for HIV, STD, and TB Prevention • Unfunded since 2004 • 8/10 project areas currently participating

7. MSM Prevalence Monitoring Project Key Collaborators . Washington (Seattle) . . . . Mass (Boston) . . . New York City Philadelphia Chicago . Washington D.C. San Francisco Colorado (Denver) . California (Long Beach) Texas (Houston) SSuN Cycle 2 Sites

8. MSM Prevalence Monitoring Project – Objectives • Objectives: • Assess prevalence of and trends in STDs, HIV, and risk behaviors among MSM • Enhance prevention and control efforts for MSM

9. MSM Prevalence Monitoring Project – Data Collection • STD, HIV and behavioral risk data collected on MSM seeking care in a variety of facilities • Data obtained during routine clinical care • medical history, physical exam, laboratory test results • Unit of analysis: clinic visit • Data sent to CDC on a quarterly basis

10. Test positivity for gonorrhea, chlamydia, HIV, and syphilis seroreactivity among MSM, by race/ethnicity, STD clinics, 2007 * Excludes persons known to be HIV positive † Seroreactivity

11. Test positivity for gonorrhea, chlamydia, and syphilis seroreactivity among MSM, by HIV status, STD clinics, 2007 *Seroreactivity

12. MSM Project - Limitations • Lack of data standardization and completeness • Duplication of efforts and resources • Data limited to MSM • No comparison population • Data collected at the visit-level

13. MSM Project - Plan • Integrate as SSuN Cycle 2 activity • Unit of analysis: visit person-event • Current MSM Prevalence Monitoring sites: • Continue to transmit data per current protocols until SSuN Cycle 2 guidelines are finalized • Revisit objectives, data management, analysis, and dissemination plans • Develop/update data dictionary • Merge SSuN Cycle 1 and MSM data elements • Identify elements to keep, add, or remove for core dataset

14. Data Elements – Proposed Core Variables • Age, race/ethnicity, sex, sex of sex partners • GC, CT, syphilis test • GC, CT, and syphilis test result • HIV test • HIV test result • Other diagnoses (e.g., GW, proctitis) • Consider: • GC, CT, and syphilis test types • GC and CT infection by anatomic site • HIV rapid test? • Self-reported HIV status • Symptoms • Exam findings

15. Data Elements – Proposed Core Variables • Consider: • number of sex partners • type of sex (oral/anal/vaginal) • condom use • anonymous sex • visits to a sex club and/or bathhouse • drug use

16. MSM Prevalence Monitoring - Discussion Topics • Keep the same objectives? • What variables should be included in the core dataset? • Do we still want to collect condom data? • Move to one time frame for drug and sex questions for all activities?

17. Questions & Comments?

18. Core STD clinic data collection Activity #3: HIV testing coverage in STD clinics

19. Monitoring HIV Testing – CDC Guidelines • CDC recommends routine screening all patients: • 13-64 years old • Regardless of risk • All health care settings where prevalence > 0.1% • Targeted testing based on risk in settings with < 0.1% prevalence • Repeat screening: • Test patients with known risk at least annually: • IDU, exchange of sex for money/drugs, sex partners of HIV+ persons, MSM, heterosexuals who have not been monogamous since their most recent HIV test

20. Monitoring HIV Testing - Background • Estimated 25% of persons with HIV in U.S. do not know they are infected • Fail to receive effective therapy • Unknowingly transmit HIV • Persons who know they are infected are more likely to alter behavior to prevent transmission to others • Prevention goal: assure HIV+ persons know about their status as soon as possible following HIV acquisition • Conventional HIV serological tests can take days to weeks for results • Up to 1/3 of patients never return for test results

21. HIV Screening in STD Clinics • STD clinics serve high risk populations that should be screened for HIV • How can we improve HIV screening in STD clinics? • Collect data to determine proportion being screened and frequency of screening • Does use of rapid HIV testing affect the proportion of patients who receive their results?

22. Monitoring HIV Testing – Objectives • Measure percentage of patients screened for HIV at visits to STD clinic • Measure patients tested for HIV who receive test results??

23. Monitoring HIV Testing - Methodology • Objective # 1: • Numerator = No. of patients presenting at an STD clinic who are screened for HIV • Denominator = Total no. of patients presenting at STD clinics

24. Monitoring HIV Testing - Methodology • Objective # 2: • Numerator = No. of patients tested for HIV who receive their results • Denominator = No. of patients tested for HIV at STD clinics

25. Monitoring HIV Testing – Proposed Core Variables • Age, race/ethnicity, sex, sex of sex partners • HIV test • HIV test result • Consider: • Ever been HIV tested? • Date of last HIV test? • Last HIV test result? • Self-report, provider-report • Rapid test done? • Currently receiving HIV care? • Patient receipt of results

26. Monitoring HIV Testing – Proposed Core Variables • Consider: • Reason for visit • Education & employment • Age at first sex • Anonymous sex & internet • Exchange of sex, incarceration, drug use

27. Monitoring HIV Testing - Discussion Topics • HIV Testing - objectives • Should we expand the scope? • Can clinics monitor who receives test results? • HIV Testing - methodology • Do clinics test if a patient reports that he/she is HIV positive? • What is our denominator? • new visits, 1-yr period?, etc. • HIV Testing - data elements • What are the “core” data elements?

28. Questions & Comments?