Sexually Transmitted Infections Clinic Public Health/ CHSB Lilibeth Grandas x1211 Sharron Martin x1239 Program Purpose Program Information Reduce and prevent the incidence of sexually transmitted infections (STIs) and its negative consequences such as infertility and pregnancy complications Clinic services follow the Centers for Disease Control and Prevention (CDC) guidelines and the Virginia Department of Health (VDH) standards. The program provides services on a sliding scale fee basis. Clients with insurance are charged the full fee and given documentation they can submit to their insurance company for reimbursement. Services are available to all individuals over the age of 13 with no residency restrictions as follows: 1. Screening and diagnosing the following STIs: o Chlamydia o Yeast o Gonorrhea o Trichomoniasis o Syphilis o Genital Herpes o HIV o Genital Warts o Pelvic Inflammatory Disease o Pubic Lice o Bacterial Vaginosis (BV) Treatment: Treatment is offered to clients based on laboratory results, symptoms or exposure to a person with a confirmed STI diagnosis. The HD (Health Department) has access to the federal 340B Drug Pricing Program. This program provides access to a wide range of medications at a significantly reduced price. Clients found to have HIV are referred to an Infectious Disease Specialist in the area. 2. Education and risk reduction counseling: All clients receive education and risk reduction counseling, including how to appropriately use a condom. Patients diagnosed with an STI are educated on the importance of having sexual partner(s) tested and treated as soon as possible to prevent reinfection or further spread in the community. 4. Referrals to other resource providers are based on client s needs: Those at risk for hepatitis B are referred to Open Immunization Clinic (OIC) or other medical provider for hepatitis B vaccination Clients at risk for hepatitis C infection are referred for testing Family Planning services HIV Pre-exposure prophylaxis (PrEp) Sexual assault victims are referred to Doorways Teenagers are referred to the Teen Health Clinic for follow up In addition, program staff conduct community outreach to increase STI awareness and decrease stigma, especially about HIV. The Public Health Division, like other health care providers in Virginia, is mandated to report Chlamydia, Gonorrhea, and Syphilis and HIV cases to VDH. The STI clinic works closely with the Community Health Protection Bureau (CHPB) to ensure that reported cases, including clients that are difficult to find, Page 1
receive appropriate follow up to control and prevent the spread of STIs in our community. Funding for the STI program comes mainly from local and state funding through a cooperative agreement. HIV testing funding comes from CDC through VDH. An additional source of revenue originates from charging clients on a sliding fee scale. This new requirement was established by the Virginia Department of Health (VDH) in July 2017, Partners: CDC, Virginia Department of Health, NOVASalud, Inova Juniper Program, Doorways and Whitman Walker Clinic in Washington DC. PM1: How much did we do? Staff Total 1.7 FTEs: o 0.22 FTE Nursing Supervisor o 0.27 FTE Nurse Coordinator o 0.52 FTE Public Health Nurse o 0.47 FTE Clinic Aide o 0.25 FTE Clinician Customers and Service FY 2016 FY 2017 Clients 2,079 1,582* 854** Visits 2,275 1,793 1,233** Outreach: Communityrelated events providing information or testing 38 24 31 *The STI program previously ran a Monday afternoon and a Thursday evening clinic. The Monday clinic had low attendance rates historically and it was eliminated on November 2016. Clients who couldn t be seen in our clinic were referred to other jurisdictions to receive comparable services. **The number of clients decreased significantly when STD clinic started charging clients for services as mandated by VDH. As the number of clients decreased, so did the number of visits. PM2: How well did we do it? 2.1 STI client satisfaction 2.2 Clients with chlamydia, gonorrhea or syphilis who were notified and offered options for treatment within one week of laboratory results PM3: Is anyone better off? 3.1 Clients with chlamydia, gonorrhea or syphilis who returned for their 3 month re screen to ensure they were not re infected 3.2 Individuals diagnosed with HIV who saw an Infectious Diseases Specialist within 30 days of diagnosis per VDH standards Page 2
Percent of Clients Measure 2.1 STI client satisfaction 8 6 4 2 STI Clinic Client Satisfaction Survey 2% 2% 9% 9% 7% 7% 9% 9% 33% 33% 34% 34% 36% 36% Goal = 95% 58% 58% 57% 57% 55% 55% 71 Clients (projected) 71 Clients (projected) 71 Clients (projected) Overall Satisfaction How well did we explain things to you? How well did we use a language you easily understood and spoke? Wow Excellent Satisfactory Unsatisfactory In, a new client survey was implemented as part of the Customer Experience Initiative in public health. Components of customer experience are rated as unsatisfactory, satisfactory, excellent, or wow to match division expectations of delivering an excellent or wow experience to all customers. Survey conducted twice a year, capturing all clients served over a two-week period, using a paper survey in English and Spanish response rate was 75%. In, 91% of clients rated their overall customer experience with STI Clinic services as excellent or wow ; 91% rated how we explained things as excellent or wow ; and 91% rated we used a language that they understood and spoke as excellent or wow. Comments on surveys were overwhelmingly positive and focused on personal attention and good customer service. Stay the course : satisfaction will continue at about the same level Page 3
Measure 2.2 9 8 7 6 5 4 3 2 1 Clients with chlamydia, gonorrhea or syphilis who were notified and offered options for treatment within one week of laboratory results Clients with Chlamydia, Gonorrhea or Syphilis who were notified and offered options for treatment within one week of laboratory results 9% 9% 91% 91% 96 of 105 Clients Goal = 95% Projected STI Clients not notified within one week of lab results STI Clients notified within one week of lab results In, 91% of clients testing positive for chlamydia, gonorrhea, or syphilis were notified within one week of laboratory results. on client notification tracked in the STI database. collection began in. When positive laboratory results are received, clients are notified by telephone and offered treatment. If the client cannot be reached by telephone, a letter is sent to the address on file. The STI database is used to track the date of positive results, the date treatment was initiated, or date the letter was sent, if the client was unable to be reached by telephone. The nurses were unable to reach 9% of the clients within 7 days. Of those clients not contacted on time, 78% were contacted after 7 days. Stay the course For clients who are difficult to find, the Community Health Protection Bureau will deploy additional resources to locate clients to prevent an outbreak in the community. In, the percent of clients notified within one week of laboratory results will remain the same. Page 4
Measure 3.1 9 8 7 6 5 4 3 2 1 Clients with Chlamydia, Gonorrhea or Syphilis who returned for their 3 month re-screen to ensure they were not reinfected Clients with Chlamydia, Gonorrhea or Syphilis who returned for their 3 month re-screen 78% 78% 78% 78% 2% 5% 5% 5% 2 17% 17% 17% FY 2016 39 of 178 Returned FY 2017 41 of 184 Returned 24 of 109 Returned Goal = 5 projected Returned and Negative Upon Re-screen Did not return for Re-screen Returned and Positive Upon Re-screen In, 22% of clients testing positive for Chlamydia, Gonorrhea, or Syphilis returned to be re-screened for infections within 4 months, consistent with previous years. In, 5 clients were positive when they returned for re screening. on clients testing positive tracked in the STI database. on client visits tracked in WebVision. The CDC recommends that clients with STIs be re-screened in three months. STIs arise when safe sex practices are not adhered to. The purpose of re-screening is to detect reinfections, either from an untreated prior partner or from an infected new partner. The purpose of rescreening these clients who have demonstrated at risk behaviors is to reinforce the importance of engaging in safe sex practices to prevent infection and its adverse consequences, including infertility and STI spread. Literature shows that the single-dose treatment given under observation at the clinic is highly effective. For Chlamydia and Gonorrhea, CDC does not recommend testing to see if the treatment is effective. Re-screening is solely for the purposes of detecting if the client has been re-infected. For Syphilis, because of the potentially serious long-term health effects, Call clients close to the threemonth mark to schedule an appointment. Explore scheduling follow-up appointments at time of initial treatment. Work with public health nurses to ensure standardized ways of discussing the need to re-screen clients. Page 5
testing is done both to ensure the treatment was successful and to detect reinfection. Program staff compared clients that return for rescreening with clients that did not return and did not find any meaningful differences by demographic or diagnosis. Clients who did not return for re-screening may have been rescreened with a private provider or at another health department. The program only has data on clients who are re-screened at the STI clinic. The STI database was updated to create a tickler system for clients with positive results in the past 3 months that should return for re-screening. Monitor progress and evaluate the effectiveness of the system to remind clients about rescreening. In, the percent of clients testing positive for chlamydia, gonorrhea, or syphilis return to be re-screened will remain the same. Page 6
Measure 3.2 Individuals diagnosed with HIV who saw an Infectious Diseases Specialist within 30 days of diagnosis per VDH standards Individuals diagnosed with HIV who saw an Infectious Diseases Specialist within 30 days of diagnosis 14% Goal = 95% 5 86% FY 2016 6 of 7 FY 2017 2 of 2 Yes 1 of 1 No (proj) In, of individuals diagnosed with HIV saw an Infectious Disease Specialist within 30 days of diagnosis. from VDH 900 Test Form Part 2 and the HIV/STI database Includes only new, confirmed diagnoses of HIV that are followed by Arlington Public Health Division In, there were 821 HIV tests performed in clinic. Once a client tests positive for the HIV virus, it is important they start medical care and begin HIV treatment as soon as possible. Antiretroviral therapy (ART) is recommended for all people with HIV. Starting ART slows the progression of HIV and helps protect the infected person s immune system. ART can keep the infected person healthy for many years and greatly reduces the chance the patient transmits HIV to sex partners if medicines are taken consistently and correctly. Many people living with HIV who do not seek medical care eventually receive an AIDS diagnosis. This happens because, if left untreated, HIV will attach the immune system and allow different types of life-threatening infections and cancers to develop. While a cure for HIV does not exist, ART can dramatically prolong the lives of many people living with HIV and lower their chance of infecting others. In FY 2016, the client who did not see a specialist within the timeframe was referred, but decided to see a different provider. The client subsequently could not be located to determine if or when he or she saw a specialist. Stay the course In, the percent of clients diagnosed with HIV who saw an Infectious Diseases Specialist within 30 days of diagnosis will remain the same. Page 7