Introduction of an Online Emergency Contraception Prescription Service in San Francisco Susan S. Philip 1, Katherine Ahrens 1, Jacqueline Moro 2, Deb Levine 3, Kyle T. Bernstein 1, and Jeffrey D. Klausner 1 1 STD Prevention and Control Services, San Francisco Department of Public Health 2 University of California, San Francisco 3 Internet Sexuality Information Services, Inc.

Background 2002 California law allows trained pharmacists to counsel and dispense Emergency Contraception (EC) without a prescription –No age restrictions for females –Counseling fees may apply August 2006, the FDA approved EC as an OTC product for those ≥18 Online EC Service developed to provide convenient, ready access to EC for women in San Francisco

Online Emergency Contraception Initiated 2006 from the San Francisco City Clinic website: Asked to certify age ≥18, then can print or fax prescription to a local pharmacy Autofax confirmation to STD Section began in February 2007

Objectives 1.Describe use of the online prescription service by women in San Francisco 2.Evaluate association with STD clinic visits 3.Evaluate association with STD morbidity

105 prescriptions 83 evaluable 76 unique persons Missing name, duplicate name+DOB+date Repeat users: 1 x 2 dates 1 x 3 dates 1 x 5 dates February – October 2007

Birthdates available84% (64/76) Average age22 Linked to SF STD clinic database21% (16/76) Total # STD Clinic visits49 Visits before first online EC script use37 Visits after first online EC script use12 1 st visit after using online EC prescription31% (5/16) Positive chlamydia or gonorrhea test19% (3/16) Of the 76 Unique Users Feb-Oct 2007:

Limitations Cannot easily verify autofax data Women may access care at outside clinics Did not have information about how users arrived to site, ease of use or reason for use

Conclusions Novel online EC service has been regularly used For some women, may serve as initial connection to further STD or reproductive health services Of women matched to services, there was STD morbidity

Next Steps Develop systems to use “moment of opportunity” with EC to further reinforce sexual health and STD screening in young women Advocacy for decreased cost of EC

Acknowledgements San Francisco City Clinic staff Caryn Graves, Internet Sexuality Information Services, Inc.

Online Emergency Contraception Volume: February - September 2007 Feb March April May June July August September 9 faxes/month 12 faxes/month