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

Oct 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

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

SSuN Operational Guidelines Questions or comments?

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

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 MSM Prevalence Monitoring Project – Brief History

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

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

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 MSM Prevalence Monitoring Project – Data Collection

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

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

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

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 MSM Project - Plan

 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 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 Data Elements – Proposed Core Variables

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?

Questions & Comments?

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

Monitoring HIV Testing – CDC Guidelines  CDC recommends routine screening all patients: 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

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

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?

Monitoring HIV Testing – Objectives 1.Measure percentage of patients screened for HIV at visits to STD clinic 2.Measure patients tested for HIV who receive test results??

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

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

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

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

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?

Questions & Comments?