1. Using Texting for STD Prevention

2. Potential Uses I.Information Campaign II.Helping DIS locate partners III.Appointment Reminders

3. Background 1995 Average of 0.4 texts per month 2000 Average of 35 texts per month 2007 More texts than phone calls 2011 Average of 357 texts per month http://www.tatango.com/blog/history-of-text-messaging-timeline-wide/

4. Information Campaign o Target audience signs up for information about topic using “short code”. o A short code is a short telephone number, often used for short message service (SMS) or text messaging.

5. Short Codes Shared Shared short codes: use keywords to identify their incoming messages from each other. For example, pay to use short code “55555”. For a minimal fee, assign a “keyword” to this number (e.g., “Chlamydia”, “Safersex”, etc). Disadvantage: same number with the keyword “Burgers” get you coupon from local diner. Dedicated o Exclusive use of the short code o Can assign whatever key words you want o Disadvantage: more expensive

6. Bulk Messaging/Alerts o Encourage people to sign up to receive regular text messages with news, healthy tips, etc. When a client texts "QUITNOW" to 22122, they receive a text message response stating that a quit coach will call them within one business day. Example, New Hampshire Tobacco Helpline: Image: NCI’s Smokefree TXT Program

7. Example: New Hampshire Tobacco Helpline Text Messaging Initiative o Within this platform, messages are customized based on a client’s stage of change (e.g., thinking about quitting, want to set a quit date, already quit) and type of tobacco use. o Each client can potentially receive up to 90 text messages to assist him/her throughout the quitting process. Image: Text2Stop Program Message

8. Example Vendors Mobile Commons http://www.mobilecommons.com sumotext http://www.sumotext.com 2ergo http://www.2ergo.com/us/ We are not endorsing any vendors.

9. Using SMS for DIS Multnomah County, Oregon wrote SMS Protocol for DIS in 2010: o Already doing online partner notification (2006); easy transition to mimic the same system. o Had established track record of providing confidential services via email. o HIPAA officer wrote procedure. o Procedures do not require opt-in when used for partner notification. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0CHMQFjAE&url=http%3A%2F%2Fsextech.org%2Fsites%2Fdefau lt%2Ffiles%2Fpresentations%2F2012%2FDiaz_Edwin_THE_CUTTING_EDGE_OF_STD_TESTING_TREATMENT_AND_PARTNER_NOTIFICATION.ppt &ei=BEC8T4buJu-e6wG84MRf&usg=AFQjCNHdg5R-W-m7Mf3CflTwr02IqEVwJg

10. 5 TH Annual ISIS CONFERENCE ON NEW MEDIA, YOUTH & SEXUAL HEALTH April 1 st - 3 rd, 2012 San Francisco, CA The Procedures

11. 5 TH Annual ISIS CONFERENCE ON NEW MEDIA, YOUTH & SEXUAL HEALTH April 1 st - 3 rd, 2012 San Francisco, CA The Procedures, Continued. o Text messaging are not secure! o Subject to public records retention laws! o Phone Call first! o The purpose of sending a text message is to engage the individual in a voice call or face-to-face conversation. o Protected health information (PHI) must never be sent via text messaging.

12. 5 TH Annual ISIS CONFERENCE ON NEW MEDIA, YOUTH & SEXUAL HEALTH April 1 st - 3 rd, 2012 San Francisco, CA Comparison: 01/01-3/26 CasesTexted24811% 54% 20112012 27929% 78% Responded

13. Appointment Reminders o Clients give permission to use cell phone number o Automatic texts from EMR to remind clients of appointments

14. Do Text Messages for Appointment Reminders Work? o Acceptability of test message reminders has been specifically demonstrated in the sexual health context. o 2009 Study in Family Planning Clinics in Maine found that text messaging the least preferred and least efficacious method compared to phone and letters. Kegg S, Natha M, Lau R. Communication with patients: Are e-mail and text messaging the answer? Int J STD AIDS 2004;15(46).

15. Maine Study o For scheduling rescreening appointment, reminder methods offered were text messaging, phone, mail or no contact for confidential clients. o Family planning staff explained that a generic message “To Your Health” would be sent and the client was instructed to call the clinic for an appointment. o Not possible for the client to text back to schedule an appointment. o HIPAA laws and confidentiality concerns prohibited offering an appointment via text messaging.

16. Results of Maine Study 188 Positive Test March 2009 – October 2009 Contact option OptionAppointment scheduled Appointment kept Phone44%20%94% Mail30%10%94% Text21%15%33%

17. STD Clinic in Peoria County, IL Peoria City/County Health Department STD Clinic, 2010 o Text messaging among the target population (male/female 25 and younger) is accepted communication practice. o Majority preferred text messaging to phone calls -confirmed by survey of clients. o Among those clients proactively treated and who opted for text message, 40% of them called the clinic to confirm their result compared to 15% of clients who chose to call the clinic. http://www.naccho.org/topics/modelpractices/database/practice.cfm?practiceID=731

18. Comparison of time to treatment before/after texting implemented Treated for GC within 14 Days 20082009 76% Treated for CT within 14 Days 74%81% 87% http://www.naccho.org/topics/modelpractices/database/practice.cfm?practiceID=731

19. Thank You.