Meighan Rogers

Reaching out to boys at bars: utilizing community partnerships to employ a wellness strategy for syphilis control among men who have sex with men in New York City.

Objective: To explore the impact of a holistic approach for syphilis control to improve the sexual health and well-being of men who have sex with men (MSM). Goal: The New York City Department of Health & Mental Hygiene (NYC DOHMH) developed Hot Shot! to address a variety of general MSM health issues, including syphilis, gonorrhea, chlamydia, and human immunodeficiency virus (HIV)/acquired immunodeficiency virus. Results: Between November 2003 and June 2004, 9 Hot Shot! events were held throughout NYC. Services delivered at events included STD/HIV screening; relevant adult vaccinations, cardiovascular health screenings; and mental health, tobacco, and other drug use assistance. Of 1634 attendees, 445 persons accessed ≥1 service; 4 persons were newly diagnosed with syphilis and 7 with HIV. Conclusions: The Hot Shot! approach to syphilis control can facilitate STD education, screening, and treatment of MSM while addressing comprehensive health issues. Future integrated health service delivery programs may be more successful by using stable venues for events to ensure continuity of care for MSM.

Patient-Delivered Partner Treatment and Other Partner Management Strategies for Sexually Transmitted Diseases Used by New York City Healthcare Providers

Objectives: The objectives of this study were to measure frequency and predictors of patient-delivered partner treatment (PDPT) and the frequency of other partner management strategies among New York City healthcare providers (HCPs) as well as to determine whether use of PDPT detracts from other partner management strategies. Study Design: The authors conducted a cross-sectional survey of New York City HCPs. Results: Frequent patient referral was reported by 93.6% (368 of 393) of healthcare providers; only 20% (80 of 401) reported frequent use of provider referral. Overall, 49.2% (196 of 398) of HCPs reported ever using PDPT and 27.1% (108 of 398) reported using PDPT frequently. HCP specialty, practice setting, duration of practice, report of frequent provider referral practice, and HCP race/ethnicity were the strongest predictors of PDPT use. HCPs reporting PDPT use were more likely to report frequent provider referral than those who had never used PDPT (26.7% vs. 12.6%; P <0.001). Conclusions: PDPT use is common and is being used in conjunction with other partner management strategies.

Patterns of Chlamydia/Gonorrhea Positivity Among Voluntarily Screened New York City Public High School Students

PURPOSE Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are common sexually transmitted infections that disproportionately affect adolescents. Annual screening for CT for sexually active female adolescents is recommended. In 2006, New York City began conducting CT/GC education, screening, and treatment in public high schools. We examine 3-year programmatic outcomes and the relationship between sexual activity, screening, and CT/GC positivity. METHODS We describe the epidemiology of students who screened and those infected with CT/GC. Univariate, bivariate, and multivariate logistic regression analyses were performed to assess relationships between sex, race/ethnicity, age, sexual activity, and screening status; and the relationship between sexually transmitted infection positivity and sexual activity. RESULTS Between July 2006 and June 2009, we educated 57,418 students and screened 27,353 (47.6%) for CT/GC; 1,736 (6.3%) students were reported to be infected with either organism. Students who screened positive were more likely to be females (8.9%), report black race (8.3%) and be ≥16 years of age (6.6%-9.7%). Screening rates were 70.6% for students who were sexually active, 27.9% for those who had never had sex, and 47.3% for those who did not respond to the sexual activity question; CT/GC positivity was 7.2%, 1.4%, and 6.1%, respectively. CONCLUSIONS Black, older adolescent females were most likely to screen positive for CT/GC in this population. A large proportion of students who did not answer the sexual activity question chose to screen for CT/GC and screened positive. School screening programs should offer screening to all students regardless of reported sexual activity. Programs should target females and older adolescents.

Integrating intervention for substance use disorder in a healthcare setting: practice and outcomes in New York City STD clinics

ABSTRACT Objective: This article reports the integration and outcomes of implementing intervention services for substance use disorder (SUD) in three New York City public sexually transmitted disease (STD) clinics. Methods: The screening, brief intervention, and referral to treatment (SBIRT) service model was implemented in the STD clinics in 2008. A relational database was developed, which included screening results, service dispositions, face-to-face interviews with 6-month follow-ups, and treatment information. Results: From February 2008 to the end of September 2012, 146 657 STD clinic patients 18 years or older were screened for current or past substance use disorders; 15 687 received a brief intervention; 954 received referrals to formal substance abuse treatment; 2082 were referred to substance abuse support services such as Alcoholics Anonymous (AA), and 690 were referred to mental health, social or HIV awareness services. Intervention services delivered through SBIRT resulted in improvements in multiple outcomes at 6 month follow-up. Patients who received interventions had reduced SUD risks, fewer mental health problems, and fewer unprotected sexual contacts. Conclusion: Delivery of SUD services in a public health setting represents a significant policy and practice change and benefits many individuals whose SUDs might otherwise be overlooked. Intervention services for substance use disorder were integrated and highly utilized in the STD setting. Further research needs to focus on the long-term impact of SUD interventions in the STD setting, their cost effectiveness, and the extent they are financially sustainable under the new healthcare law.

Expedited partner therapy in federally qualified health centers--New York City, 2012.

Background Management of patients’ sex partners is a critical element of sexually transmitted disease (STD) control. Expedited partner therapy (EPT), a practice in which patients deliver medication or a prescription directly to their partners, is one option for partner management. As of 2009, New York State law specifically allows EPT for chlamydial infection. Federally qualified health centers (FQHCs) in New York City (NYC) care for patients at risk for STDs. We describe the policies and practices surrounding EPT and other STD management in NYC FQHCs. Methods In 2012, we surveyed medical directors at all NYC FQHC parent entities and clinicians at a sample of their corresponding clinical sites about written policies and actual practices regarding EPT for chlamydial infection and other STD management. Results Twenty-two entities (22/29; 76%) and 51 sites (51/72; 70%) responded to the survey. More than half of entities have a written policy permitting EPT, and 80% of sites provide EPT. Most entity policies allow EPT for, and most sites provide EPT to, adolescents and adults with both opposite-sex and/or same-sex partners. Most sites use electronic health records and provide EPT by prescriptions, and one third of sites do not provide educational materials with EPT. Conclusions Our results indicate widespread EPT provision by NYC FQHCs; however, areas for improvement exist, specifically in following guidelines that recommend providing educational materials with EPT and do not recommend EPT for men with male partners. The use of prescriptions for EPT and electronic health records were identified as potential barriers to EPT provision.

Impact of a Brief Intervention for Substance Use on Acquisition of Sexually Transmitted Diseases Including HIV: Findings From an Urban Sexually Transmitted Disease Clinic Population.

Background Unhealthy substance use is associated with increased rates of sexually transmitted diseases (STDs), including HIV. The screening, brief intervention, and referral to treatment strategy is effective at reducing substance use over time. We investigated whether STD clinic patients who received a brief intervention (BI) had lower rates of STD/HIV acquisition over time than those who did not. Methods A retrospective sample of 7665 patients who screened positive for substance abuse or dependence between May 1, 2008, and December 31, 2010, was matched with STD and HIV surveillance registries for a 1-year follow-up period to determine incidence of STD and HIV infection. Results Overall, 44.6% (n = 3420) received BI; 7.0% of this population acquired a bacterial STD compared with 8.8% of persons who did not receive BI (P < 0.005). In multivariate analysis, BI had a protective effect against STD infection for men (odds ratio, 0.774; 95% confidence interval [CI], 0.63–0.96), after controlling for age, race/ethnicity, and sex of partner. There were 61 new HIV infections over the follow-up period; however, we found no significant association between BI and subsequent HIV diagnosis. Conclusions Brief intervention is associated with a reduction in STD incidence among men who screen positive for substance abuse and should be considered as an STD prevention strategy. Further study is needed to identify mechanisms through which BI may impact STD outcomes.

Hepatitis Vaccination and Infection Among Gay, Bisexual, and Other Men Who Have Sex With Men Who Attend Gyms in New York City

The authors examined hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination rates, hepatitis infection, and health care access in a gym-attending sample of 311 gay, bisexual, and other men who have sex with men (MSM) in New York City. Overall, 69% reported having been vaccinated for HAV and 70% reported having been vaccinated for HBV. Multivariate models were used to identify predictors of HAV and HBV vaccination, and younger men, HIV-positive men, and men who had access to a doctor or clinic were more likely to be vaccinated than older men, HIVnegative men, and men without access to a doctor or clinic. Men with health insurance coverage were more likely to have received HBV vaccination than men without coverage. Findings indicate that there is still a significant proportion of unvaccinated men in our sample.

The Impact of Prescriptions on Sex Partner Treatment Using Expedited Partner Therapy for Chlamydia trachomatis Infection, New York City, 2014-2015.

Background Chlamydia trachomatis reinfections, often resulting from resuming sex with untreated partners, can increase the risk of pelvic inflammatory disease, infertility, and ectopic pregnancy. Expedited partner therapy (EPT) has been shown to prevent reinfection when provided as medication (Medication-EPT) that patients give to sex partners; however, EPT is often provided as a prescription (Prescription-EPT). We compared partner treatment outcomes for Medication-EPT versus Prescription-EPT. Methods We conducted telephone interviews from October 2014 to October 2015 with a population-based random sample of women aged 15 to 25 years diagnosed with Chlamydia trachomatis. Interview questions included: demographics, patient-treatment, EPT type, and patient report of partner treatment. The main outcomes explored were: proportion of women receiving EPT, proportion of Prescription-EPT and Medication-EPT, and proportion of partners reported as treated. We used &khgr;2 and Fisher exact tests for analysis. Results A total of 421 women completed the interview; 357 (84.8%) of 421 women reported having been treated, and 109/357 (30.5%) received EPT for any partner. Women given a prescription (vs medication) for their own treatment were more likely to receive EPT (odds ratio, 1.57; P = 0.05) and to receive Prescription-EPT specifically (odds ratio, 6.85; P < 0.0001). Forty-eight (52.2%) of 92 patients who received EPT for their most recent partner received Prescription-EPT. There was no difference by EPT type in proportion of index patients reporting partner treatment: 77.1% (37/48) for Prescription-EPT versus 79.5% (35/44) for Medication-EPT (P > 0.05). Conclusions Prescription-EPT and Medication-EPT appear to result in comparable rates of partner treatment. Further research is needed to assess the effects of Prescription-EPT on partner treatment among adolescents and in other contexts.

Sentinel Surveillance for Expedited Partner Therapy Prescriptions Using Pharmacy Data, in 2 New York City Neighborhoods, 2015

Background Expedited partner therapy (EPT) for Chlamydia trachomatis (Ct) is the practice of providing Ct-infected patients with medication, or prescription (prescription-EPT) to deliver to their sex partners without first examining those partners. New York City (NYC) providers commonly use prescription-EPT, yet NYC pharmacists report only occasional receipt of EPT prescriptions. This project assessed the frequency of EPT prescriptions filled in 2 NYC neighborhoods. Methods The 2 NYC facilities reporting the most frequent use of prescription-EPT were identified from Ct provider case reports and contacted to ascertain their EPT practices. Providers at the first facility (facility 1) prescribed two 1-g doses of azithromycin, including sex partner treatment on the index patients electronic prescription. Providers at the second facility (facility 2) gave patients paper prescriptions for sex partners. We reviewed prescriptions filled in 2015 for azithromycin, 1 or 2 g at pharmacies near these facilities; prescriptions indicating partner therapy were classified “EPT prescriptions”. Results Facility 1 providers submitted 112 Ct case reports indicating prescription-EPT, compared with 114 submitted by facility 2 providers. Twelve of 26 identified pharmacies agreed to participate. At 7 pharmacies near facility 1, we found 61 EPT prescriptions from facility 1 and 37 from other facilities. At 5 pharmacies near facility 2, we found only 1 EPT prescription from facility 2 and 3 from other facilities. Conclusions Expedited partner therapy prescriptions were received in NYC pharmacies near to EPT-prescribing facilities, but with great variability and at a lower frequency than suggested by provider case reports. Provider EPT prescribing practices may impact the likelihood that partners receive medication and should be further evaluated.

Optimizing the impact of alcohol and drug screening and early intervention in a high-risk population receiving services in New York City sexual health clinics: A process and outcome evaluation of Project Renew

Unhealthy substance use is associated with increased rates of STDs, including HIV. Within three high-risk New York City (NYC) sexual health clinics between 2008 and 2012 (n = 146,657), 17% of patients screened positive for a current SUD but only 5.3% ever received prior treatment. The goal of Project Renew was to expand the reach of substance use early intervention services within and across sexual health clinics citywide and decrease substance use, poor mental health, and risky sexual behavior. To accomplish this goal, Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence-based substance use early intervention model, was implemented in all eight NYC sexual health clinics February 2012-January 2015. Clinic patients were screened for substance misuse using the AUDIT/DAST-10, and those who screened positive were eligible for on-site brief intervention. Overall, 130,597 substance misuse screenings were conducted (66,989, or 51%, positive), and 17,474 on-site brief interventions and 1238 referrals were provided (not unique to individual patients). A 10% sample of 14,709 unique patients who screened positive were interviewed using a federal data collection tool at baseline and six months later to assess changes in substance use, sexual risk behaviors, mental health, and health status (n = 1328). At six-month follow-up, patients reported reduced substance use, less sexual activity, improved overall health, and fewer days of depression and anxiety compared to measures at baseline (p < 0.05). Based on positive results, Project Renew SBIRT services have been sustained, ensuring essential care which may help prevent acquisition of HIV/STDs among a large population of high-risk New Yorkers.