title: Improvement of Sexually Transmitted Disease Screening Among HIV-Infected Men Who Have Sex With Men Through Implementation of a Standardized Sexual Risk Assessment Tool.
abstract: BACKGROUND
  Screening for gonorrhea (GC) and chlamydia (CT) and syphilis among HIV-positive (HIV+) men who have sex with men (MSM) is recommended at least annually. However, significant gaps in screening coverage exist. We conducted a quality improvement intervention to determine whether informing providers of preintervention screening rates and routinizing sexual risk assessment would improve sexually transmitted disease (STD) screening in a large HIV care clinic.
  
  
  METHODS
  In partnership with Kaiser Permanente Northern California, we developed and implemented a 10-item assessment addressing sexual and other behavioral risk factors among HIV+ MSM. We analyzed the proportion of patients screened for GC/CT and syphilis in a preintervention period (June 25-September 26, 2012) and during the intervention period (June 25-September 26, 2013).
  
  
  RESULTS
  Of 364 HIV+ MSM seen for care during the intervention period, 47.3% completed the sexual risk assessment. Improvements in GC/CT screening and syphilis screening were observed; when comparing the preintervention period with the intervention period, the proportion of HIV+ MSM receiving GC/CT screening increased by 26.8% (31.6%-40.1%, P = 0.01) at any anatomical site and by 45% (19.5%-28.3%, P = 0.003) at the pharyngeal site. Syphilis screening significantly increased by 18.8% (48.7%-58.0%, P = 0.009).
  
  
  CONCLUSIONS
  Overall STD screening increases were observed after this intervention that included didactic training on the urgency of STD screening needs for HIV+ MSM, a presentation of preintervention clinic STD screening data, and the implementation of self-reported sexual risk assessment. Additional efforts are needed to determine feasible ways to accurately assess the appropriateness of STD screening and success of interventions to improve STD screening.
authors.affiliation: From the *California STD/HIV Prevention Training Center, University of California San Francisco, San Francisco, CA; †The Permanente Medical Group, Oakland, CA; ‡Kaiser Permanente Northern California Division of Research, Oakland, CA; and §Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Ashley P
authors.initials: AP
authors.lastname: Scarborough
authors.forename: Sally
authors.initials: S
authors.lastname: Slome
authors.forename: Leo B
authors.initials: LB
authors.lastname: Hurley
authors.forename: Ina U
authors.initials: IU
authors.lastname: Park
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000523:psychology / Q000635:transmission; D003430:Cross-Sectional Studies; D006069:Gonorrhea / Q000175:diagnosis* / Q000523:psychology / Q000635:transmission; D006679:HIV Seropositivity / Q000453:epidemiology / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration / Q000523:psychology; D010342:Patient Acceptance of Health Care; D018570:Risk Assessment; D012309:Risk-Taking; D012725:Sexual Behavior; D012747:Sexual Partners; D014481:United States / Q000453:epidemiology