Management of sexually transmitted infections in New York State health care organizations: who is thinking about the quality of STI care?

BACKGROUND: Rising rates of sexually transmitted infections (STIs) warrant a renewed focus on the management of STIs in health care organizations. The extent to which hospitals and community health centers (CHCs) have established processes and allocated staff for the management of STIs within their organizations remains poorly understood. METHODS: A New York State Department of Health survey was distributed electronically through a closed state communication network to targeted administrators at New York State hospitals and CHCs. The survey asked if STI management in their facilities included the following: the ability to measure and report rates of STIs, a process to assess the quality of STI care and treatment outcomes, and a centralized person/unit to coordinate its work throughout the facility. Multivariate analysis was performed to identify whether organizational characteristics were associated with survey findings. RESULTS: Ninety-five percent (243/256) of hospitals and CHCs responded to the survey. Fifty percent of respondents had a person or unit to report rates of STIs; 30% reported an organization-wide process for monitoring the quality of STI care, which, according to the multivariate analysis, was associated with CHCs; only 23% reported having a centralized person or unit for coordinating STI management. CONCLUSIONS: Most facilities report STI cases to comply with public health surveillance requirements but do not measure infection rates, assess the quality of STI care, or coordinate its work throughout the facility. The development of this organizational capacity would likely decrease STI rates, improve treatment outcomes, and address local public health goals.

Legislated human immunodeficiency virus testing in New York State Emergency Departments: reported experience from Emergency Department providers.

In 2010, New York (NY) passed new legislation mandating Emergency Departments (EDs) to offer HIV tests to patients 13-64 presenting for care. We evaluated the requirement's implementation and determined differences based on HIV prevalence or site-specific designated AIDS centers (DACs). We also evaluated policies for linkage to care of new HIV positive patients. An electronic survey on testing practices and linkage to care was administered to all NY EDs, excluding VA hospitals. Basic descriptive statistics were used for analysis. The response rate was 96% (184/191). All respondents knew of the legislation and 86% offered testing, but only 65% (159/184) to all patients required by the law. EDs in NYC, high prevalence areas, and DACs were more likely to offer HIV testing. Most facilities (104/159, 65%) used separate written consent despite elimination of this requirement. Most EDs (67%) used rapid testing: oral point-of-care ED testing and rapid laboratory testing. Only 61% of EDs provided results to patients while in the ED. Most (94%) had a linkage-to-care protocol. However, only 29% confirm linkage. We provide the first report of NY ED HIV testing practices since the mandatory testing law. Most EDs offer HIV testing but challenges still exist. Linkage-to-care plans are in place, but few EDs confirm it occurs.

Nonoccupational post-exposure prophylaxis for HIV in New York State Emergency Departments.

New York State (NYS) established guidelines for nonoccupational post-exposure prophylaxis (nPEP) to HIV in 1997. To assess current nPEP practices in NYS Emergency Departments (EDs), we electronically surveyed all ED directors in NYS, excluding Veterans' Affairs hospitals, about nPEP and linkage-to-care protocols in the EDs. Basic descriptive statistics were used for analysis. The response rate was 96% (184/191). Of respondents, 88% reported evaluating any patient with a possible nonoccupational exposure to HIV, in accordance with NYS guidelines. Of these, 83% provided the patient with a starter pack of medications, while 4% neither supplied nor prescribed antiretroviral drugs in the ED. Sexually transmitted infection screening, risk reduction counseling, and education about symptoms of acute HIV seroconversion were performed inconsistently, despite NYS guidelines recommendations. Only 22% of EDs confirmed whether linkage to follow-up care was successful. Most NYS EDs prescribe nPEP to appropriate patients but full implementation of guidelines remains incomplete.