Understanding the Impact of Mpox on Sexual Health Clinical Services: A National Knowledge, Attitudes, and Practices Survey-United States, 2022.

BACKGROUND: During the 2022 mpox outbreak, most cases were associated with sexual contact, and many people with mpox sought care from sexual health clinics and programs. The National Network of STD Clinical Prevention Training Centers, in partnership with the Centers for Disease Control and Prevention, conducted a survey of US sexual health clinics and programs to assess knowledge, practices, and experiences around mpox to inform a future public health response. METHODS: Between August 31 and September 13, 2022, the National Network of STD Clinical Prevention Training Centers facilitated a web-based survey. Descriptive statistics were generated in R. RESULTS: Among 168 responses by clinicians (n = 131, 78%) and program staff (n = 37, 22%), more than half (51%) reported at least somewhat significant mpox-related clinical disruptions including burdensome paperwork requirements for mpox testing (40%) and tecovirimat use (88%). Long clinic visits (51%) added additional burden, and the median mpox-related visit lasted 1 hour. Few clinicians felt comfortable with advanced pain management, and clinicians felt most uninformed about preexposure (19%) and postexposure (24%) prophylaxis. Of 89 respondents involved in vaccination, 61% reported using equity strategies; however, accounts of these strategies revealed a focus on guideline or risk factor-based screenings instead of equity activities. CONCLUSIONS: These findings highlight the substantial impact of the 2022 mpox outbreak on sexual health care in the United States. Critical gaps and barriers were identified that may inform additional mpox training and technical assistance, including challenges with testing, diagnosis, and management as well as a disconnect between programs' stated goal of equity and operationalization of strategies to achieve equity.

Characteristics of the Audience Reached by the National Network of Sexually Transmitted Disease Clinical Prevention Training Centers and Correlation With Sexually Transmitted Infection Rates, 2015 to 2020.

BACKGROUND: The National Network of Sexually Transmitted Disease Clinical Prevention Training Centers (NNPTC) trains clinical providers to diagnose and treat sexually transmitted infections (STIs) in the United States. The purpose of this study was to examine the demographics of clinical providers and to correlate the number of training episodes with STI rates at the county level. METHODS: Registration data were collected between April 1, 2015, and March 31, 2020, in a custom Learning Management System from clinical providers taking NNPTC training. Using the 2018 STI surveillance data, counties were divided into quartiles based on reportable STI case rates and the number of county-level training events was compared per quartile. Univariate and multivariate analyses were conducted in IBM SPSS Statistics 23 (Armonk, NY) and SAS Enterprise Guide 7.1 (Cary, NC). RESULTS: From 2015 to 2020, the NNPTC trained 21,327 individuals, predominantly in the nursing professions and working in a public health environment. In multivariate analysis, the number of training events was significantly associated with higher STI rates at the county level (P < 0.0001) and the state where a prevention training center is located (P < 0001). CONCLUSIONS: The analysis suggests that NNPTC trainings are reaching the clinical providers working in geographic areas with higher STI rates.

Sexual-risk and STI-testing behaviors of a national sample of non-students, two-year, and four-year college students.

OBJECTIVE: To determine whether sexual-risk and STI-testing behaviors differ by college student status. PARTICIPANTS: Sexually experienced 17- to 25-year-olds from a 2013 nationally representative panel survey that evaluated the "Get Yourself Tested" campaign. Non-students (n = 628), 2-yr (n = 319), and 4-yr college students (n = 587) were surveyed. METHODS: Bivariate analyses and multiple logistic regression were used. RESULTS: Students were less likely than non-students to have had an early sexual debut and to have not used condoms in their most recent relationship. 4-yr students were less likely than non-students to have had multiple sexual partners. 2-yr students were less likely than non-students to have not used contraception in their most recent relationship. CONCLUSIONS: 2-yr and 4-yr college students were less likely than non-students to engage in sexual-risk behaviors. Given potentially greater risk for STI acquisition among non-students, identification and implementation of strategies to increase sexual health education and services among this population is needed.

Sexual History Taking in Clinical Settings: A Narrative Review.

BACKGROUND: This study aimed to explore gaps between Centers for Disease Control and Prevention's clinical guidelines for obtaining a sexual history and regular clinical practice. We examine how patient, provider, and setting characteristics may influence the likelihood of obtaining comprehensive sexual histories and examine patient outcomes linked to sexual history taking. METHODS: We performed a narrative review to identify studies that examined clinical practice and sexual history taking via 8 databases. A 2-level inclusion protocol was followed, wherein the abstract and full text of the article were reviewed, respectively. Data were abstracted using a standardized tool developed for this study. RESULTS: The search yielded 2700 unique studies, of which 2193 were excluded in level 1, and 497 were excluded in level 2, leaving 10 studies for data abstraction. None of the studies reported comprehensive sexual history taking, and 8 studies reported differences in how providers obtain a sexual history when patient and provider demographics are considered. Three studies found a positive link between providers who discuss sexual history and provider sexually transmitted disease testing. CONCLUSIONS: When sexual histories are obtained, they are not comprehensive, and providers may discuss sexual history differentially based on patients' demographic characteristics. Providers who discuss patients' sexual history may be more likely to also provide sexual health preventive care.

Health Care Access and Service Use Among Behavioral Risk Factor Surveillance System Respondents Engaging in High-Risk Sexual Behaviors, 2016.

INTRODUCTION: Access to health care services such as screening, testing, and treatment of sexually transmitted diseases is vital for those who engage in high-risk behaviors. Studies examining the relationship between high-risk behaviors and health care access and utilization are crucial for determining whether persons at risk are receiving appropriate health services. METHODS: We examined 2016 data from the Behavioral Risk Factor Surveillance System. Our study population included persons aged 18 to 65 years. χ and logistic regression analyses were used to examine relationships between high-risk behaviors including drug use and high-risk sexual behaviors, and access to and utilization of health care services. RESULTS: Among our study population, 6.2% engaged in a high-risk behavior in the past year. Those engaging in high-risk behaviors were more likely to have no health insurance coverage (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.34), have no personal health care provider (OR, 1.14; 95% CI, 1.06-1.21), have foregone care because of cost (OR 1.54; 95% CI, 1.42-1.65), or have had no routine check-up in the past 2 years (OR 1.16; 95% CI, 1.09-1.25). CONCLUSIONS: Those who engaged in high-risk behaviors had poorer health care access and utilization outcomes. Future studies should incorporate the relationships between changes in behaviors, health care access and utilization, and resulting sexually transmitted disease morbidity.

Sexually Transmitted Disease, Human Immunodeficiency Virus, and Pregnancy Testing Behaviors Among Internet and Mobile Dating Application Users and Nonusers, 2016.

We examined 2016 United States market research to understand the demographics and sexual health testing behaviors of dating app users. Internet/app users were more likely to be young adults, male, nonwhite, of Hispanic ethnicity, and unmarried. Users also reported greater testing for sexually transmitted disease, human immunodeficiency virus, and pregnancy.

University efforts to address confidentiality issues for STI services.

Objective: This study assessed university policies for addressing confidentiality issues for students seeking STI services. Participants: Universities with sponsored health insurance plans (SHIP) and/or wellness centers were selected from a university health services survey in 2017. Methods: STI service coverage and polices for addressing confidentiality issues related to explanation of benefit (EOB) forms were stratified by institution type (4-year versus 2-year) and minority serving institution (MSI) status. Rao-Scott chi-square tests were used to assess for differences in STI service coverage and polices. Results: More non-MSIs (61.6%) had SHIPs compared to MSIs (40.0%, p < .001). Only 40.8% of health centers had a policy for addressing EOB-related confidently issues. Of those, the most reported policy was that students could pay out-of-pocket to avoid generating an EOB (36.2%). Conclusions: Reducing confidentiality barriers are important for STI prevention in students. Universities may consider establishing policies for addressing EOB-related confidentiality concerns.

Assessment of sexual health services at US colleges and universities, 2001 and 2014.

Background Approximately 19million students attend post-secondary institutions in the US. With rates of sexually transmitted infections (STIs) at unprecedented highs, the college and university setting can provide the opportunity to engage young adults in their sexual health and deliver recommended services. The purpose of this study was to compare the provision of sexual health services at US college and university health centres across studies conducted in 2001 and 2014. METHODS: We compared data from nationally representative surveys administered by the Centers for Disease Control and Prevention (2001, n=736 schools; 2014, n=482 schools), assessing the provision of services, including STI diagnosis and treatment, contraception, STI education, condom distribution and availability of health insurance. RESULTS: Compared with 2001, statistically significant increases were observed in 2014, including in the provision of contraceptive services (56.1% vs 65.0%), HIV testing (81.5% vs 92.3%) and gonorrhoea testing (90.7% vs 95.8%). Significant decreases were found in the number of schools offering health plans (65.5% vs 49.4%) and specific modes of offering STI education, such as health fairs (82.3% vs 69.9%) and orientation presentations (46.5% vs 29.8%; all P<0.001). CONCLUSIONS: From 2001 to 2014, there have been some improvements in sexual health services at colleges and universities, but there are areas that require additional access to services. Schools may consider regular assessments of service provision in order to further promote sexual health services on college campuses.

The Use of Technology for Sexually Transmitted Disease Partner Services in the United States: A Structured Review.

BACKGROUND: Since the late 1990s, health departments and sexually transmitted disease (STD) programs throughout the United States have used technologies, such as the Internet and mobile phones, to provide services to persons with a sexually transmitted infection, including human immunodeficiency virus (HIV), and their sex partners, also known as partner services. This study reviewed the published literature to assess and compare partner services outcomes as a result of using technology and to calculate cost savings through cases averted. METHODS: We conducted a structured literature review of all US studies that examined the use of technology to notify persons exposed to an STD (syphilis, chlamydia, gonorrhea), including HIV, by health care professionals in the United States from 2000 to 2017. Outcome measures, including the number of partners notified, screened or tested; and new positives identified, were captured and cost savings were calculated, when data were available. RESULTS: Seven studies were identified. Methods used for partner services differed across studies, although email was the primary mode in 6 (83%) of the 7 studies. Only 2 of the 7 studies compared use of technology for partner services to traditional partner services. Between 10% and 97% of partners were successfully notified of their exposure through the use of technology and between 34% and 81% were screened or tested. Five studies reported on new infections identified, which ranged from 3 to 19. Use of technology for partner serves saved programs between US $22,795 and US $45,362 in direct and indirect medical costs. CONCLUSIONS: Use of technology for partner services increased the number of partners notified, screened or tested, and new infections found. Importantly, the use of technology allowed programs to reach partners who otherwise would not have been notified of their exposure to an STD or HIV. Improved response times and time to treatment were also seen as was re-engagement into care for previous HIV positive patients. Data and outcome measures across the studies were not standardized, making it difficult to generalize conclusions. Although not a replacement for traditional partner services, the use of technology enhances partner service outcomes.

The state of sexual health services at U.S. Colleges and Universities.

OBJECTIVE: To describe the array of sexual health care services provided at US colleges and universities. PARTICIPANTS: During 2014-2015, 885 colleges were surveyed about their provision of sexual health services. METHODS: 55% of colleges responded. Data were weighted and stratified by minority-serving institutions (MSIs), 2-year and 4-year institutions. RESULTS: 70.6% of colleges reported having a health center (HC), of which 73.0% offered STI diagnosis/treatment (4 years vs. 2 years; 77.9% vs. 53.1%) and contraceptive services (70.1% vs. 46.4%), all p < .001. HCs less frequently offered LARC (19.7%), express STI testing (24.4%) and self-collection (31.4%). Condoms were available on 66.8% of campuses. HPV vaccination was available at more 4-year colleges (73.7% vs. 48.5%, p < .003) and non-MSIs (74.4% vs. 58.5, p = .019). Regarding MSM-targeted services, 54.6% offered pharyngeal and 51.8% rectal STI testing. CONCLUSIONS: 2-year colleges may require additional support with providing sexual health care. Improvements could entail increasing express testing, extra-genital STI testing, and LARC.