Successful Provision of Long-Acting Reversible Contraception in a Sexual Health Clinic.

BACKGROUND: Women who attend sexual health clinics are at high risk for sexually transmitted infections and unintended pregnancy. Long-acting reversible contraceptives (LARC) are very effective contraceptive methods, but the provision of LARC in such clinics is not well described in the literature. METHODS: We conducted a retrospective chart review of women who presented to Denver Sexual Health Clinic for any reason and received family planning services between April 1, 2016, and October 31, 2018. We assessed demographic and clinical factors associated with contraceptive method received and conducted a subanalysis of those with intrauterine device (IUD) insertions on the same-day versus delayed insertion. Among those who received an IUD, we assessed rates of pelvic inflammatory disease (PID) 30 days after insertion. RESULTS: Of the 5064 women who received family planning services in our clinic, 1167 (23%) were using a LARC method at the time of their visit. Of the 3897 who were not using a LARC, fewer women, 12.6%, chose LARC (IUD and progestin implant), compared with 33.3% who chose new short-acting reversible contraceptives. Further analysis of the 270 IUD initiators revealed 202 (74.8%) received the IUD on the same day, whereas 68 (25.2%) had delayed IUD insertion. There were 9 incident cases of gonorrhea or chlamydia in those who received same-day IUD and 1 incident case among those who had delayed IUD insertion. There were no cases of PID at 30 days after insertion in either group. CONCLUSIONS: Study findings support IUD provision in a sexual health clinic on the day of initial visit without increased risk of PID.

Prevalence of high-risk HPV types and abnormal cervical cytology in American Indian/Alaska Native women, 2003-2005.

UNLABELLED: OBJECTIVES; We described prevalence estimates of high-risk human papillomavirus (HR-HPV), HPV types 16 and 18, and abnormal Papanicolaou (Pap) smear tests among American Indian/Alaska Native (AI/AN) women compared with women of other races/ethnicities. METHODS: A total of 9,706 women presenting for cervical screening in a sentinel network of 26 clinics (sexually transmitted disease, family planning, and primary care) received Pap smears and HR-HPV type-specific testing. We compared characteristics of 291 women self-identified as AI/AN with other racial/ethnic minority groups. RESULTS: In our population, AI/AN and non-Hispanic white (NHW) women had similar age- and clinic-adjusted prevalences of HR-HPV (29.1%, 95% confidence interval [CI] 23.9, 34.3 for AI/AN women vs. 25.8%, 95% CI 24.4, 27.2 for NHW women), HPV 16 and 18 (6.7%, 95% CI 3.9, 9.6 for AI/AN women vs. 8.8%, 95% CI 7.9, 9.7 for NHW women), and abnormal Pap smear test results (16%, 95% CI 11.7, 20.3 for AI/AN women vs. 14.9%, 95% CI 13.7, 16.0 for NHW women). AI/AN women had a higher prevalence of HR-HPV than Hispanic women, and a similar prevalence of HPV 16 and 18 as compared with Hispanic and African American women. CONCLUSIONS: We could not demonstrate differences in the prevalence of HR-HPV, HPV 16 and 18, or abnormal Pap smear test results between AI/AN and NHW women. This finding should improve confidence in the benefit of HPV vaccine and Pap smear screening in the AI/AN population as an effective strategy to reduce rates of cervical cancer.

Trends in clinic visits and diagnosed Chlamydia trachomatis and Neisseria gonorrhoeae infections after the introduction of a copayment in a sexually transmitted infection clinic.

BACKGROUND: To meet their sexually transmitted infection (STI) control mission, STI clinics most often offer services at no or minimal cost to clients. However, there is little knowledge about the effects of charging service fees on clinic attendance and STI identification. As a result of budget shortfalls, a clinic fee of 15 US dollars for Denver residents (up to 65 US dollars for nonresidents) was introduced in the Denver Metro Health (STI) Clinic (DMHC) in December 2002. We evaluated the effects of the fee on clinic utilization and diagnosed Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections. METHODS: Using the DMHC computerized medical record system, we compared clinic visits and CT/GC diagnoses between the first 3 quarters of 2002 and 2003. We also compared CT/GC cases reported by DMHC with those reported by other Denver providers during 2002 and 2003. RESULTS: Compared with 2002, there were 3250 fewer visits (-28.5%) to DMHC in 2003 with no variance across quarters. CT diagnoses declined by 427 cases (-28.1%), disproportionately affecting women (-40%) and those under 20 (-42%). In addition, there were 332 fewer GC diagnoses (-38.1%) with no clear demographic preponderance. Although there were some decreases in non-DMHC CT/GC reports, the ratio of DMHC to non-DMHC reports declined from 0.42 to 0.33 (-21.4%) for CT and from 0.94 to 0.61 (-35.1%) for GC. CONCLUSIONS: Even a modest fee for service appears to have a major impact on the use of STI clinic services and may result in a significant effect on the ability to diagnose CT/GC infections, especially among those at highest risk.