Normalizing HIV testing in a busy urban sexually transmitted infections clinic.

BACKGROUND: Increased awareness of HIV serostatus is a cornerstone of HIV prevention efforts. Thus, routine HIV testing in clinical settings has been identified as a priority. We report on our experience with making rapid HIV testing a routine procedure in a large STI clinic. METHODS: A series of logistical changes were implemented to enhance HIV testing uptake, including introduction of rapid testing, changes in sequence of clinical procedures, and an opt-out consent process. The impact of these changes on HIV testing was measured by the ratio of HIV testing and syphilis RPR testing, with the latter defined as the gold standard of routine testing in an STI clinic setting. RESULTS: Over time and in relationship to the introduction of clinic changes, the HIV/RPR ratio increased from 0.79 at baseline to 0.96 after full implementation. Overall HIV positivity rates did not vary significantly over time. CONCLUSION: After the introduction of several changes in clinic procedures, we experienced an increase HIV testing uptake relative to routine syphilis testing. In STI clinics, HIV testing can be made as normal as other routine STI testing.

Evaluation of a testing-only "express" visit option to enhance efficiency in a busy STI clinic.

OBJECTIVE: To evaluate the use of a testing-only "express" visit option to enhance efficiency in a busy STI clinic. METHODS: At the Denver Metro Health Clinic, clients at low risk for sexually transmitted infections (STI) are offered an express visit comprised of a urine test for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) as well as optional syphilis and human immunodeficiency virus (HIV) testing, but no physical examination. Higher risk clients (STI-related symptoms, contact to STI, men having sex with men, injection drug use, exchange of sex for money or drugs) are offered a comprehensive visit that includes a physical examination. The triage system was evaluated for the period April 2005--July 2006 by comparing rates of CT, GC, syphilis, and HIV between the 2 visit options. RESULTS: Of 13,447 clients with new visits, 3284 (24.4%) were express visits. When compared with clients with comprehensive visits, express visit clients had lower rates of CT (8.1% vs. 17.2%), GC (0.9% vs. 7.4%), syphilis (0.7% vs. 1.2%), and HIV (0.1% vs. 0.2%). Of 2969 STI cases, only 10.8% were diagnosed among clients with express visits. Express visits resulted in a 39% time saving for men and a 56% for women. With the possible exception of asymptomatic urethritis among men, underdiagnosis of STI beyond CT, GC, syphilis, and HIV among express visit clients appeared to be low. CONCLUSION: The triage system at DMHC effectively selects clients at highest risk for STI and increases clinic efficiency.