UNC Clinic Offers New Intervention Resulting in Increased STD Screening Rates

The quality improvement group at the UNC Infectious Disease Clinic has come up with a process to increase rates of STD screening that includes providing patients with the option to self-swab.

With sexually transmitted diseases (STDs) reaching an “unprecedented high” in the United States, individuals in the healthcare community are working to enhance preventive efforts within their facilities.

One such facility that is making strides in the fight against these diseases is North Carolina Memorial Hospital’s University of North Carolina’s Infectious Disease Clinic. How? By providing their patients with the opportunity to self-swab for STDs.

“Sex is normal and healthy,” social practitioner Ellen McAngus, LCSWA, said in a press release. “But we need to give our patients the right tools to protect themselves and their partners.”

The clinic’s quality improvement group, comprised of individuals from all different areas of the healthcare sector, includes nurses, social workers, a provider, as well as a certified medical assistant. Self-swabbing is just one of several interventions that this group has come up with.

The clinic provides care for around 1,800 individuals who are living with HIV — which results in weakened immune systems. These individuals are, therefore, susceptible to coinfection with other diseases, such as syphilis. Nationwide, syphilis rates continue to climb, prompting the Centers for Disease Control and Prevention to issue a “Call to Action.” The rates are particularly high in North Carolina, where, according to the North Carolina Department of Health and Human Services, the number of syphilis cases in the state increased by a staggering 64% in just one year, from 2014 to 2015.

In 2015, Anita Holt, RN, clinic nurse, and Amy Heine, FNP, associate clinic director, noticed that “screening rates for syphilis in patients living with HIV were down,” despite the high rate of infected individuals in the state.

To address this, clinic nurses decided to take action by opening discussions with their patients regarding their sexual health. If the nurses found out that a patient hadn’t been screened in a year for syphilis, or if they felt the patient is at particular risk for infection, they flagged the patient’s chart. The results? The number of syphilis screenings increased. This inspired them to consider adding chlamydia and gonorrhea as well, since the rate of infection with these STDs was also rising in the state, making screening for these diseases even more imperative.

STD screening “increases access to treatment, reduces transmission to uninfected partners, and educates patients about where these infections can hide.” McAngus pointed out that individuals are not always aware that they can still get these diseases “in places other than the vagina or penis.” For example, although syphilis that is present anywhere within an individual can be detected by a blood test, chlamydia and gonorrhea “can live in extragenital sites.”

In the press release, Dr. Menza explained, “You could screen a woman vaginally, and if the test is negative, it doesn’t necessarily mean she hasn’t had an exposure to chlamydia or gonorrhea. She could have been exposed through condomless oral or anal sex. Many people think oral sex isn’t sex, so they won’t tell their provider. And anal sex, especially for women, is also rarely discussed.”

For this reason, Tim Menza, MD, PhD, brought self-swabbing to the clinic.

“This project really opened the door for us to empower providers and patients to have more sexual health conversations, and to offer patients self-swabbing if we feel they are at risk for an STI exposure. The option to self-swab puts part of a patient’s health care in their hands. And they do just as good of a job as providers as far as getting an adequate sample for testing,” he said.

So, what does the routine for the intervention consist of?

First, the nurse will check the patient’s vital signs and ask them “lifestyle questions” pertaining to smoking habits, drug use, and sexual behavior.

Then, if the nurse feels that the patient is at particular risk based off of their answers, she/he will offer the patient the opportunity to self-swab; more often than not, patients will choose to self-swab. However, if the patient chooses not to, the nurse will either offer to screen them or flag their chart so that the healthcare provider will know to ask them again about swabbing. By leaving a testing tray ready-to-go, they provide the healthcare provider an additional reminder to discuss screening.

In addition, according to social worker lead Alyssa Draffin, LCSW, those who are HIV-positive have increased rates of having experienced sexual trauma. Due to that, “being swabbed in the vagina or rectum can trigger anxiety or panic.” Therefore, providing these patients with the choice to self-swab might put them more at ease.

If a patient ends up with a positive diagnosis, the clinic provides them with the needed treatment and then put into contact with a social worker, who will hold an educational “behavioral intervention,” which typically runs from five to ten minutes. After following up with a phone call, the social worker will then share their findings with the patient’s healthcare provider.

The results of this process? The number of chlamydia and gonorrhea screenings has increased by 16%, going from 34% to 50%. However, the clinic isn’t stopping there; they are actively seeking feedback from their patients to make the process even better and to ensure that the patient’s experience is a positive one.

By working together, facilities can make a difference in the fight against STDs.