Barriers to Bacterial STI Testing of HIV-Infected Men who have Sex with Men Engaged in HIV Primary Care
Published Date:Oct 2015
Source:Sex Transm Dis. 42(10):590-594.
Ambulatory Care Facilities
Barriers To STI Testing
Behavioral Risk Factor Surveillance System
Primary Health Care
Sexually Transmitted Diseases, Bacterial
Pubmed Central ID:PMC4576720
Funding:K23 AI113185/AI/NIAID NIH HHS/United States
K23 AI113185/AI/NIAID NIH HHS/United States
PS1-1103/PS/NCHHSTP CDC HHS/United States
T32 AI07041/AI/NIAID NIH HHS/United States
Approximately 15% of HIV-infected MSM engaged in HIV primary care have been diagnosed with an STI in the past year, yet STI testing frequency remains low.
We sought to quantify STI testing frequencies at a large, urban HIV care clinic, and to identify patient- and provider-related barriers to increased STI testing. We extracted laboratory data in aggregate from the electronic medical record to calculate STI testing frequencies (defined as the number of HIV-infected MSM engaged in care who were tested at least once over an 18-month period divided by the number of MSM engaged in care). We created anonymous surveys of patients and providers to elicit barriers.
Extra-genital gonorrhea and chlamydia testing were low (29%–32%), but the frequency of syphilis testing was higher (72%). Patients frequently reported high-risk behaviors, including drug use (16.4%) and recent bacterial STI (25.5%), as well as substantial rates of recent testing (>60% in prior 6 months). Most (72%) reported testing for STI in HIV primary care, but one-third went elsewhere for “easier” (42%), anonymous (21%) or more frequent (16%) testing. HIV primary care providers lacked testing and treatment knowledge (25–32%), and cited lack of time (68%), discomfort with sexual history taking and genital exam (21%), and patient reluctance (39%) as barriers to increased STI testing.
STI testing in HIV care remains unacceptably low. Enhanced education of providers, along with strategies to decrease provider time and increase patient ease and frequency of STI testing, are needed.
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