Laboratory-confirmed HIV and sexually transmitted infection seropositivity and risk behavior among sexually active transgender patients at an adolescent and young adult urban community health center

Abstract Background The reasons why bacterial sexually transmitted infections (BSTIs) are increasing in US men who have sex with men (MSM) have not been fully characterized. Methods An open cohort of MSM accessing medical care at a Boston community health center was used to assess secular trends in BSTI diagnoses. Frequency of infection and the estimated population size were used to calculate diagnosis rates. Poisson models were fit for multivariable analyses. Results Between 2005 and 2015, 19 232 men had at least 1 clinic visit. Most (72.4%) were white; 6.0% were black, and 6.1% were Latino. Almost half had documented self-report of identifying as gay (42.6%) or bisexual (3.2%). Most had private health insurance (61.7%); 5.4% had Medicare, 4.6% had Medicaid, and 8.4% reported no insurance. Between 2005 and 2015, BSTI diagnoses increased more than 8-fold. In 2015, of 1319 men who were diagnosed with at least 1 BSTI; 291 were diagnosed with syphilis, 554 with gonorrhea (51.4% rectal, 31.0% urogenital), and 679 with chlamydia (69.1% rectal, 34.3% urogenital). In 2015, 22.7% of BSTIs were diagnosed among HIV-infected patients (15.4% of the clinic population), and 32.8% of BSTIs were diagnosed among HIV-uninfected patients using pre-exposure prophylaxis (PrEP; 10.1% of all men in care). In multivariable analyses, age 18 to 24 years, being HIV-infected, using PrEP, being nonwhite, or reporting Medicaid or not reporting having private insurance or Medicare were independently associated with being diagnosed with a new BSTI. Conclusions Over the past decade, BSTI diagnosis rates increased in HIV-infected and uninfected MSM, with disproportionate increases in PrEP users, racial and ethnic minority MSM, those aged 25 to 34 years, and those without stable health insurance, warranting focused education, screening, and accessible services for these key subpopulations.

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Rectal Specimen Self-Collection for Chlamydia and Gonorrhea Screening: A Cross-Sectional Pilot Feasibility Study at a Community Health Center

10.21203/rs.3.rs-150316/v1 ◽

2021 ◽

Author(s):

Marwan Haddad ◽

Lauren Bifulco ◽

Jeannie McIntosh ◽

Meghan McClain Garcia

Keyword(s):

Primary Care ◽

At Risk ◽

Community Health ◽

Health Center ◽

Feasibility Study ◽

Resource Constraints ◽

Community Health Center ◽

Transmitted Infection ◽

Cross Sectional ◽

Sexually Transmitted

Abstract Purpose: Rectal self-collection increases detection of asymptomatic chlamydia and gonorrhea among at-risk men who have sex with men and transgender women. This feasibility study assessed patient and primary care provider (PCP) perceptions of implementing rectal self-collection at a large, general practice community health center.Methods: PCPs offered rectal self-collection to at-risk patients due for routine or risk-based screening. Patients and PCPs completed brief cross-sectional assessments.Results: Rectal screening was feasible in a large primary care setting despite clinical time and resource constraints and was universally accepted when offered (n=36; 91.6% of whom opted for self-collection). Both PCPs and patients preferred self-collection over clinician-collection.Conclusions: Rectal self-collection can increase screening and improve extra-genital chlamydia and gonorrhea diagnoses. Adoption of rectal self-collection in primary care is a scalable, useful, and acceptable strategy to increase extra-genital screening among medically underserved sexual and gender minority patients and combat the current sexually-transmitted infection epidemic.

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