Los Angeles County Department of Public Health STD

Los Angeles County Department of Public Health STD Clinics SSu. N Project Staff Sarah Guerry MD, Medical Director Michael Chien MPH, Epidemiologist Ali Stirland MBCHB MSC, Clinic Liaison 1

Part 1 Description of STD Clinics 2

Los Angeles County Area: >4000 square miles Population: 10 million STD clinics: 12 3

12 STD Clinics Clinic visits 2008 No. of Clinics 27, 500 new visits/yr 17, 200 return visits/yr 3380 sessions/yr 67 sessions/wk Number of sessions/week 4

STD Clinic Flow New visits (walk-in, free of charge) • • • Registration Intake interview by PHI (DIS) or nurse Examination / wet mount micro by doctor (1 NP) Phlebotomy and other tests Doctor &/or nurse administers/dispenses meds Results • Phone or return appointment 5

Routine • • Testing GC/CT NAAT urine or cervical swab Syphilis (RPR/TPPA) HIV serology Wet mount micro Selected patients • • • GC/CT NAAT rectal (CT/GC), throat (GC only) Liquid based Paps with HPV triage Hepatitis ABC serology (testing and pre-vax) HSV PCR and HSV-2 serology Urinalysis and pregnancy test 6

Services • STD diagnosis and treatment, including warts • Emergency contraception • Hepatitis A and B vaccination 7

Challenges collecting data I Single form for multiple purposes • Clinical management • Data collection for: – Performance evaluation – Surveillance (STDP and SSu. N) – Reporting (Office of Aids Program and Policy) Different variables & time periods SSu. N & OAPP II Manual Process • Form completion in clinic • Data entry at STD Program from NCR copy 8

Part 2 STD Clinic Data 1 st Quarter 2009 9

Populations of Interest • All STD New Clinic Clients – 6, 498 total visits • MSM/MSMW Clients – 646 (9. 9%) visits • Clients diagnosed with Genital Warts (GW) – 330 (5. 1%) visits • Clients testing positive for HIV – 44 (0. 7%) visits 10

Gender Male - MSM Female Transgender Overall GW HIV+ 4094 (63. 0%) 274 (83. 0%) 41 (93. 2%) 646 (9. 9%) 32 (9. 7%) 30 (68. 2%) 2352 (36. 2%) 56 (17. 0%) 2 (4. 5%) 15 (0. 2%) 0 0 11

Age Overall MSM GW HIV+ 15 -19 707 (10. 9%) 37 (5. 7%) 23 (7. 0%) 1 (2. 3%) 20 -24 1626 (25. 0%) 155 (24. 0%) 91 (27. 6%) 4 (9. 1%) 25 -29 1254 (19. 3%) 136 (21. 1%) 98 (29. 7%) 10 (22. 7%) 30 -34 844 (13. 0%) 98 (15. 2%) 57 (17. 3%) 2 (4. 5%) 35 -44 1148 (17. 7%) 139 (21. 5%) 43 (3. 9%) 16 (3. 6%) 45+ 892 (13. 7%) 79 (12. 2%) 18 (5. 5%) 11 (25. 0%) 12

Race/Ethnicity Overall MSM GW HIV+ African. American 2685 (41. 3%) 123 (19. 0%) 77 (23. 3%) 17 (38. 6%) Hispanic 2155 (33. 2%) 299 (46. 3%) 134 (40. 6%) 16 (36. 4%) White 958 (14. 7%) 140 (21. 7%) 86 (26. 1%) 7 (15. 9%) Other / Unknown 684 (10. 5%) 84 (13. 0%) 33 (10. 0%) 4 (9. 1%) 13

CT, GC, and HIV Prevalence Overall MSM GW HIV+ CT positive 722 (11. 8%) 64 (10. 3%) 26 (8. 6%) 6 (14. 3%) -Urethral 680 (11. 1%) 29 (4. 7%) 24 (7. 9%) 3 (7. 1%) -Rectal 56 (12. 0%) 42 (12. 3%) 3 (11. 5%) 4 (20. 0%) GC positive 290 (4. 7%) 93 (15. 0%) 6 (2. 0%) 5 (11. 9%) -Urethral 233 (3. 8%) 46 (7. 5%) 5 (1. 7%) 3 (7. 1%) -Pharyng. 63 (3. 7%) 44 (9. 5%) 1 (1. 4%) 4 (15. 4%) -Rectal 35 (7. 5%) 30 (8. 8%) 1 (3. 8%) 3 (15. 0%) 44 (0. 8%) 30 (6. 2%) 4 (1. 5%) -- HIV positive 14

Behavioral Risk Factors (past 90 days) among MSM (n=646) • 509 (78. 8%) engaged in anal sex – 69 (10. 7%) reported always using condom • 258 (39. 9%) reported some drug or alcohol use – – – 21 (3. 3%) 168 (26. 0%) 33 (5. 1%) 99 (15. 3%) methamphetamines marijuana ecstasy cocaine binge drinking 15

Behavioral Risk Factors (past 12 months) among MSM (n=646) • 20 (3. 1%) injection drug use or IDU sex partner • 44 (6. 8%) incarcerated or incarcerated sex partner • 77 (11. 9%) HIV positive sex partner • 196 (30. 3%) anonymous sex partner • 50 (7. 7%) sex at bathhouse or sex club • 74 (11. 5%) casual sex partners from the internet 16

MSM infected with CT, GC, or HIV vs. MSM testing negative for CT, GC and HIV 17

Summary • Implementation has been smooth with no major challenges • High number of visits with sufficient volume for populations of interest 18