Improving Extra-genital GC/CT Screening Among HIV-positive Patients at the University of North Carolina Infectious Diseases Clinic

BACKGROUND: Asymptomatic rectal and pharyngeal gonococcal (GC) and chlamydial (CT) infections are common among HIV-positive men who have sex with men (MSM) and women. However, screening for extra-genital gonococcal and chlamydial infections among HIV-positive patients is low. While urogenital screening is more common, this method may miss more than 70% of extra-genital infections among MSM and more than 15% of rectal infections among women. METHODS: We initiated a quality improvement project with 4 plan-do-study-act (PDSA) cycles, beginning in 3/2016, to increase screening for extra-genital infections among HIV-positive patients attending the UNC Infectious Diseases clinic by 10%. The first PDSA cycle initiated nurse-based counseling on GC and CT testing. The second PDSA cycle increased verbal nursing prompts to providers about screening for extra-genital GC and CT. The third cycle placed screening supplies out on Mayo stands in each examination room. The final PDSA cycle introduced a self-screening program for extra-genital sample collection. Our outcome of interest was the percentage of patients seen in clinic in the prior 12 months who had screening for GC and CT in that same 12-month period. We also assessed the acceptability of self-collection of extra-genital samples with an anonymous survey. RESULTS: For the year prior to the initiation of PDSA cycles, 33% of patients were screened for GC and CT at any anatomic site. Since the initiation of the PDSA cycles, screening at any site increased to 40%. For MSM, screening increased from 44% in the year prior to project initiation to 52%. Of 35 patients who underwent self-screening and completed an acceptability survey, over 90% agreed or strongly agreed that screening was easy, that they preferred to collect their own samples, that they would collect their own samples at home, and that they would recommend self-screening to a friend. CONCLUSION: We observed a 7% increase in GC and CT screening since the initiation of our quality improvement project. Self-collection of extra-genital GC and CT samples is an acceptable screening method and may have potential to further increase screening with both in-clinic and at-home sample collection, especially when combined with interventions that prompt routine screening. DISCLOSURES: All authors: No reported disclosures.