1. 11 Los Angeles County Department of Public Health STD Clinics SSuN Project Staff Sarah Guerry MD, Medical Director Michael Chien MPH, Epidemiologist Ali Stirland MBCHB MSC, Clinic Liaison

2. 2 Part 1 Description of STD Clinics 2

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

4. 44 Number of sessions/week Clinic visits 2008 27,500 new visits/yr 17,200 return visits/yr 3380 sessions/yr 67 sessions/wk No. of Clinics 12 STD Clinics

5. 55 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

6. 66 Testing Routine 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

7. 77 Services STD diagnosis and treatment, including warts Emergency contraception Hepatitis A and B vaccination

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

9. 9 Part 2 STD Clinic Data 1 st Quarter 2009 9

10. 10 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

11. 11 Gender OverallGWHIV+ Male 4094 (63.0%)274 (83.0%)41 (93.2%) - MSM 646 (9.9%)32 (9.7%)30 (68.2%) Female 2352 (36.2%)56 (17.0%)2 (4.5%) Transgender 15 (0.2%) 0 0

12. 12 Age OverallMSMGWHIV+ 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%)

13. 13 Race/Ethnicity OverallMSMGWHIV+ 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%)

14. 14 CT, GC, and HIV Prevalence OverallMSMGWHIV+ 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%) HIV positive 44 (0.8%)30 (6.2%)4 (1.5%)--

15. 15 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%) methamphetamines –168 (26.0%) marijuana –33 (5.1%) ecstasy –33 (5.1%) cocaine –99 (15.3%) binge drinking

16. 16 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

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

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