1. WELCOME!
The Center for HIV/AIDS Care and Research (CHACR) at Boston Medical Center A Model of Integrated Programs: Public Health and Clinical Care
Encourage audience to ask questions as the presentation goes.

2. Agenda
Background
Sexually Transmitted Diseases (STD)/Public Health Clinic
Integrated Counseling, Testing and Referral Services (ICTR)
Linkage to Care

3. South End/Roxbury map BMC
BMC is on the border of the South End & Roxbury
Accessible by public transportation

4. Campus Map
STD Clinic

5. Definition of Our Roles: within the Department of Infectious Diseases – Center for HIV/AIDS Care and Research
Vanessa Sasso
Manager
HIV CTR
Project TRUST, 721
Massachusetts Avenue
Glory Ruiz
Manager
Public Health/STD Clinic
Center for Infectious
Diseases, Dowling
Ground

6. Timeline
1996
2007
1943
1987
2003
2004
1943- Boston City Hospital (BCH) awarded the STD clinic grant by Massachusetts Department of Public Health (MDPH)
BCH awarded the HIV testing grant by MDPH
ATS= “anonymous testing site”
1996- Boston University/BCH merger = Boston University Medical Center
2003- hepatitis testing starts at Project TRUST
CTS= “comprehensive testing site”
2004
Rapid HIV testing (Project TRUST- pilot site for MDPH)
Free hepatitis vaccines administered at the Center for Infectious Diseases
BMC awarded CDC prevention grant to create Project Umbrella
2007
ICTR starts
Human Papilloma Virus vaccine administered at the STD clinic
B02B World War II: “The Most Extensive Syphilis Case Finding Program in the History of the World”
Laura McGough
Johns Hopkins University, Baltimore, MD
Background: Previous research has emphasized the importance of the biomedical model, first Ehrlich’s “magic bullet” followed by penicillin, in the campaign to control STDs during WWII. This paper re-examines the strategies undertaken by public health officials during WWII in order to determine what policies were adopted during this period, regarded as one of the “successes” of twentieth century STD control.
Objectives: To evaluate the successes and failures of one of the largest STD control efforts in US history
Methods: The records of the US Public Health Service (USPHS) at the National Archives were read, along with relevant publications from the 1940s
Results: Despite initial conflict with the Armed Forces, by 1943 the USPHS and the Armed Forces cooperated in an effort to reduce the prevalence and incidence of STDs among soldiers as well as the civilian population. The result was an STD control program that integrated prevention, treatment, surveillance, research and education. Rapid Treatment Centers (RTCs), primarily for the treatment of women, were opened as early as The rationale behind these centers was that civilian women served as a reservoir of infection for soldiers. Early publicity focused on how the RTCs would treat prostitutes, a strategy that undermined the effectiveness of the centers in reaching out to infected women not engaged in prostitution. Because the American public regarded STDs primarily as a problem of prostitution, USPHS officials expressed concern that public support for the backbone of the STD control program—contact tracing and case holding—could be undermined.
Conclusions: Control of STDs during WWII cannot be attributed to the introduction of penicillin therapy alone, but to the combination of case finding, education, prophylaxis, and surveillance with treatment.
Implications for Programs, Policy, and/or Research: Comprehensive STD control programs are more effective than treatment alone.
Songs:
1943- “Sunday, Monday or Always” by Bing Crosby
1987- “Walk like an Egyptian” by The Bangles
1996- “One Sweet Day” by Boyz II Men & Mariah Carey, “La Macarena” was number 3!!!
2003- “Crazy in Love” by Beyoncé
2004- “Yeah!” By Usher, feat. Li’l Jon & Ludacris
2007- “No One” by Alicia Keys (this week)

7. (Gilead, other pharmaceuticals) Hospital Funding
Women’s
Center
HIV Pharmacy Adherence
HIV
Clinic
HIV Medical Case Management
HIV
Nursing
HIV Clinical Research
Pediatric ID
Travel
Clinic
Public Funding
(MDPH, CDC,
NIH, HRSA, etc)
Private Funding
(Gilead, other pharmaceuticals)
Hospital Funding
HIV
Home Health
International/
Refugee Clinic
Diagram explains all the services offered at the Center for Infectious Diseases (CID)
For the purposes of this presentation, we will focus on the ones in green and blue, which explain how these services are integrated and work together in a seamless way
Patients are not aware of the multiple funding streams supporting their care.
HIV Counseling
and Testing
ICTR
Clinic Support Staff
HIV Prevention and Education
STD
Nursing
Public Health STD Clinic

8. HIV CTR Sites at BMC Drop-in Center Headquarters (MDPH)
Social Networking
Project
(CDC)
Public Health
STD Clinic
(CDC)
Urgent Care
Center/ED
(MDPH)
Drop-in Center
Headquarters
(MDPH)
Women’s
Center
(Gilead)
Adult Primary
Care Clinic
(MDPH)
CTR program consists of a team of 12 counselors who are stationed all over the hospital as well as the community.
For this presentation, we’ll focus on the sites in blue.
Our team reflects the diverse population that we serve in terms of racial/ethnic background and sexual orientation.
Multilingual STD and CTR staff (explain languages spoken).
Collaboration: Glory covers the CTR at the STD clinic for Spanish and Portuguese speakers.
Inpatient
Medical Service
(MDPH)
Community Based
Sites
(CDC)
MALE Center
Family Van
Dimock Detox
Boston Center for
Refugee Health
& Human Rights
Van Outreach
CAB Detox
Needle Exchange Van

9. Overall HIV Testing Data
Tests Seropositives Seroprevalence
2005 MDPH (PT) & CDC (PU) 7, %
MDPH (PT) & CDC (PU) 7, %
2007 MDPH (PT) & CDC (PU) 9, %
Averages:
Tests: 683 tests/mo
Seropositives: ~8 reactives/mo
Seroprevalence: 1.13%

10. HIV testing data at the Public Health/STD Clinic
Tests Seropositives Seroprevalence
*Aug-Dec/ %
1, % %
*Aug/05- Rapid testing begins at the STD Clinic
Averages:
Tests: 130 tests/mo
Seropositives: ~2 reactives/mo
Seroprevalence: 1.35%

11. So, what does this really mean?
More than 1 million reported chlamydia cases set STD record
Story Highlights:
CDC: 1 million reported chlamydia cases sets U.S. record
Gonorrhea rates also up; drug-resistant "superbug" form increasingly seen
Rate of congenital syphilis, which babies get from mothers, up first time in 15 years
Chlamydia record may be result of better and more intensive screening
updated 1:44 p.m. EST, Tue November 13, 2007
BMC STD Clinic’s QRNG:
2006 – TOTAL: 64 cases, 14 were QRNG = 22%
2007, mid September- TOTAL: 41 cases, 5 were QRNG = 12%
DIAGNOSIS
YEAR
MSM
STATE
BMC
RESISTANT GC
2006 N 12 2 Y 52
2007 16 25 3

12. STD Clinic Data: Name that STD!
# of clinic visits
June 05*- May 06
2,798
175 77 48 17
1.65%
June 05- May 07
2,845
219 71 59 31
1.55%
June 07- Jan 08
1,715
115 49 45 18
0.95%
Averages:
CT: 16 cases/mo*
GC: 6 cases/mo*
Syphilis: 5 cases/mo
Herpes: 2 cases/mo*
HIV: 1.33%
* CT and GC= explain sites swabbed/samples taken
* HSV= explain sampling (culture not blood testing)
* Rapid syphilis testing available for patients with bumps or known contacts.
* Aug/05- Rapid testing begins at the STD Clinic

13. Integrated CTR Program
HBV & HCV
HIV
HIV
STD
Making the public health connection between HIV, Hepatitis and STI’s
People come in for HIV CTR and we offer them the other services – you are more likely to have Chlamydia than you are to have HIV, so why not get it checked out while you’re here….
Clients must be asymptomatic – if experiencing symptoms, we refer them directly to the STD Clinic for immediate exam, test and Tx.
Gave us the ability to expand our Hep B&C testing – previously there were strict guidelines around who could test
Great collaboration between Project TRUST & STD Clinic – because the STD Clinic is first come first serve, with a limited amount of slots - if the STD Clinic has asymptomatic clients they can refer them to Project TRUST and therefore open up slots for the symptomatic clients
Hepatitis A & B vaccine
STD

14. Hepatitis C Testing (HCV)
Hepatitis ICTR Data
For time period June 1, 2007 through Dec 15, 2007
Gonorrhea
Chlamydia
Tests Done
Results Found
Positive
Results
Returned
241
239
188 9
% Returned
78%
Prevalence
0.0%
3.7%
Syphilis
Hepatitis C Testing (HCV)
231 2
182
140 14
103
78.8%
73.6%
0.9%
10.0%
ICTR was implemented on June 1st (2007)
Thus far we have identified 7 new Chlamydia cases – remember these people were not experiencing any symptoms and came to us for HIV CTR
Syphilis case was an old, previously treated case; referred to the STD clinic for further evaluation and testing.
RPR for screening- TPPA for specialized testing

15. Linkage to Care: what happens when we receive a positive…
(+) Hepatitis B/C
test result
(+) STD test
result
Counselor makes intake
appointment with
Hepatitis Nurse in CID
STD/PH clinic
coordinator
Hard copy of DPH result
given to coordinator
Patient examined
and treated
by STD nurse
Follow-up in 2-3 months

16. Linkage to Care: what happens when we receive a reactive/positive…
(+) HIV test result
PCRS revisited
Confirmatory test
drawn
On-call Intake Team in the CID alerted:
Intake nurse
Medical manager, if needed
Mental health, if needed
Intake appointment
scheduled for later date
In our outreach venues/community venues, if the client is willing, we transport them via taxi to the CID for intake
Patient brought to the CID
by HIV counselor
Clinic tour/orientation &
Intake
Continued care
1st MD visit

17. Center for Infectious Diseases floor plan
As mentioned before, HIV and STD testing and care are not the only clinics that are held in the CID:
Refugee
Travel
Hepatitis
Prevention, education & support groups
Clinical Research

18. Any questions?

19. Thank you!
Glory Ruiz Manager Public Health/STD Clinic (617) Vanessa Sasso Manager HIV CTR (617)