Attitudes and Perceived Barriers to Sexually Transmitted Infection Screening Among Graduate Medical Trainees

Abstract

Graduate medical training is an opportune time to improve provider delivery of sexually transmitted infection (STI) screening. A survey of trainees found that the majority feel STI screening is their job but identified barriers to successful screening. Training that intentionally address service-specific barriers will be valuable in ending the STI epidemic.R ates of sexually transmitted infections (STIs) in the United States and New York City (NYC) have been increasing since 2014. 1,2 Untreated STIs account for substantial healthcare costs and may lead to further health complications; some, such as syphilis and gonorrhea, are a reliable marker of human immunodeficiency virus (HIV) acquisition. [3][4][5] Currently, the United States Preventive Services Task Force recommends routine gonorrhea and chlamydia screening for sexually active women 24 years or younger and older women who are at increased risk of HIV. 6 The United States Centers for Disease Control and Prevention recommend broader routine screening for gonorrhea and chlamydia, including in men who have sex with men, individuals on pre-exposure prophylaxis, persons living with HIV, and young men in high prevalence clinical settings. 7 Sexually transmitted infections are frequently asymptomatic; consequentially, risk-based screening can limit the clinical and public health impact of STI screening. 8,9 Additionally, patient stigma may affect STI risk factor disclosure, and provider stigma and discomfort may result in incomplete sexual history-taking, STI testing and treatment. 10,11 Strategies to reverse STI trends will require expansion of routine STI testing and treatment beyond sexual health service platforms and integration into other health services. 12 Integrating sexual and reproductive health (SRH) into other health services poses challenges at many health-system levels including the provider level. 10,11,13 Graduate medical education, in which resident physicians complete mentored-training, is an opportunity to improve provider delivery of STI screening and treatment as physicians establish medical practices that continue throughout their professional careers. 14,15 Because residents are "durably imprinted" during this training period, incorporating STI screening and treatment into the training curriculum can support future practices like the identification, management, and prevention of STIs, their sequelae, and other coinfections like HIV.

Predictors of missed HIV screening opportunities among newly diagnosed individuals at an urban medical center in New York City, 2018–2022

“…Although these factors are beyond the scope of this study, it is important to highlight the various negative and positive predictors of HIV screening in the ED to provide insight into the complexities of having MOs in the ED. In a recent survey, the vast majority of ED providers at our institution cited higher priority issues and time constraints as key barriers to HIV screening, underscoring the importance of prescreening questionnaires or nurse-driven screenings [ 15 ]. Considering the disproportionate burden of HIV among racial and ethnic minorities, many of whom are underinsured and utilize the ED as their primary source of medical care, expanding HIV screening is especially important in the ED [ 34 ].…”

“…NYS has now revised the ETE timeline to 2024 [12]. Additional barriers to HIV screening during this time period include health system limitations such as time constraints (both in ED and outpatient settings) and higher-priority medical issues; systemic disruptions to PrEP supply and distribution in the form of suspended outreach and reduced personnel also occurred [14,15].…”

Get2PrEP: An Electronic Medical Record Laboratory Comment Increased Safe Sex Counseling But Not Preexposure Prophylaxis Services at a Large Urban Academic Medical Center in Northern Manhattan

“…31,32 The ED was the most frequent location for an STI diagnosis, but the competing priorities of ED staff often do not allow time for counseling and/or documentation. 7,33 Provider interventions are most successful when they are timely, and in this case, recommendations were not provided until after a patient had left the ED and results returned. Point-of-care STI testing, with results and immediate recommendations, may allow for improved provider-patient discussions.…”