Use retest reminders on chlamydia and gonorrhea
Executive Summary
Bedsider (www.bedsider.org), an online birth control support network operated by the National Campaign to Prevent Teen and Unplanned Pregnancy, has collaborated with the California Department of Public Health STD Control Branch and the California Family Health Council to expand the InTOUCH reminder system that was successfully piloted in California to a national scale.
• This newly expanded "reminders portal" is designed to help providers increase rates of chlamydia and gonorrhea retesting in their clinics.
• With the new partnership, text and e-mail reminders for chlamydia and gonorrhea retesting are available to providers across the nation via Bedsider’s free provider portal system.
Bedsider (www.bedsider.org), an online birth control support network operated by the National Campaign to Prevent Teen and Unplanned Pregnancy, has expanded the InTOUCH reminder system that was successfully piloted in California to a national scale. This newly-expanded "reminders portal" is designed to help providers increase rates of chlamydia and gonorrhea retesting in their clinics, says Laura Lloyd, MPH, MS, assistant director of digital media for The National Campaign.
"Our mission at The National Campaign is about helping young women to plan pregnancies, having young women be pregnant when they want to be, yet the sexually transmitted infection issue hits our population as well, with its impact on future infertility," says Lloyd. "Since we already had a national platform built for these reminders, it made sense to us to enter into this collaboration and scale [up the] InTOUCH reminder system."
The National Campaign collaborated with the Richmond-based California Department of Public Health STD Control Branch and the Los Angeles-based California Family Health Council. With the partnership with The National Campaign’s Bedsider team, text and e-mail reminders for chlamydia and gonorrhea retesting are available to providers across the nation via Bedsider’s free provider portal system, says Gil Chavez, MD, MPH, deputy director and state epidemiologist for the California Department of Public Health’s Center for Infectious Diseases. Promotion of new retesting best practices and resources has occurred through distribution of guidelines, informational webinars, in-person and online clinical trainings, and various organizational newsletters, notes Chavez. (California’s best practices on retesting are located at http://bit.ly/1ogtlUy. Also check out the California STD/HIV Prevention Training Center’s video, "Retesting for Chlamydia and Gonorrhea," at http://bit.ly/1glqHFl.)
Promotion of Bedsider’s provider portal reminder system has recently begun in California following its launch of the retesting reminder option in December 2013, Chavez reports.
How does it work?
The reminders add to the online contraceptive support, tools, and content that Bedsider offers to young adults and providers. Providers can sign up for the Bedsider Provider Network free of charge for access to the secure reminders portal.
How does the retesting reminders system work?
• Providers sign up with Bedsider to gain access to their own unique, secure reminders portal.
• When a patient is treated for gonorrhea or chlamydia, the clinic enters the date of treatment, as well as a contact phone number or e-mail address, into the portal.
• Two and a half months after the initial test, the patient receives a text message or email with a retesting reminder. The clinic’s name and phone number are prominently listed in the reminder so the patient has fingertip contact information.
The reminders portal also allows providers to enter patient prompts for birth control, prescription refills, and specific appointments. Future plans include reminders for human papillomavirus vaccination, says Lloyd.
Why retesting is key
Rapid repeat infection with chlamydia and gonorrhea generally occurs one to six months after treatment for infection and significantly increases the risk for adverse reproductive health outcomes among women, such as pelvic inflammatory disease, ectopic pregnancy, and infertility, notes Chavez. Repeat infection is very common across all patient demographics, with rates as high as 15-20% among women who are retested a few months after treatment for their initial infection.1
As the vast majority of reinfections among women occur without discernable symptoms, routine chlamydia and gonorrhea retesting three months after treatment for initial infection has been recommended for more than a decade by the Centers for Disease Control and Prevention (CDC), says Chavez. However, despite general efforts to educate providers about CDC guidelines, retesting rates in family planning and other clinical settings remain low, typically well below 50%.2
What contributes to low retesting rates? The primary barriers to institutionalizing retesting practices are lack of prioritization of retesting services in clinic protocols and among staff, lack of systems to prompt retesting when patients return to clinic, insufficient patient education counseling, limited resources for patient appointment reminder systems, the burden of additional clinic visits on scheduling and staff resources, and patients’ failure to return to clinic for retesting because they don’t understand their risk or have other barriers to accessing care, notes Chavez. Effective, easy-to-implement strategies to improve retesting in family planning and other clinical settings have been elusive, he observes.
How InTOUCH made impact
The 2010-2012 InTOUCH Study, funded by the Department of Health and Human Services’ Office of Population Affairs, was an applied research study designed to identify effective and feasible interventions to improve retesting for chlamydia and gonorrhea within the California Title X clinical setting, states Chavez. Interventions targeting the clinic and the patient were implemented and evaluated on their effectiveness in improving retesting rates within six family planning clinics across California.
Interventions in the study included the introduction of chart flag reminders (automated electronic pop-ups) to alert clinic reception staff when a presenting patient was due for retesting, improved patient education materials and health education counseling messages, protocols to allow collection of sexually transmitted infection (STI) testing samples (via urine or self-collected vaginal swab) at all clinic visits regardless of reason for visit or the presence of a clinician, and the availability of drop-in STI-test-only visits, says Chavez.
Patients are provided more comprehensive health education related to reinfections, partner treatment options, and the importance of retesting. In addition, during the final phase of the study, patients also were given the option to receive a reminder message via self-addressed postcard, text message, and/or e-mail three months after their treatment to remind them of their need to return to the clinic for retesting, Patients were provided the option to take their retest in the clinic or at home using a mailed-in self-collected vaginal swab specimen kit.
While only 5% of patients chose the home-testing option, 90% requested a reminder message, with 90% of these preferring a text and/or email-based auto-reminder, which was facilitated by the InTOUCH-developed reminder system, says Chavez. The clinic-side and patient-side interventions separately and significantly improved retesting rates within the study clinic sites, with the combined interventions increasing retesting rates overall by just more than 30%, notes Chavez.
Retesting data for approximately 5,000 non-pregnant female patients age 16 or older who had tested positive and were treated for a chlamydia or gonorrhea infection at one of six family planning clinic sites across CA were included in the study. The study included almost 600 who were enrolled in the patient-targeted study phase and offered the options for a retest reminder and home-test kit.
"While the InTOUCH clinic-side interventions can be feasibly implemented in most clinical care settings for no or little cost, home-testing and automated reminder messages have not been available to providers and patients without investments in infrastructure," observes Chavez. "Due to our partnership with The National Campaign to Prevent Teen and Unplanned Pregnancy’s Bedsider team, text and email reminders for chlamydia and gonorrhea retesting are now available to providers across the nation via Bedsider’s free provider portal system."
- Rosenfeld CB, Workowski KA, Berman S, et al. Repeat infection with chlamydia and gonorrhea among females: A systematic review of the literature. Sex Transm Dis 2009;36(8):478-489.
- Howard H, Barandas A, Steiner A, et al. Increasing retesting for chlamydia & gonorrhea. Accessed at: http://www.caiglobal.org/caistage/images/pdfs/ntc/Grantee2013/breakout3-4-hhoward.pdf.
