Leichliter Jami S, Heyer Kate, Peterman Thomas A, Habel Melissa A, Brookmeyer Kathryn A, Arnold Pang Stephanie S, Stenger Mark R, Weiss Gretchen, Gift Thomas L
From the *Centers for Disease Control and Prevention, Atlanta, GA; †National Association of County and City Health Officials; and ‡National Coalition of STD Directors, Washington DC.
Sex Transm Dis. 2017 Aug;44(8):505-509. doi: 10.1097/OLQ.0000000000000629.
We examined the infrastructure for US public sexually transmitted disease (STD) clinical services.
In 2013 to 2014, we surveyed 331 of 1225 local health departments (LHDs) who either reported providing STD testing/treatment in the 2010 National Profile of Local Health Departments survey or were the 50 local areas with the highest STD cases or rates. The sample was stratified by jurisdiction population size. We examined the primary referral clinics for STDs, the services offered and the impact of budget cuts (limited to government funding only). Data were analyzed using SAS, and analyses were weighted for nonresponse.
Twenty-two percent of LHDs cited a specialty STD clinic as their primary referral for STD services; this increased to 53.5% of LHDs when combination STD-family planning clinics were included. The majority of LHDs (62.8%) referred to clinics providing same-day services. Sexually transmitted disease clinics more frequently offered extragenital testing for chlamydia and/or gonorrhea (74.7%) and gonorrhea culture (68.5%) than other clinics (52.9%, 46.2%, respectively; P < 0.05). The majority of LHDs (61.5%) reported recent budget cuts. Of those with decreased budgets, the most common impacts were fewer clinic hours (42.8%; 95% confidence interval [CI], 24.4-61.2), reduced routine screening (40.2%; 95% CI, 21.7-58.8) and reductions in partner services (42.1%; 95% CI, 23.6-60.7). One quarter of those with reduced STD budgets increased fees or copays for clients.
Findings demonstrate gaps and reductions in US public STD services including clinical services that play an important role in reducing disease transmission. Furthermore, STD clinics tended to offer more specialized STD services than other public clinics.
我们研究了美国公共性传播疾病（STD）临床服务的基础设施。
在2013年至2014年期间，我们对1225个地方卫生部门（LHD）中的331个进行了调查，这些部门要么在2010年地方卫生部门全国概况调查中报告提供性传播疾病检测/治疗服务，要么是性传播疾病病例或发病率最高的50个地区。样本按辖区人口规模分层。我们研究了性传播疾病的主要转诊诊所、提供的服务以及预算削减的影响（仅限于政府资金）。使用SAS对数据进行分析，并对无应答情况进行加权分析。
22%的地方卫生部门将专科性传播疾病诊所作为其性传播疾病服务的主要转诊机构；当包括性传播疾病-计划生育联合诊所时，这一比例增加到53.5%。大多数地方卫生部门（62.8%）转诊到提供当日服务的诊所。性传播疾病诊所比其他诊所更频繁地提供衣原体和/或淋病的生殖器外检测（74.7%）和淋病培养（68.5%）（其他诊所分别为52.9%和46.2%；P<0.05）。大多数地方卫生部门（61.5%）报告近期有预算削减。在预算减少的部门中，最常见的影响是诊所工作时间减少（42.8%；95%置信区间[CI]，24.4 - 61.2）、常规筛查减少（40.2%；95%CI，21.7 - 58.8）以及性伴服务减少（42.1%；95%CI，23.6 - 60.7）。四分之一性传播疾病预算减少的部门提高了患者的费用或自付费用。
研究结果表明美国公共性传播疾病服务存在差距和减少，包括在减少疾病传播中起重要作用的临床服务。此外，性传播疾病诊所往往比其他公共诊所提供更专业的性传播疾病服务。
