Horberg Michael, Eberhart Lindsay, Bhatia Mamta, Jonas Cabell, Cherico-Hsii Sara, Tamrat Yonas, Bhandari Binamrata, Kadlecik Peter, Gahunia Mona K
Kaiser Permanente Mid-Atlantic Permanente Medical Group.
Geisinger Health System, Rockville, MD.
Sex Transm Dis. 2022 Apr 1;49(4):268-273. doi: 10.1097/OLQ.0000000000001585.
At Kaiser Permanente Mid-Atlantic States, we designed a 3-anatomic-site panel (urine, oropharynx, and rectum) with a self-collect feature for rectal sites. We compared the proportion tested at each anatomic site, demographic factors, and HIV status between those who received the 3-site panel versus usual care.
Patients entered our laboratories without a prior appointment and underwent urine (usual care [patient collected]), oropharynx (laboratory technician collected), and rectal site (patient collected) testing. Providers recommended the panel to their patients. Patients then had the choice to accept or to reject the panel. Multivariate and logistic regressions were conducted to explore the relationship of age, sex, race, and HIV status with Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) test results as well as the type of testing (3-site panel vs. usual care testing) received.
A total of 145,854 patients received usual care testing as compared with 9227 who received the panel. For those who underwent usual care testing, 4.0% tested positive for CT and 0.85% for GC. For those who received the panel, 9.1% tested positive for CT and 6.4% for GC. Those who received the 3-site panel were more likely to test positive for CT (odds ratio [OR], 2.70; confidence interval [CI], 2.46-2.97) and GC (OR, 4.00; CI, 3.59-4.64). White patients were the most likely to receive the panel compared with Black patients (OR, 3.14; CI, 2.96-3.33). Patients with HIV had greater odds of undergoing the panel (OR, 15.62; CI, 14.67-16.64) and of testing positive for CT (OR, 1.27; CI, 1.07-1.51) and GC (OR, 1.39; CI, 1.14-1.68).
Patients who received the panel had higher odds of testing positive for CT and GC compared with patients with usual testing. Physician training may address the racial and sex differences observed in the panel enrollment and increase utilization. Self-collection for rectal sites should lead to higher detection of CT and GC.
在凯撒医疗中大西洋各州分院，我们设计了一个包含三个解剖部位（尿液、口咽和直肠）的检测组合，直肠部位采用自我采集的方式。我们比较了接受该三部位检测组合的患者与接受常规护理的患者在每个解剖部位的检测比例、人口统计学因素及艾滋病毒感染状况。
患者无需预约即可进入我们的实验室，接受尿液检测（常规护理[患者自行采集]）、口咽检测（实验室技术人员采集）和直肠部位检测（患者自行采集）。医护人员向患者推荐该检测组合。然后患者可以选择接受或拒绝该检测组合。进行多变量和逻辑回归分析，以探究年龄、性别、种族和艾滋病毒感染状况与淋病奈瑟菌（GC）和沙眼衣原体（CT）检测结果以及所接受的检测类型（三部位检测组合与常规护理检测）之间的关系。
共有145,854名患者接受了常规护理检测，而接受检测组合的患者有9227名。在接受常规护理检测的患者中，CT检测呈阳性的比例为4.0%，GC检测呈阳性的比例为0.85%。在接受检测组合的患者中，CT检测呈阳性的比例为9.1%，GC检测呈阳性的比例为6.4%。接受三部位检测组合的患者CT检测呈阳性（优势比[OR]，2.70；置信区间[CI]，2.46 - 2.97）和GC检测呈阳性（OR，4.00；CI，3.59 - 4.64）的可能性更高。与黑人患者相比，白人患者接受检测组合的可能性最大（OR，3.14；CI，2.96 - 3.33）。感染艾滋病毒的患者接受检测组合（OR，15.62；CI，14.67 - 16.64）以及CT检测呈阳性（OR，1.27；CI，1.07 - 1.51）和GC检测呈阳性（OR，1.39；CI，1.14 - 1.68）的几率更高。
与接受常规检测的患者相比，接受检测组合的患者CT和GC检测呈阳性的几率更高。医生培训可能有助于解决在检测组合纳入方面观察到的种族和性别差异，并提高其利用率。直肠部位的自我采集应能提高CT和GC的检测率。
