Strategies to Increase Access to Care
A major barrier to STI and HIV testing and treatment services is stigma. Individuals may experience fear, shame, and discomfort that prevent them from seeking out STI and HIV services or from disclosing risk factors to providers.
Strategies to increase access to STI and HIV care therefore include those that support confidentiality and enable people to exercise more autonomy in the care they receive and how they receive it. Modalities that emphasize and enable self-care are increasingly commonplace in the care of STIs and HIV. Some of these include self-swabbing for specimen collection, at home testing, and telehealth. Providers may offer these strategies to patients when possible.
Express Visits
STI express visits increase access to care by allowing people to receive walk-in STI testing and treatment without a full clinical exam. Research has found that express visits increase clinic capacity, reduce time to treatment, reduce visit time, decrease visit cost, and are associated with high patient satisfaction.130, 131 Express visits rely on a system of triage to quickly assess which patients are eligible for express services; they can be implemented alongside comprehensive services. Clinical settings interested in starting or scaling up STI express visits can find adaptable resources in a toolkit developed by the National Association of County and City Health Officials in collaboration with the CDC.131
Self-Testing
Self-testing is another option that can benefit individuals who do not want to or are not able to come into a facility for testing and may help reach people who would not otherwise get tested. An FDA-approved home tests for HIV and syphilis allow people to test and find out their result in a location of their choosing. Other STI test kits produced by various private and public entities enable people to collect their own specimens, which they then mail in for testing. Providers should support all people who want to access testing through self-tests. Clinic protocols and workflows should be adapted to facilitate timely access to follow-up care and treatment for persons selecting self-testing.
Performing Self-Swab for Specimen
Many people who receive in-clinic testing prefer to collect their own specimens for STI testing. Specimens obtained through self swabbing have the same sensitivity as clinician-obtained samples. Providers can offer people the option to perform their own swabs with FDA-authorized self-collection kits during in-clinic testing as part of a trauma informed and person-centered approach. Visual aids— which can be posted in restrooms or other areas where self-swabbing occurs—can help explain how to effectively collect a specimen. Diagrams in English and Spanish show how to self-collect vaginal, anal, and oral swabs.132
Partner Services, Including Expedited Partner Therapy
Patients should also be counseled about the need to communicate with, evaluate, and treat partner(s) to avoid reinfection. Clinical staff can offer to assist those notifying partners of STI exposure through coaching on partner notification, providing written information to share with partners, or reaching out to partners directly with the person’s consent and authorization. In some cases, state health departments may provide partner notification for some STIs as part of a broader range of public health services; if this is the case, patients can be informed of these services and that their partners may be notified of their exposure. People may also use online anonymous partner notification services, though the effectiveness of these services is unknown.
It is important to encourage all partners to seek timely evaluation and treatment. If a person did not receive same-day testing and treatment, providers can encourage them to bring their partner(s) with them when returning for treatment and treat everyone concurrently. Expedited partner therapy (EPT)—which involves treating the sex partners of persons diagnosed with chlamydia or gonorrhea by providing prescriptions or medications to the person to give to their partner(s) without the health care provider first examining the partner(s)—is a strategy to increase access to treatment for individuals who might not otherwise receive timely treatment.133 EPT is legal in most states.134 Providers should routinely offer EPT to people with chlamydia as a way to support patients to ensure all their partners will be able to receive timely treatment regardless of the partner’s ability to seek and obtain treatment on their own. For partners exposed to gonorrhea, every effort should be made to provide treatment using the recommended intramuscular treatment regimen; however, if an exposed partner is unable or unlikely to access intramuscular treatment, EPT can be provided using the oral treatment regimen recommended by the CDC.135