July 16, 2020, 02:59 pm Michael Devitt – Family physicians are ideally suited to educate and treat patients who have HIV infection or other sexually transmitted infections, and the AAFP has developed and maintains a multifaceted collection of resources members can use to screen patients for STIs and provide appropriate care.
For FPs interested in additional HIV infection and STI resources -- especially those who have transitioned to caring for patients remotely during the COVID-19 pandemic -- here's a welcome development from the CDC. In June, the agency updated its online Toolkit for Technology-based STD and HIV Partner Services, which serves as a general resource for health departments, community-based organizations and others authorized to provide HIV/STD partner services. The updates are intended to make it easier for family physicians and other health care workers in these settings to leverage technology to identify and notify people who have potentially been exposed to STIs and advise them to seek treatment.
"The CDC recommends partner services as an effective public health measure, and as family doctors, we can really make a difference in reducing community transmission if we embrace this concept," said Shannon Connolly, M.D., of Los Angeles, a member of the AAFP's Commission on Health of the Public and Science. "The great thing about the toolkit is that it covers many of the technical and practical implementation questions that physicians may have about partner services."
The updated toolkit features additional information on how to use mobile apps for partner notification, including a link to an app simulator that introduces users to various shared features common to popular social and sexual networking apps.
The toolkit also contains updated examples of technology-based partner services strategies such as sample emails and text messages clinicians can use when contacting clients for partner services.
In addition, the toolkit's Data Security & Confidentiality section has been updated to include sample confidentiality policies and agreements, which will help ensure that digital information such as screen names and email addresses is managed securely and confidentially.
One particularly timely feature is a link to an interim guidance document for health departments on how to develop and implement a COVID-19 case investigation and contact tracing plan.
Finally, the toolkit contains an updated list of suggested training topics, along with links to various programs from the CDC and other organizations.
Recently published research highlights the importance of family physicians in caring for patients with HIV infection and other STIs.
A research letter published in Family Medicine in 2019 found that 55% of all so-called HIV clinicians (defined as someone who provides treatment to 20 or more patients diagnosed with HIV infection) are primary care physicians; of those, 28% specialized in family medicine. The letter also cited internal communications with the American Academy of HIV Medicine, which reported that 44% of the PCPs credentialed by the Academy as HIV specialists were family physicians.
Similarly, the CDC's Sexually Transmitted Disease Surveillance 2018 report found that most reported cases of STIs came from non-STD clinics, such as private physician offices and community health centers, while new recommendations on providing STI services in a January 2020 Morbidity and Mortality Weekly Report cited research that suggested primary care clinics diagnose as many as one-half of all reported STIs.
Connolly, who practices in southern California, said she empathizes with her colleagues regarding the challenges associated with treating patients with these conditions.
"As family physicians, I think we've all had the experience of treating a patient for chlamydia, and then having them test positive for it again within a short time frame because their partner was not adequately treated at the same time," Connolly told AAFP News.
Connolly also shared some of her experiences in using technology to share information with patients.
"In my community, I'm very fortunate that our public health department manages notification, so I don't personally use apps or emails to contact patients about STIs," she said. "However, often when I'm counseling patients who may feel reluctant or unable to reach out to past partners about a possible STI exposure for whatever reason, I recommend using an app, as it is fast, can be anonymous and gets the information out there effectively."
Finally, Connolly recommended that FPs take advantage of the technological tools available to them to communicate with patients more effectively overall, while being aware of the potential risks involved.
"In this day and age, patients expect to be able to communicate with their health care providers electronically," she said. "We can really deliver more patient-centered care by reducing communication barriers and embracing technology.
"However, I would encourage my colleagues to always consider security and privacy risks when evaluating the use of new communication methods."