This document discusses the collaboration between the LA Gay & Lesbian Center (LAGLC) and the Los Angeles County Sexually Transmitted Disease Program (STDP) over 35 years. Their collaboration has led to integrated STD/HIV testing, data sharing, and several successful collaborative projects. These projects include pooled nucleic acid amplification testing for acute HIV, patient-collected rectal swabs for screening, and a community-embedded disease intervention specialist program for partner notification. The partnership has improved epidemiological monitoring, increased screening, and enhanced partner notification outcomes.

1. Collaboration between
Health Departments and
Community-Based
Healthcare Organizations:
A Case Study of Success
Robert K. Bolan,1 MD, Ellen T. Rudy, PhD,2
Swanand D. Tilekar,MSc,MPH1, Christine
Wigen, MD,MPH,2 Peter R. Kerndt, MD, MPH2
1 LA Gay & Lesbian Center (LAGLC) and the
2Los Angeles County (LAC) Sexually Transmitted
Disease Program (STDP)

2. BENEFITS OF COLLABORATION
 The technical expertise and organization
skills of a public health department
– plus
 The passion of a CBO and its community
credibility
– together
SHAPE RESEARCH AND HELP
MAKE IT RELEVANT
 Increasing the likelihood that resultant
programs will have sustainability and
effectiveness

3. OVERVIEW
 LAGLC and LAC STDP
have worked
together for OVER 35
years
 With the consultation
of STDP, in October
2005 LAGLC
integrated its STD
clinic and HIV
Testing & Counseling
programs to form:
THE SEXUAL HEALTH PROGRAM

4. OVERVIEW
 With integration
– Emphasis on the importance of testing for
both HIV and STIs at every visit
– Data sharing between LAGLC and STDP
– Increase in number of collaborative projects

5. EPIDEMIOLOGY OF SEXUALLY
TRANSMITTED INFECTIONS AMONG MSM AT
LAGLC SHP
 LAGLC SHP serves as the sentinel surveillance site
to monitor STIs among MSM in LAC
 Significant STD Morbidity facts from LAGLC SHP:
– Dx’d 14% of early syphilis cases in LAC in 2008
– Over 1000 cases of GC, 950 cases of CT per year
– Approximately 200 cases of recent HIV infections per
year
– 52 acute HIV infections between Feb 2006 and June
2009 (median HIV VL 466,386)

6. COLLABORATIVE PROJECTS
 Pooled Nucleic Acid Amplification Test
(NAAT) for diagnosing acute HIV
 Patient-collected rectal swab for GC
and CT evaluation
 Community-Embedded Disease
Intervention Specialist (CEDIS)

7. POOLED NAAT TESTING FOR ACUTE HIV
 2006-07 LAGLC participated in CDC-
funded multi-site NAAT study
 LAGLC dx’d 82% (33/40) of acute cases
found in LA county
 Patient and staff acceptability was high
 NAAT testing now integrated into routine
HIV testing

8. 2007 VALIDATION AND DEMONSTRATED
FEASIBILITY OF PATIENT-COLLECTED
RECTAL GC/CT SWABS
 Adding self-collected rectal swabs has been associated with a
284% increase in rectal screening and a 145% increase in +CT
Rectal and a 112% increase in +GC Rectal
2007 Total New Visits Positive 2008 Total New Visits Positive
(N=9,877) n (%) (N=10,078) n (%)
Laboratory Test N (%)** n (%) n (%)** n (%)
Chlamydia
Urethra 7295 (74) 363 (5) 7665 (76) 331 (4)
Rectal 1840 (19) 249 (14) 7079 (70) 611 (9)
Gonorrhea
Urethra 7295 (74) 306 (4) 7665 (76) 274 (4)
Pharyngeal 7214 (73) 471 (7) 7520 (75) 358 (5)
Rectal 1840 (19) 207 (11) 7079 (70) 440 (6)

9. COMMUNITY-EMBEDDED DISEASE
INTERVENTION SPECIALIST (CEDIS)
PROGRAM IN LOS ANGELES
 Innovative strategy for notifying partners of
STI and/or HIV index cases (partner services)
 Modeled after Howard Brown Clinic, Chicago
 Established in Los Angeles in 2008
 Organization of CEDIS Program:
– Employed by and stationed at LAGLC SHP for
timely interviewing of clients
– Peer of the community and staff at LAGLC
– Technical training at STDP
– Daily schedule at LAGLC

10. OVERALL BENEFITS OF PARTNER
NOTIFICATION
 Partners notified confidentially
 Partners may not be aware of their risk
 Earlier testing, counseling and linkage to
care
 Heighten partners sense of susceptibility
and vulnerability to infection
 Potential to reduce STI rates

11. BENEFITS OF PARTNER NOTIFICATION
BY CEDIS
 Notification is by an employee of the
trusted CBO where testing and other
services are obtained
 Reduce the time to interview of index
case
 Interviewer is most commonly a peer
of the person being interviewed

12. CHALLENGES TO PARTNER
NOTIFICATION
 Acceptance by client
 Anonymous partners
 Negative effect on relationships
 Clients with repeat infections

13. TWO DATASETS TO EVALUATE PROGRAM
Compare data before and after CEDIS
implementation
 Pre dataset represent Traditional PN
– Jan – Dec 2007
– 150 ES Cases (102 PS)
 Post dataset represent CEDIS PN
– Jan – Dec 2008
– 142 ES Cases (98 PS)
 Data extracted from STD surveillance
system

14. TIME TO INTERVIEW
Percent of Cases Interviewed within 7 days-LAGLC
0.80
70%
0.70
0.60
Percentage
0.50
41%
0.40
2007 - Traditional
29% 2008 - CEDIS
0.30
0.20
8% 9%
0.10 4% 5% 3%
0.00
1 2 3 4
Quarter
Continued improvement each quarter in 2008

15. LOST TO FOLLOW-UP
Percentage of Cases Not Interviewed -
LAGLC ES Cases
0.35
0.30
0.25
Percentage
0.20 Traditional - 2007
0.15 CEDIS - 2008
0.10
0.05
0.00
1 2 3 4
Quarter

16. PARTNERS ELICITED/CASE ASSIGNED)
Partner Elicited per Cases Assigned Ratio -
LAGLC-ES CASES
2.50
2.11 2.06
2.00
1.56
1.50 1.32 1.30
Ratio
1.11 2007 - Traditional
1.00 0.91
1.00 2008 - CEDIS
0.50
0.00
1 2 3 4
Quarter

17. BENEFITS SEEN FROM CEDIS PROGRAM
BETWEEN LAGLC AND STDP
 Significant improvement in partner
outcomes: time to interview; lost to follow-
up; partners elicited, located and notified
 Reduced burden of cases at STDP
 Medical record searches within 1 day
 Buy-in from CBO staff and community

18. MAKING PARTNER NOTIFICATION SOCIALLY
ACCEPTABLE

19. THE PATH AHEAD
 Initiated HIV PN follow-up at LAGLC in 2009
 Newly diagnosed HIV cases including acute
– Acute followed up within 48 hours
 Include existing HIV cases co-infected with
gonorrhea (GC) or chlamydia (CT)
 Existing HIV cases w/ GC or CT not followed-up in
the past
– Evidence suggests co-infected STDs facilitate HIV
transmission –Fleming et al (1999); Bolan et al (2008).

20. CONCLUSIONS
 All 3 collaborative programs integrated
into clinic routine after initial evaluation
found successful
 Buy-in from CBO staff and community
crucial to sustainability of projects
 Intent not to control but to respect the
strengths of each organization

21. Thanks…
 To the diligent staff at LAGLC
 To our collaborators at LAC STD
Program