provision of emergency contraception in an std clinic evaluation of a pilot project in new york city...
TRANSCRIPT
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Provision of Emergency Contraception in an STD
ClinicEvaluation of a pilot project in
New York City
New York City Department of Health and Mental Hygiene (NYCDOHMH)
Bureau of Maternal, Infant and Reproductive Health
Bureau of Sexually Transmitted Disease Control
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Background Emergency Contraception (EC)
• Definition -- Use of a drug or device to prevent pregnancy after intercourse
• Action --• prevents ovulation• disrupts fertilization • inhibits transport of the egg or sperm or
implantation in the uterus
• EC IS NOT A MEDICAL ABORTION
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BackgroundEmergency Contraception (EC)
Types:• Insertion of a copper intrauterine device (IUD)
• Emergency contraceptive pills (ECPs)
Preven (estrogen and progestin) – FDA approved 98’
Plan B (progestin only) – FDA approved 99’• Two doses:• 1 tablet within 72 hours of unprotected intercourse • 2nd tablet taken 12 hours later
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Background New York City (NYC)
• March 2003 the NYCDOHMH designated staff to conduct a pilot project evaluating integration of EC into STD clinic services
• March 18, 2003 NYC Council passed local law 19 requiring the integration of EC into public STD clinic services
• Local law 19 took effect July 18, 2003
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Objectives of EC Pilot Project
• Assess ability to integrate EC services into STD clinic services
• Determine the value of integrating EC services into STD clinic services
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Outcomes of Interest• Assess number of women eligible to receive
EC at a NYC STD clinic
• Assess number of women eligible to receive EC that were offered EC
• Assess number of women accepting EC
• Compare the characteristics of women attending for EC only to those seeking an STD exam
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MethodsEvaluation Design
• Pilot site: Jamaica, Queens STD clinic
• Population: women attending Jamaica, Queens clinic for first visit between 4/16/03 – 11/10/03
• Data collection: data extracted from clinic medical record, database developed to capture information
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MethodsDetermining Eligibility
• Women– first visit to clinic (not follow up)– not surgically sterilized– not pregnant, and did not desire pregnancy– had unprotected vaginal intercourse in the
72 hours before clinic visit
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MethodsOffered EC/Accepting EC
• Offered EC – eligible women who were offered EC
• Accepting EC – eligible women who accepted the offer of EC
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MethodsSTD Morbidity
• STD Morbidity – diagnosed with, or contact to any of the following:
Chlamydia, Gonorrhea, genital Herpes infection, Human papillomavirus, Mucopurulent cervicitis, Non gonococcal urethritis, Pelvic inflammatory disease, pubic lice, Syphilis, Trichomonas vaginalis
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Reason for Visit
• EC Only
• HIV Test Only
• STD evaluation– Routine exam / pap smear– Symptoms– Contact– Women listing EC, HIV testing among
reasons for visit
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Results EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03
Age (Years) N %
<14 8 0.5
15 – 19 391 26.0
20 – 24 484 32.2
25 – 29 225 15.0
30 – 34 127 8.4
35 – 39 121 8.0
40 – 44 68 4.5
> 45 80 5.3
Missing 1 0.1
Total 1505 100
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Results EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03
Race / Ethnicity N %
Black Non-Hispanic 1056 70.2
Hispanic/Latino 247 16.4
White Non-Hispanic 66 4.4
Asian Pacific-Islander 43 2.9
American Indian/Alaskan Native 12 0.8
Other 72 4.8
Missing 9 0.6
Total 1505 100
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Results
EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03
Usual Method of Contraception N %
None / Natural 604 40.1
Barrier 547 36.3
Hormonal 119 7.9
IUD 7 0.5
Hormonal and Barrier 14 0.9
Surgical Sterilization 47 3.1
Missing 167 11.1
Total 1505 100
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Results - EC Eligibility
EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03
1st time female visitsN = 1505
STD EvaluationN = 1160
EC OnlyN = 91
HIV C&T OnlyN = 56
Repro hx present
N = 1103
Repro hx missingN = 57
Repro hx presentN = 88
Repro hx missingN = 3
EC EligibleN = 192(17%)
EC eligibleN = 58(66%)
Reason MissingN = 198
Total = 250 women eligible
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Results - EC Acceptance EC Pilot Project - Jamaica, Queens STD Clinic 4/16/03 – 11/10/03
N %
Assessed for EC Eligibility 1191
Eligible to Receive EC 250 21.0
Offered EC 146 58.4
Accepted EC 95 65.1
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Comparison of EC-only to STD Evaluation
Age
EC only
(n=91)
STD Evaluation
(n=1098)Total
(n=1198)
< 19 years 43 (12%) 303 (88%) 346
> 20 years 48 (6%) 795 (94%) 843
p < .01
Contraception
None/Natural/Barrier 86 (9%) 916 (91%) 1002
Hormonal/IUD 1 (0.9%) 112 (99.1%) 113
p < .01
Race / Ethnicity
Black Non-Hispanic 57 (16%) 837 (94%) 894
All Other Races 33 (9%) 319 (91%) 352
p =.085
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Comparison of EC-only to STD Evaluation
STD Morbidity1
EC Only
(n=27)
STD Evaluation
(n=839)Total
(n=866)
1 (.2%) 495 (99.8%) 496
p < .01
1 STD morbidity assessed among women who had a physical exam
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Conclusions• Of the 1505 women attending the Jamaica clinic during the pilot, 6% attended
the clinic for EC only
• 40% of women reported using no contraception and 36% reported use of barrier as usual method
• 21% of women were eligible to receive EC
• 58% of women EC eligible were offered EC
• EC accepted by majority of eligible women offered EC
• 1 of 27 women attending for EC only, who had a physical exam, were diagnosed with an STD
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Implications
• Clinic utilization should be monitored to assure introduction of EC does not reduce the number of women seen for STD evaluation
• STD morbidity should be monitored among women seeking EC only to guide decisions regarding the value of screening in this group
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Acknowledgements
Bureau of STD Control
Julia A. Schillinger
Susan Blank
Susan Wright
Maushumi Mavinkurve
Linda Kupferman
Robin Recant
Bureau of Maternal Infant & Reproductive Health
Nalda Mussington
Lili Farhang
Deborah Kaplan