Provision of Emergency Contraception in an STD Clinic

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Provision of Emergency Contraception in an STD
Clinic

• Evaluation 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
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Results EC Pilot Project - Jamaica, Queens STD
Clinic 4/16/03 11/10/03
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Results EC Pilot Project - Jamaica, Queens STD
Clinic 4/16/03 11/10/03
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Results - EC Eligibility EC Pilot Project -
Jamaica, Queens STD Clinic 4/16/03 11/10/03
Total 250 women eligible
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Results - EC Acceptance EC Pilot Project -
Jamaica, Queens STD Clinic 4/16/03 11/10/03
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Comparison of EC-only to STD Evaluation
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Comparison of EC-only to STD Evaluation
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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