Kees Rietmeijer, MD, PhD, MSPH Colorado School of Public Health University of Colorado Denver

1. Providing Comprehensive Reproductive Health Services for Men Visiting Clinics for Sexually Transmitted Infections Kees Rietmeijer, MD, PhD, MSPH Colorado School of Public Health University of Colorado Denver Contact: kees.rietmeijer@dhha.org Advancing Men’s Reproductive Health in the Unites States: Current Status and Future Directions Atlanta, September 13, 2010

2. Want Slides? www.stdpreventiononline.org

3. Providers of reproductive health services are poised to address sexual risk taking and contraceptive decision making among men

4. Where to Access Menfor Reproductive Health Services • Family planning clinics? • Primary Care / Community Health clinics? • School-based clinics?

5. STD Clinics? • Serve men • Serve men at high risk for • Sexually Transmitted Infections • Causing unwanted pregnancy • Provide counseling for STI/HIV prevention • Provision of reproductive health counseling for women has been integrated in many STI clinics • Why not do the same for men?

6. A Tale of one STI Clinic Denver Metro Health Clinic

7. Denver Metro Health Clinic: • Largest STI clinic in Rocky Mountain West • Provides comprehensive STI care at no cost to client • Integrated services: • STI diagnosis and treatment • HIV testing, counseling, and linkage to care • Hepatitis A/B vaccinations • Hepatitis C testing • Family planning • 18,000 visits per year

8. DMHC Clinic Visits - 2009

9. DMHC Chlamydia - 2009

10. DMHC Gonorrhea - 2009

11. Denver Chlamydia Cases Reported from DMHC - 2009

12. Denver Gonorrhea Cases Reported from DMHC - 2009

13. Male Family Planning DMHC • Started in 2009 • Funding source: Title X • Eligibility criteria: • Hetero/Bisexual male • New problem visit • Not previously enrolled in calendar year • 2010 data: • 3,421 men enrolled • 99% of eligible men

14. Streamlining Clinic Processes Registration Triage  Identify symptoms  Interest in FP Services New Pt Visit  Sexual history  STD testing  Physical exam  FP, if applicable  NP, RN STD Follow-up  STD follow-up  Physical exam prn  FP, if applicable  NP, RN • Express Visit •  Sexual history •  STD screening •  FP, if applicable •  LPN, HCP, RN, • NP • FP Visit Only •  FP only •  NP, RN

15. Prevention Counseling at DMHC • All clinicians are trained in the basics of prevention counseling • Project Respect Model • Motivational Interviewing • Counseling adapted to single-session, clinician-based approach within the context of the clinic visit • Quality assurance through ongoing training and EMR prompts • Family planning counseling follows same counseling protocol

16. Electronic Medical Record

17. Electronic Medical Record

18. Demographics – Age(N= 3,421)

19. Demographics – Race/Ethnicity(N= 3,421)

20. Current vs. Planned Birth Control Method (N= 3,421)

21. Conclusions • Provision of family planning counseling to men is feasible in the setting of an STI clinic with almost 100% coverage achievable • Use of electronic records and prompting proved critical in achieving coverage (data not shown) • Preliminary data suggest that modest gains can be achieved, specifically in terms of a shift from relying on partner methods to an increased intent to use condoms

22. Acknowledgments • Judy Shlay, MD, MSPH • MoisesMaravi, PhD • Christie Mettenbrink, MPH • DMHC Clinic Staff Slides are available on www.stdpreventiononline.org Click “Resources”