Gonorrhoea and chlamydia screening in HIV clinics: time for new tools and targets

Time constraints are commonly brought up by doctors. 14 Task shifting to nurses, patient self-collection and electronic reminders have yielded successes. 1 2 8 15 Not surprisingly, sexual health specialists who provide HIV care outperform other HIV providers, screening 41% of MSM completely at urethral, rectal and oral sites compared with 6% complete screening by other providers in an Australian study. 10 How can non-sexual health specialists be trained, and what clinical and policy incentives will lead to sustained, improved compliance? Implementation of more targeted screening will be easiest when the groups are well defined. Because data are lacking, US guidelines indicate that for HIV-infected women (over 25 years old) and for men without a history of receptive rectal or oral exposure, providers should decide whether to screen based on individual risk assessment. 17 Having to consider each case may be prohibitively time consuming and may prevent interventions like task shifting to nurses and electronic reminders.