# Presentation: 110131

## 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**

## 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

## BackgroundEmergency 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

## 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

## 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

## 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

## MethodsEvaluation 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

## MethodsDetermining 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

## MethodsOffered EC/Accepting EC

- Offered EC – eligible women who were offered EC
- Accepting EC – eligible women who accepted the offer of EC

## MethodsSTD 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

## 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

## 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 |

## 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 |

## 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 |

## Results - EC Eligibility EC Pilot Project - Jamaica, Queens STD Clinic  4/16/03 – 11/10/03

- Total = 250 women eligible

## 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 |

## 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
 |  |  |

## 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 |  |  |  |  |

## 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

## 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

## 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