LAUSR

Background The U.S. Preventive Services Task Force (USPSTF) recommends behavioral counseling for youth at high-risk for STDs, but little work has explored translation of these guidelines into practice. Here, we evaluated a large-scale implementation of behavioral counseling in federally qualified health centers (FQHCs). Methods Implementation occurred between June 2017 and May 2018 in four FQHCs in Northeastern US. Many patients were below the poverty level (27–65%) or uninsured (13–47%). Training content comprised motivational interviewing skills and techniques for talking to youth about sex and sexual histories, delivered to pilot providers via 15 hours of online and in-person training. We measured the proportion of patients who received (a) a sexual history, (b) behavioral counseling, (c) HPV vaccine and (d) chlamydia screening. We tracked changes in work-flow and implementation and allowed for tailoring of sexual history taking per the needs of FQHCs. Results 39,631 eligible patients (13–24 years old, 71.0% Hispanic, 68.3% white, 24.9% black) were seen during the implementation period, of whom 9,675 (24.4%) saw a pilot provider. Similar proportions in each group completed a sexual history (70.6% vs. 71.4%, p=0.1787). However, higher proportions of patients exposed to the pilot providers received behavioral counseling (67.5% vs. 43.5%, p<0.0001), HPV vaccine (71.7% vs. 51.2%, p<0.0001) and chlamydia screening (38.4% vs.32.1%, p<0.0001). Of youth who were seen by a pilot provider and given a sexual history, 84.2% received behavioral counseling. Of counseled patients, 83.6% received HPV vaccine and 85.2% were screened for chlamydia. Work flows were individualized to each health center and became increasingly efficient over time. Conclusion Primary outcomes from this translation study support the conclusion that an intensive, but short, training regimen on behavioral counseling, coupled with a flexible strategy for assessing sexual histories, results in higher rates of behavioral counseling and provision of prevention services as compared to those who did not receive training. Disclosure No significant relationships.