Chris Wolski (00:06):
Welcome to Clinical Lab Chat, part of the MEDQOR Podcast Network. I’m Chris Wolski, director of Business Intelligence for C L P, and today I’ll be speaking with bds Dr. Jeff Andrews about the implications of bds recent S t I survey for testing access. We’ll be talking about testing access and the need for just better health education in general. Jeff is vice President of Medical Affairs for Integrated diagnostic solutions at bd, and he’s also a board certified obstetrician and gynecologist who has provided care and com community settings in both metropolitan Toronto and Washington d c. He has also provided care and academic settings, such as, as an associate professor at Duke University Medical Center at Vanderbilt University Medical Center. So, Jeff, welcome to Clinical Lab Chat. I, I think we’re gonna have a really, hopefully a very interesting conversation, particularly in light of the, the, the BD survey.
So with STIs rates reaching record highs the C D C unfortunately puts the infection rates at one in five Americans, which is just, seems really, really through the roof. I think BDS survey is super well timed and certainly is shedding light on some of the really important issues surrounding testing and healthcare in general. So, Jeff, there were some really striking stats in the survey and two that really stood out to me were the low rates of gynecological exams for Asian, black and Hispanic women. They’re all at about 10%. The other thing that struck me is that only 19% of women report that their healthcare providers have discussed that types of tests that are available for their symptoms. Now, what are some of the other striking statistics that came out of the survey that the laboratory audience should know about, and what does that really say about healthcare for women in general?
Dr. Jeff Andrews (02:03):
Thanks, Chris, and it’s great to be here. I I just wanna explain a bit more. The, the numbers of Asian, black and Hispanic women who have not had a gynecologic exam numbered in the, in the realm of, of 10%, there was some variation, whereas in white women, it was 4%. So they were, they were, women of color were as mixed, was three times less likely to have had a gynecologic exam. That was, that was one of the points. Absolutely. the fact that only 19% said their provider was explaining the test they were ordering or, or getting seems very low. And, and as you pointed out, this is an epidemic that keeps increasing, not decreasing. And one of the reasons for it is lack of awareness about the diseases. Some of the symptoms or the fact that they can be asymptomatic and certainly about testing. So there’s also an access problem that you’ll probably ask me about. ’cause I know you’re interested in that.
Chris Wolski (03:09):
I I will be asking that
Dr. Jeff Andrews (03:11):
<Laugh>. Yeah. Even when women are accessing healthcare, they’re not receiving information during the visit. So that’s disappointing. And, and we found that the women in the survey reported that eight 82% thought their provider could have told them more about STIs. 79% thought their provider could have told them more about vaginal infection. And 82% also thought they, they could have been better informed about treatment options for both STIs and vaginal infections. Of the women who had had a vaginal infection, only 37% thought that their healthcare provider was able to diagnose their symptoms and prescribe the appropriate treatment after one visit. In other words, they were dissatisfied with what happened following that visit, maybe had to go back for more visits.
Chris Wolski (04:01):
Right, right. And cer and certainly that’s, that’s a drain on the, in, in a, in a more general way. That’s a, a drain on the health healthcare system in and of itself, if you have to go back multiple times for, for treatments or to address other, other issues that have come up. So, as you indicated, and as regular listeners know healthcare access is something that really, really interests me. And I, and I think it’s a really important thing that, that we all need to talk about a lot more. And that comes particularly in light for our laboratory audience of another statistic from an earlier survey this one from the Lancet, I think it was last year or the year before I think it was last year, that that study came out, that 47% of people worldwide don’t have access to basic medical tests. I think some of them, including some basic gynecological tests as well, in particular is part of what’s fueling the s t i epidemic a a lack of access to these, you know, very crucial and basic tests for STIs. And even more to the point, are we supposed to address the epidemic without testing since testing overwhelmingly is relied on to make healthcare decisions. So it seems like we are, we’re kind of in a, a vicious circle here a little bit.
Dr. Jeff Andrews (05:19):
Yes, Chris, I think that Lancet quote you’re giving there is probably from W H O and yes, access to healthcare diagnostics and therapeutics is a factor. There’s, there’s other factors that we’ve touched on. Knowledge, condom use, things like that, right? You could say, oh, well, we’re in the United States. We’re not we’re not in the, in the, in the whole world, but if we look across SS t i statistics from c D C, we see that states like Mississippi and Louisiana have very high rates matching some of the global rates. And so the problem here is really underserved communities that, that have less access to all types of, of healthcare in including this one. Right. You don’t necessarily have the the resources.
Chris Wolski (06:18):
Right now, I know I’m in California and I and bd, I, I, I know that they worked with Planned Parenthood up in the Bay Area to get some testing provided to women who may not have access or, or, or have the economic ability to, to pursue testing or, or, or healthcare in general. So is that some something as well? I mean, you know, Cal California, you know, you think we’re, we’re a big state or, you know, or, you know, we’re, you know, always at the forefront of everything, you know, of Silicon Valley, and we have this huge epidemic going on. I mean, is that kind of a model? Is, is that more of a model of what needs to be done in terms of getting access? Maybe starting from, you know, particularly those underserved communities and some of the people that you know, the statistics that, that we were talking about earlier in, in reaching those women who are in those communities who might not have the access again that, that other other folks have,
Dr. Jeff Andrews (07:25):
You’re right. That Medicaid clinics within states and county healthcare as well as Planned Parenthood and federally qualified health clinics do offer these services. But not everyone’s aware of that, or Right. Or aware that they are someone who may be at, maybe at risk and should be screened, either based on age or other factors. Another one of the disturbing statistics is the 32% increase in congenital syphilis babies born as sli.
Chris Wolski (07:57):
Dr. Jeff Andrews (07:58):
Because there should be a 100% screening for that. It means women aren’t having the prenatal screening. Right. So in many of these STIs that we’re talking about, gonorrhea, chlamydia, trais, syphilis, even H I v, can be asymptomatic for long periods of time. And so that, that may be part of the problem too, is that lack of recognition for that.
Chris Wolski (08:23):
Yeah. I mean, should, I mean, this is, you know, so let’s, let’s talk about testing for a second, just in general. I mean, should, should STI s t i screening and testing, do you think, in your opinion do you think that that should become kind of as basic as checking for A one C or some of the other basic tests that we all we’re all getting tested for cholesterol, et cetera, that we’re all getting tested for from, you know, the time we’re in our twenties or, or, or even younger? Do you think that should become more of a go-to sort of test, if I could use that term, or, or, you know, more of a universal testing? Should we have more universal testing in your opinion? Make this part of the menu that we’re all getting tested for, you know, men and women are getting tested for?
Dr. Jeff Andrews (09:15):
I’d like to refer to the current US guidelines that are from the C d C or, or the organization for OBGYNs or for primary care or the United States Run of Task Force services. They, they recommend testing based on age under 26 but not universal testing, and then testing in pregnancy and testing for people who have risk factors. And the risk factors include unprotected sex with more than one sex partner drug use and other sorts of things like that. Right. So there’s, there’s definitely large numbers of the US who are, who are high risk, but there are also people who may not consider themselves to be high risk, but also have an s t i, as you said, it’s one, one in five people in the United States a given moment, have an sti.
Chris Wolski (10:10):
Right. Okay. So let’s talk about, let’s, let’s get into that then a little bit, understanding. Another thing that struck me from the survey is just a general, the general lack of understanding about health in general. Just there was just a couple of statistics that it’s obvious that the respondents really just didn’t understand certain basic healthcare concepts or, or, or issues relating to their, to their health. What we really saw, and to broaden this out just a little bit, and I, I think this is important to put it maybe in this context, we really saw that during the pandemic. And, and, and I know I heard a lot of really wrongheaded and wrong ideas about health from my family, friends, and acquaintances about some really bad ideas <laugh>. So, and, and really, and I’d say bad. I, I wouldn’t even say silly, I would just say bad and uninformed and, and ignorant in, in that just how stunningly badly we’re, we’re educated about our, our health.
How bad is our health education, particularly around sexual health. You know, again, as you as a professional, how bad is it really? And what do, what do we do about it, particularly in the climate that we’re in now, I don’t wanna get in politics too much, but how, how do we fix this? How do we do this? I mean, we’re having a, you know, an epidemic here in California. And, and as you pointed out in other parts of the country, how do, how do we, how do we address this? You know, how do we improve this? And how do we address, how do we address, how do we address it?
Dr. Jeff Andrews (11:40):
Yeah. I was a little surprised by this survey, but we did a, a similar Harris poll a few months ago around H P D caused cancers. Oh, yeah. And found out that the knowledge about H P V was much lower than what we see in this survey. And again, the need for more education, which, when you work in the field, it’s surprising that everyone doesn’t know what you know. So there’s Right.
For more education that came out now, among these women that, you know, there were a thousand women over the age of 18, a majority, 77% said they were knowledgeable about vaginal infections. I think, ’cause that’s fairly common. It’s the number one reason for teaching G Y N or urgent care. So they felt like they knew about that, but they were less knowledgeable about STIs, which is, which is not surprising. And so there’s different ways that you could receive education kind of push pull in a sense. So you could go look into, it’s fairly easy to find, as you were pointing out when you asked me the question, there’s also a lot of misinformation. So for STIs, I would, I would direct people to go to the C D C because they have good information for lay people. But then what, what was disturbing to me about the survey was that even when someone was in with symptoms or asking about vaginitis or STIs, they still weren’t receiving information or the notion that they would, they knew they had a test, but they didn’t know why that test or what the test was.
So we could do better as a clinical healthcare system and forming people at the moment. ’cause That was a teachable moment.
Chris Wolski (13:26):
Right. I mean, it’s, it’s interesting you know, to switch, switch gears a little bit, but away from women’s health. But, you know, it’s interesting, and there was a survey I think that came, or a study that came out, I think about EM impacts and about how that really got got tamped down because of the at-risk populations really said, understood, we have an, there’s an issue here. They got the word out and they, and, and, and people who thought, you know, they either had symptoms or thought they may have been exposed, were getting tested. And that really tamped that down. I mean, so you have a, and a lot of that came out of experiences with h Hi, which with H I V back in the eighties and early nineties. So, I mean, so you had, in that case, you, you see what a really educated community looks, you know, how they react and how they really, you know, kept, kept those addressed, addressed that what could have been a really big, big issue, a big mess.
And again, it wasn’t perfect how everything was handled, but better certainly than what we’re doing with our current s t i out epidemic. And, and of course, it’s affecting not only, you know, the mothers and their partners, but also any children that they’re having as well, potentially. So I mean, I think that was a really interesting model. How do we replicate that? How do we get that in? Do, I mean, is this, is this does this start with just, this can’t just be in the doctor’s office that can’t just be in your office. It has to be in other other areas as well, you know, sex, sex education in schools and, and and and beyond. How do, how do we do outreach to, to help help with that in, in that regard? And again, you know, we’re gonna, you know, it’s, it’s, you know, the political you know, again, I don’t wanna talk about politics here, but necessarily, but, you know, some of it is, you know, there is that overlay of some of the political issues going around as well that I think is tamping down or, or, or suppressing some of that, that education and a, and a really honest, forthright sort of way.
Dr. Jeff Andrews (15:48):
Yeah. interesting. BD did join into the the <inaudible> fight by, by rapidly developing a, a test for that. Right. I think some of the differences there is that there, the people who had, that had symptoms and there was visible signs, and they were able to share photographs and other images of what it looked like, which we saw on television in the news and in social media. Right.
Chris Wolski (16:20):
Dr. Jeff Andrews (16:20):
There are a couple STIs that that you can see visually like right. Al Ada or venereal warts, but most of the ones that we’re talking about, gonorrhea, chlamydia, ssis, syphilis, h i v, there’s nothing to see. And, and people aren’t sharing sexually related diseases as freely as they might have with M Fox. So I think that part of the problem is that people tend to keep quiet about sexually transmitted infection because it’s right there in the name. How did I get this? It’s not
Chris Wolski (16:55):
Dr. Jeff Andrews (16:56):
A concert and got covid. That sounds fairly innocent.
Chris Wolski (16:59):
Yeah, for sure. And that, and that’s the problem. It’s always been, it’s been the problem. It’s the problem with H I V back 40 years ago. You know, there’s the social, the social stigmas that are attendant with that. And, and certainly that is maybe something that might be something we need to you know, maybe that’s something we need to address once we you know, get the get the infections under control a bit. I, you know, I think being more forthright and open about these issues I think is certainly a way to to help get over it. So alright. So certainly education is a big, big thing. And, and we’re not gonna solve that today, but one thing we can talk about is solutions. So let’s, let’s switch gears a little bit. Let’s talk about testing. So what are some of the technologies that are making a difference in s t i testing that’s being provided to healthcare professionals in labs? So what are those tests out there? Are there any new ones you know, at home testing, new, new rapid testing testing new tests for different diseases? What, what’s out there that, what, what can we add to the, the tool, the laboratory toolbox here?
Dr. Jeff Andrews (18:16):
So, BD has developed molecular tests for CH gonorrhea and trichy isis, which are on an instrument that’s kind of a mid volume that you could find in a small lab, but it also can be in a large clinical practice. And then we also have that now on our large high throughput fully automated device that the BD core device within the office type setting, that, that instrument could give results the same day. And then we were also in the forefront of developing molecular testing for vaginitis, which could be bacterial vaginosis or a candida, also known as ssis. That test is also on both our max instrument mid, mid-size, and our large high throughput core instrument. So that’s where, that’s where we’ve been advancing. We still have our, our decades old Affirm test, which was a point of care test for the vaginitis as well. And then we continued to develop other rapid molecular point of care testing. That’s probably the future. Mm-Hmm. <affirmative>, we can use one swab to, to test for all of these things. And that swab can be self collected. So, as you know, self collection is getting a lot of attention and boosted by Covid somewhat. So we’re very interested in supporting both self collection and in some areas self testing in, in this area. It’s because of the sophistication of a test you need, need a lab. Mm-Hmm. <affirmative>.
Chris Wolski (19:51):
Okay. All right. So I always like to leave our discussions with what the audience can do to be part of the solution. So how can CLPs laboratory listeners help to improve testing for STIs? I mean, is there anything they could do? Is this a, you know, a, I don’t know, can they evangelize in some ways? Can they help work with healthcare providers to help them get the word out get instruments like the ones you were talking about out there in their, in the labs or in the offices, and help them reach, reach these, reach women that, that need, that need it the most?
Dr. Jeff Andrews (20:37):
Yeah. Chris, my, my own experience with that is quite, quite positive. And I, it’s tied to the electronic medical record, which the vast majority of clinicians are using now. So the E M R can help us be better clinicians by reminding us to do things and, and prompting us. Mm-Hmm. <affirmative>. So it’s, it’s pretty easy to program it based on age risk factor or another diagnostic code that I put in to ask me if I want to order SS t i screening, and then that can be, can be batched in, into a code. So my own experience is the lab folks coming by the office to chat with me, to raise my awareness to make sure that mm-hmm. <Affirmative> I have the right codes to help me put in prompts to make sure that I am doing optimal testing for, for my patients. So I think that relationship is very important.
Chris Wolski (21:29):
Okay. Great. Well, with that, unfortunately, we’ve come to the end of our time. Jeff, thanks again for taking the time to speak with me. I think we covered a lot of really important issues here and certainly is a critical issue of our time. I also wanna thank you the laboratory audience for listening. Look for more episodes of Clinical Lab Chat in the future and visit us [email protected] and on all the major social media platforms. So until then,