Washington State’s SSuN Project: Overview and Population Sampling Schema Principal Collaborators Meeting Atlanta, GA December 2009

WA SSuN Overview Clinic Surveillance Trich Susceptibility Testing Patients seen at Harborview STD Clinic in Seattle Trich Susceptibility Testing King County Public Health Laboratory Population Surveillance GC patients 39 Counties Random sample Data Quality Assurance

Clinic & Trich Surveillance Summary Clinic Surveillance Harborview STD Clinic (Seattle) Data collected for 6,634 patient visits (1/2009 - 9/2009) Core, Standard, Lab and Dx data transmitted Trich Resistance Surveillance Women seen at Harborview STD Clinic (Seattle) Started 5/2009 Submitted 48 specimens as of 11/15 47 survived and were assayed 6.4% demonstrated in vitro resistance (MLC 50+)

What’s Happening with GC in WA? Gonorrhea Incidence Rate by Census Tract, Washington State, 2008 Gonorrhea Cases and Crude Incidence Rate, Washington State 1992 - 2008

Sampling Schema for Population-based Surveillance Activities There are two random samples 1. Fixed sample 0.22 sample fraction (22% of all cases) in 25 counties 0.15 sample fraction in King County 2. Variable Sample 0 - 0.50 sample fraction for some jurisdictions Can be changed to reflect staff capacity All GC cases diagnosed are eligible for sampling Sample assigned at the time the case is initially entered into the surveillance system

Sampling Schema Imports System.Web.Caching Public Class Randomizer Public Shared Function GetRandomObj As System.Random Dim ha As HttpApplication = HttpContext.Current.ApplicationInstance Dim cash As Cache = HttpContext.Current.Cache If ( IsNothing( cash("RandomizerObj") ) ) Then dim randomObj as New System.Random() cash.Insert( "RandomizerObj", randomObj, nothing, Cache.NoAbsoluteExpiration, TimeSpan.FromMinutes(20) ) End If return ctype(cash.Item("RandomizerObj"), System.Random) End Function End Class Random number generator returns an integer between 0 and 100 The random sample ‘cascades’ If Fixed Sample = No Then eligible for Variable Sample Effective sample fraction is increased for jurisdictions with a Variable Sample set at > 0

Sample Fractions

PHIMS-STD Data Management System Screenshots

Assigning the SSuN Sample

Overview

Brief Progress Report Population-based Surveillance 1,912 eligible GC cases diagnosed through 9/09 516 (27%) randomly selected 350/516 (68%) completed interview Completed interviews comprise 18.3% of all cases diagnosed Test data transferred and reviewed Quality assurance processes in place to assess missing data and provide interviewer feedback

Challenges Staff/Interviewer capacity at the local level Diversion of staff resources to H1N1 Interviewer turnover & training Finding and organizing metadata for analysis Permanent $ resources to support data/surveillance system Pressure to change existing data systems to conform with SSuN formats (e.g., exposure period of 2 vs. 3 months) Changing standards of care, new protocols, etc. Data collection methods (CASI in clinic, etc.)

Questions? Acknowledgements & Contacts: Mark Stenger, MA IDRH Assessment Unit, Washington State Department of Health Mark.stenger@doh.wa.gov, 360-236-3446 Roxanne Pieper Kerani, PhD Public Health – Seattle & King Co. STD Program/Harborview Medical Center rkerani@u.washington.edu , 206-744-8769 Matthew Golden MD, MPH Director, PHSKC STD Control Program Associate Professor of Medicine, UW Center for AIDS & STD Harborview Medical Center golden@u.washington.edu , 206-744-6829