, J Kraut 1, A McIntyre 2, H Beidinger 3,4, K Irwin 3 1 Northern Illinois University, DeKalb, IL 2 University of Illinois at Chicago School of Public Health 3 Centers for Disease Control and Prevention, Atlanta, GA 4 Chicago Department of Public Health Cost-Effectiveness Evaluation of Syphilis Screening at Cook County Jail Cost-Effectiveness Evaluation of Syphilis Screening at Cook County Jail

Background 1987: Routine syphilis screening for all detainees by Chicago Dept of Public Health (CDPH) 1996: High rates of early syphilis detected at Cook County Jail (CCJ)  “Stat RPR Project” –CDPH Disease Intervention Specialist at Women’s Intake Unit –Pilot Program with limited scope Women Second work shift (3 PM - 11 PM), M-F

Percent of detainees treated prior to release from jail*: –Routine RPR: 44%  Stat RPR: 88% New cases of early syphilis declining  1996: 152 cases  1999: 139 cases High recidivism Is Stat RPR screening still valuable? *MMWR, June 5, 1998 Results of Stat RPR Project

Objectives Determine the cost and cost effectiveness of Stat RPR vs. Routine RPR screening for syphilis in female inmates Evaluate long-term value of Stat RPR screening at CCJ

Decision Analysis Model: Program Alternatives Program Alternative 1 –Stat RPR Screening  2 nd shift Voluntary specimen collection at women’s intake unit RPR Testing—immediately—at women’s intake unit Treatment within hours of arrival TOTAL TIME: Several HoursTOTAL TIME: Several Hours –Routine RPR Screening  All other shifts Voluntary specimen collection at women’s intake unit RPR Testing—next day—at onsite lab Results back within a few days Location and movement of detainee for treatment TOTAL TIME: 3-4 DaysTOTAL TIME: 3-4 Days Program Alternative 2 –Routine RPR Screening  All shifts

Methods: Data RPR Test Data –RPR Test results provided by CDPH and lab onsite at CCJ –RPR Test performance measures: Literature estimates Costs –Labor costs: Time-Motion studies at CCJ [3/7/00-4/3/00] Laboratory Technician Correctional Medical Technician Disease Intervention Specialists (DIS) –Jail-Based STD Clinic –Field Follow Up (+RPRs Released Prior to Treatment) –Stat RPR Project: Women’s Intake Unit –Tests, Treatment, Equipment: CDPH –Sequelae Costs: Literature estimates

Methods: Data Detainee Data –Collected by CDPH [March 7 – April 3, 2000] –Demographics Age, Race, Education, Number of Children –Booking Data Length of stay at CCJ Reason for this arrest Number of previous arrests within past 3 years

Results: Program Characteristics Stat (2 nd Shift) Routine (1 st, 3 rd Shifts) # Women Booked 616/1341 (46.0%)725/1341 (54.0%) # Women Screened 553/616 (89.7%)690/725 (95.1%) # Reactive RPR 54/553 (9.8%)39/690 (5.7%) # Serofast 43/54 (79.6%) 25/39 (64.1%) # Biologic False Positive 4/54 (7.4%) 3/39 (7.7%) # New Cases 7/54 (13.0%)11/39 (28.2%) # New Cases Diagnosed & Treated On-Site 4/7 (57.1%)4/11 (36.4%) # New Cases Discharged Prior to Treatment 3/7 (42.9%)7/11 (63.6%)

Results Screening Program Alternative Program Cost New Cases Syphilis Treated Cost per New Case Detected & Treated Routine RPR Screening $39,1757$5,596 Stat RPR Screening $62,2639$7,027

Limitations Small sample size Potential measurement error in data –All data elements manually collected –Lab results not automated –Data not centralized

Ongoing Data Collection 1996 – 2000 Data Examine cost to detect new case of syphilis in 1996 vs. cost to detect new case of syphilis in 2000 Examine cost effectiveness of Stat RPR screening in 1996 vs. cost effectiveness of Stat RPR in 2000

Conclusions Stat RPR screening is effective way to treat inmates prior to release from jail –Cost of Stat RPR screening > Routine RPR screening –Cases detected and treated with Stat RPR screening > Cases detected and treated with Routine RPR screening Other issues surrounding jail, syphilis control influence programming decisions Local decision-makers must decide whether Stat RPR screening can be sustained given their budget