March 2011 Chicago

 IDPH Laboratory Update  Rescreening  Treatment Timeliness  SBHC/JDC Chlamydia Screening Initiative  SBHC-Sports Physical Project  Special CT/GC testing initiative  EPT Survey and Findings

 Oral/Rectal Study  Pooling

 Howard Brown Clinic Clinic staff  Illinois Department of Public Health John Nawrocki, Ph.D. (BD Qx Assay) Gary Boyce  University of Illinois William Janda, Ph.D. (GenProbe Assay)

 Testing positive for CT by both assays 3 oral & 7 rectal specimens  Testing positive for GC by both assays 17 oral; 6 rectal

 Objective: to determine the sensitivity of the BD Qx assay for the detection of known positive specimens (NG/CT) in pools of 4 specimens.  Specimens identified as positive for either or both agents were re-tested in pools with 3 known negative specimens.

SpecimenType #Positive Sx tested #Positive Sx detected in pools %Sensitivity Male Urine Female Urine Endocervical Swab 4544*97.7 Vaginal Swab 4544*97.7 Urethral Swab Dual positives – picked up one of the positive test results

 Gaydos et al: CT Reinfection Rates Among Female Adolescents Seeking Rescreening AT SBHCs 236 of 897 ( 26.3% ) females students reinfected  Broussard et al: Screening Adolescents in a JDC for GC/CT: Prevalence and Reinfection Rates Reinfection rates: 10 % for GC and 28.9% for CT  IDPH STD Section: Jan – May 2009, 1,714 females tested positive for chlamydia at a family planning or SBHCs. A total of 746 (43.5%) females returned for rescreening within two to 12 months CT re-infection rate was 22.3% (166 of 746)

 Reinfection increases risk of: Pelvic inflammatory disease Ectopic pregnancy Chronic pelvic pain  Majority of post-treatment infections result from reinfection Sex partners not treated Patient resumes sex with a new partner infected with CT/GC  Recommendation: Clinicians should advise clients treated for CT/GC to be retested 3 months after treatment

ALL PROVIDER TYPES # Tests# Pos% Pos days % Rescreened days % Rescreened days % Rescreened 58,5394,

 IDPH STD Section developed “Rescreening” reports using Access Reports by:  Age, Ethnicity, Race, and Sex  Provider type  Working on reports to determine positivity rate of those rescreened  RVIPP Data subcontractors Developing similar reports for each state

 CDC Performance Measure Among female clients, the proportion of women with positive chlamydia/gonorrhea tests that are treated within 14 and 30 days of the date of specimen collection.  Prompt treatment of chlamydia and gonorrhea will reduce the duration of infectiousness and further transmission of infection in the community  Aimed at preventing sequelae such as pelvic inflammatory disease (PID), ectopic pregnancy and infertility

Treatment Rates of Female Clients with Reported CT (Excluding Chicago) Provider Type w/i 14 days STD Clinics 74%78%90% Family Planning 71%77%86% Other HD Clinic 70%73%90% Priv Physician 89%92%91% School Based 86%87%88% Univeristy/College99%99%99%

 ID clinics receiving test result via mail and set them up for FAX transmittal if feasible  Focus on clinics with greatest number of cases and the lowest rates  Collaborate with IDHS nurse consultants and program managers for clinics with low rates  Provide constructive criticism and positive feedback  Develop a corrective action plan with clinics and follow up with quarterly data

 OBJECTIVE: increase CT/GC screening at SBHCs  Collaboration IDPH STD Section IDHS SBHC Program IDHS Bureau of Community Nursing Individual SBHCs  Prioritized: Largest SBHCs with highest CT positivity rate

 Teleconference/Powerpoint with SBHCs Sexual behavior data for adolescents resulting in high incidence of disease Prevalence and incidence data showing high rates of infection in adolescents Site specific CT/GC screening data: all students and female students Clinical fusion data compared to testing data Barriers Recommendations Q/A and brainstorming

 Outcome: 41 SBHCs participated between March 2009 thru May 2010  CT Testing: Jan-Dec 2010 vs 2009 CT screening increased 28% (additional 2,099 CT tests submitted) 249 (30%) additional CT positive tests identified 36 (18%) additional GC positive tests identified

 Future plans: Continued monitoring of site specific data Quarterly data sent to SBHCs  IDHS Bureau of Nursing SBHC intervention if CT screening decreases

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 Collaboration: CDC MTV Kaiser Family Foundation Planned Parenthood Federation of American  April STD Awareness Month  Public Information campaign targeting young people who may be uncomfortable or uncertain about asking providers for sexual health services or talking to their partners or friends about testing

 Objective: increase CT/GC screening at JDCs  Unique challenges Safety first – secure facility and movement of residents is often difficult Residents often angry and don’t want to participate County budget cuts e.g. hours for one JDC nurse cut to 10 hrs/week or 2 hrs/day JDC “buy in” – convincing JDC staff of the importance of CT screening

 Outcome: 12 JDCs participated in teleconference calls during 2010  CT Testing: Jan – Dec 2010 vs JDCs provided CT screening in JDCs in 2010  Overall, during 2010: CT screening increased 34% (additional 449 CT tests submitted Jan-Dec 2010) 33 (28%) additional CT positive tests identified

 National Chlamydia Coalition Grantee  Four School Based Health Centers Provide free CT/GC screening at the time of male & female athletes’ pre-participation sports physicals For many students, sports physical exam may be their only visit with a provider during the year  Jun-Dec 2010 CT Pos rates range: 0% % Overall: 16 of 186 (8.6%)  Study is ongoing

 Jan – Dec 2010: CT screening at WIC Clinics and Pregnancy Testing Centers  9 Non-health department pregnancy testing ctrs CT pos rate: 5.6% to 22.2% Overall: 47 of 346 (13.6%)  Local Health Dept (Many STD clinic clients are also WIC clients) 1 Pregnancy Testing Clinic: 17 of 204 (8.3%) 2 WIC Clinics: 56 of 816 (6.9%)

 CDPH and Chicago Public Schools CT screening initiative similar to the Philadelphia initiative Future presentation at the RVIPP Chicago meeting

 EPT law effective date: January 1, 2010  IDPH Web site ( Guidance for Illinois Health care professionals Partner information sheets Health care professional Fact Sheet  IDPH provides EPT Meds: Cefixime (single prepackaged doses) Azithromycin (single prepackaged doses)

 ed to LHDs - outreach to HCP regarding EPT 41 responses  23 (56%) indicated 1-5 HCP using EPT  4 (10%) indicated > 5 HCP using EPT  14 (34%) none, or uncertain how many HCP  Primary concern for not using EPT was liability  17 LHD no outreach to HCP regarding EPT  Lack of staff and time  24 LHD outreach to HCP regarding EPT  Educational mailings, in-services, faxes, phone calls  Primary recommendation for ISP to provide simplified handouts for HCP

 Family planning (28) – 21 (75%) provide EPT; 7 (25%) no; main issue liability followed by perceived need for patient education  STD (13) – 8 (62%) provide EPT; 5 (38%) no; issue is liability and lack of standing orders  SBHC (16) – 16 (100%) provide EPT; 0 no  Other type of clinic (35) – 12 detention centers (0 EPT); 4 pregnancy testing centers (4 EPT); 19 other - 13 provide EPT; 6 no

 Collaborate with a LHD physician to publish EPT information in professional newsletter, e.g. Illinois State Medical Society and others Stress EPT law and reduce fears of professional liability  Develop and distribute less technical partner/patient handouts

Richard Zimmerman IDPH STD Section