1. Region II Infertility Prevention Project Advisory Committee May 16-17, 2007 New York, New York Steven J. Shapiro Infertility Prevention Project Coordinator CDC/NCHHSTP/DSTDP/PTB (proposed) Disclaimer: The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.

2. Topics Budget Update Budget Update CSPS Update CSPS Update Ongoing Projects Ongoing Projects »Performance Measures Activities Performance Measures Data Performance Measures Data

3. Budget 2007 Flat Funding for STD Prevention Flat Funding for STD Prevention –Funded at Final 2006 levels »Approx. $107 million to grantees Infrastructure Funding Infrastructure Funding »Base Award »Special Project »STD Conference Travel Funds »Data Systems Standardization

4. CSPS 2008 CSPS 2008 CSPS 2008 Continuation Application Due August 17, 2008 Continuation Application Due August 17, 2008 Program plans, reflective of regional activities, must be developed with FP and Lab Program plans, reflective of regional activities, must be developed with FP and Lab –FP concurrence letter CSPS Background, IPP plan and budget must be made available to the regional coordinator with enough time for inclusion of feedback into application CSPS Background, IPP plan and budget must be made available to the regional coordinator with enough time for inclusion of feedback into application At least 50% used to support screening and treatment in FP partner facilities At least 50% used to support screening and treatment in FP partner facilities Local prevalence monitoring data should be used to allocate resources Local prevalence monitoring data should be used to allocate resources Application must include objectives related to the IPP Performance Measures Application must include objectives related to the IPP Performance Measures

5. CSPS 2009 CSPS 2009 CSPS 2009 5 year Cooperative Agreement 5 year Cooperative Agreement Possible increased flexibility in using awarded IPP funds Possible increased flexibility in using awarded IPP funds Integration Language Integration Language Better matching of CSPS and Infrastructure Better matching of CSPS and Infrastructure Need for regional screening criteria Need for regional screening criteria Emphasis on completing required IPP activities Emphasis on completing required IPP activities –Ensure CT and GC screening and treatment –Support laboratory testing –Ensure collection of all CDC core data elements –Program Management –Provider Training

6. Ongoing Projects Azithromycin Pricing Azithromycin Pricing Infertility Prevention Workgroup Infertility Prevention Workgroup Performance Measures Performance Measures –CSPS –Infrastructure

7. Azithromycin Off Patent 2006 Off Patent 2006 »Contract (Pfizer) Sub-ceiling 340B pricing of $95 per 10 doses of 1 gm sachet not longer valid »Available in various formulations and dosages from three manufacturers and numerous distributors nationwide Region II Region II »STD Programs $2.10-$15.52/dose »FP Programs $2.24-$10.26/dose »National Range $0.38 - $24.50/dose

8. Infertility Prevention Workgroup Summary of IPW Submission: Summary of IPW Submission: »Common theme: Should the Division support increased screening of females under the age of 26 for Ct in public and private sectors? Should the Division support increased screening of females under the age of 26 for Ct in public and private sectors? »Supporting Priorities Social Marketing Social Marketing Monitoring of Screening Coverage Monitoring of Screening Coverage Current Activities Current Activities »Blueprint Development »Staffing Plan

9. Performance Measures Activities NCSD Consultation (January 2006) NCSD Consultation (January 2006) –Expansion of CSPS Performance Measures Timeliness Treatment STD clinics Timeliness Treatment STD clinics Gender of sex partner infectious syphilis Gender of sex partner infectious syphilis –Infrastructure Performance Measures Screening Coverage Screening Coverage Proportion of tests by age Proportion of tests by age NCSD Consultation (February 2007) NCSD Consultation (February 2007) »Re-infection »Hepatitis B Vaccination in STD Clinics »Cost of partner services interventions »Congenital Syphilis Performance Measures Learning Tours Performance Measures Learning Tours

10. Questions?

11. Performance Measures Data Review Region II and National Summary Data Region II and National Summary Data Data Verification Data Verification Prevalence Monitoring and Performance Measure Data Prevalence Monitoring and Performance Measure Data »Regional Summary »Project Area Snapshot

13. Performance Measure IPP CS1 Among clients of IPP Family Planning clinics, the proportion of women with positive chlamydia tests treated within 14 and 30 days of the date of specimen collection.

14. IPP CS 1 (Chlamydia) Results Site2004.12005.12005.22006.1 Region II- 14 Days (Average) 0.520.400.550.52 Region II- 30 Days (Average) 0.740.640.720.72 National- 14 Days (Average) 0.70.750.630.64 National- 30 Days (Average) 0.90.890.780.77

16. Performance Measure IPP CS2 Among clients of IPP Family Planning clinics, the proportion of women with positive gonorhea tests treated within 14 and 30 days of the date of specimen collection.

17. IPP CS 2 (Gonorrhea) Results Site2004.12005.12005.22006.1 Region II- 14 Days (Average) 0.550.510.510.53 Region II- 30 Days (Average) 0.740.610.670.72 National- 14 Days (Average) 0.70.740.640.65 National- 30 Days (Average) 0.90.910.750.77

19. Performance Measure CSPS MLS1 Proportion of female admittees to large juvenile detention centers tested for chlamydia.

20. CSPS MLS1 (JDC Screening) Results Site2004.12005.12005.22006.1 Region II (Average) 0.690.870.540.48 National (Average) 0.630.600.500.59

22. Data Verification Performance Measures Guidance: Performance Measures Guidance: »IPP Family Planning Clinics: All family planning clinics that report data as part of the Chlamydia Prevalence Monitoring Project, regardless of whether they are integrated clinics or not. »Denominator: Total number of women who tested positive for chlamydia (at those family planning clinics) –In other words: If ten FP clinics in a jurisdiction report 500 CT positives and 9500 CT negatives to the prevalence monitoring database, then the denominator for the performance measure should be 500.

23. Prevalence Monitoring v. Performance Measure Females in IPP Family Planning Clinics Chlamydia and Gonorrhea 2005 Region II Summary Region II Prevalence Monitoring Positives Performance Measure Denominator Difference Chlamydia 7423 (4/5) 9469 2046 (28%) Gonorrhea 721 (3/5) 1121 400 (55%)

24. Reasons for Differences –2005 data –If Prev. Monitoring > Perf. Measures »Prevalence Monitoring data includes only those clinics who reported more than a total of 25 tests during the year »Not counting integrated clinics –If Prev. Monitoring < Perf. Measures »Non-prevalence monitoring FP sites submitting data for performance measures »Counting non-FP sites –???

25. Prevalence Monitoring v. Performance Measure Females in IPP Family Planning Clinics Chlamydia 2005 Grantee Prevalence Monitoring Positives Performance Measure Denominator Difference New Jersey 30102761 249 (8%) NYC 13521435 83 (6%) NYS 27654830 2065 (75%) Puerto Rico 296443 147 (50%) Virgin Islands 159NRn/a

26. Prevalence Monitoring v. Performance Measure Females in IPP Family Planning Clinics Gonorrhea 2005 Grantee Prevalence Monitoring Positives Performance Measure Denominator Difference New Jersey 343317 26 (8%) NYC 70298 228 (326%) NYS 308506 198 (64%) Puerto Rico 14NRn/a Virgin Islands 17NRn/a

27. Questions?