1. Check Your Risk: Increasing School-Based STI Screening Participation Among District of Columbia High School Students Michelle Jasczyński, Ed.M. Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention PHAP 2016 Spring Seminar April 4 th, 2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. Framing the Problem: DC Adolescents and STIs Data Source: Reportable STDs in Young People 15-24 Years of Age, 2013 courtesy of National Electronic Telecommunications System for Surveillance, Centers for Disease Control and Prevention. CDC/NCHS 2012 bridged population estimates, derived from US Census data, used for rate denominators.

3. District of Columbia Youth STI Interventions School-Based Screening WRAP MC Youth Clinic STI Education Text Message Program Special Populations Outreach Youth STI Screening Sites

4. Dr. B Card courtesy of the District of Columbia Department of Health – HIV/AIDS, Hepatitis, STD and TB Administration  Launched in 2008/2009 with public and charter high schools participating.  Approximately 20 schools participate in the program per year.  SBSP offers free urine based gonorrhea and chlamydia screening.  Results are available in approximately 5 working days.  HIV testing was fully implemented in 2014/2015. School-Based Screening Program (SBSP), 2009-2015

5. School-Based Screening Processes Planning Screening Day SurveillanceTreatment Annual organizational meetings and trainings with school staff, administrators, and community based organization staff. Coordinator creates screening and treatment schedule, contacts POCs at each school, schedules meetings and walkthroughs, trouble shoots etc. SBSP team sets up screening space. SBSP team gives presentation to students. Students fill out green demographic form and are given a brown paper bag/urine cup to take to bathroom. Student opts in or out. SBSP team collects bags, prepares samples, and sends to the lab. Lab processes samples in 24-48 hours. Coordinator pulls demographic forms for positive students and completes a field record including their lab results. Coordinator sends school POC a list of students (positives, partners, re-testers, high risk negatives) to be pulled for treatment day. Coordinator creates summary of screening data for each school. DIS return to the school with medical provider or work with staff of SBHC to treat students. DIS interview students and identify partner(s). If partner(s) are at the school, the DIS attempt to treat and interview too. DIS contact students who did not participate in treatment day to guarantee treatment with DOH or other medical provider.

6. Check Your Risk poster courtesy of the District of Columbia Department of Health – HIV/AIDS, Hepatitis, STD and TB Administration  During the summer of 2015, programmatic changes were discussed and planned to address issues related to student screening participation, HIV testing feasibility, “pop up” screening days, and overall the best use of limited resources.  Changes in staffing also influenced decisions for the 2015/2016 school year. 2015-2016 Program Changes and Challenges

7. Demographic form courtesy of the District of Columbia Department of Health – HIV/AIDS, Hepatitis, STD and TB Administration  Changes were made with adjustments to the theory of change to prioritize high-risk schools.  HIV screening was also removed from the program.  Demographic, surveillance, and clinical data were collected from each school and month. Methods and Data Collection

8. SBSP Data, 2009-2016 *As of March 2016 Data courtesy of the District of Columbia Department of Health – HIV/AIDS, Hepatitis, STD and TB Administration Annual Reports, 2009-2016 Students Attending Students Who Screened Students Testing Positive Repeat Infections 2009/201070134549 (65%)262 (6%)* 2010/201154273463 (64%)208 (6%)* 2011/201256583670 (65%)202 (6%)* 2012/201348753129 (64%)190 (6%)* 2013/201454092692 (49%)108 (4%)* 2014/201560672778 (46%)105 (4%)15 (14%) 2015/2016*40092116 (53%)80 (4%)21 (26%)

9.  Only offering chlamydia and gonorrhea screening has resulted in a small increase in overall participation.  Focusing on priority schools yielded the desired results in terms of resource allocation and finding disease.  The rate of re-infections within the last 12 months will need to be investigated further. Implications and Next Steps

10. Limitations  DC Public Health law and minors rights to access sexual health care without parental consent or notice are not universal.

11. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Questions? Michelle Jasczyński ypf7@cdc.gov Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support