1. Infertility Prevention Project Region V June 9-10, 2010 Indianapolis, Indiana Infertility Prevention Project Region V June 9-10, 2010 Indianapolis, Indiana Steven J. Shapiro Infertility Prevention Project Coordinator CDC/NCHHSTP/DSTDP/PTB 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 National Infertility Prevention Project:  Budget and Funding  Division Updates  PSCI  Health Care Reform  National Chlamydia Coalition  Gonorrhea  Performance Measures

4. Funding Applications CSPS 2011 CSPS 2011 »Guidance under development »IPP Progress on 3% CT Positivity Progress on 3% CT Positivity Targeted GC Burden Calculation and plans Targeted GC Burden Calculation and plans Progress on general objectives Progress on general objectives Progress on GC meeting action items Progress on GC meeting action items IPP-OPA IAA 2010-2011 IPP-OPA IAA 2010-2011 »IPP Regional Infrastructure Objectives Pregnancy-test Only Pregnancy-test Only AI/AN Health Care Delivery Systems AI/AN Health Care Delivery Systems

5. DSTDP Update Leadership Changes Leadership Changes »Office of the Director (Douglas) Policy Office (Pulver) Policy Office (Pulver) »Epidemiology and Surveillance (Berman) Summer Consultations Summer Consultations »Sexual Health (4/28-4/29) »Tuskegee CoAg Blue Ribbon Panel »EPT (5/13) »STD Prevention Training »STD Prevention and Health Care Reform »STD Prevention Core Priorities

6. DSTDP Update (2) STD Treatment Guidelines STD Treatment Guidelines »Recommended treatment for uncomplicated GC will be increased to 250 mg Ceftriaxone. »Cefixime 400 mg will remain as a recommended therapy »Combination therapy for GC NAAT + and CT NAAT - STD Laboratory Guidelines STD Laboratory Guidelines »CT GC and syphilis »Re-testing/Supplemental Testing GYT GYT »190K Unique visitors; average time 3 minutes »Just under 40K Toolkit Downloads

7. PCSI Funding Opportunity Announcement Funding Opportunity Announcement »Grants.gov CDC-PS10-10175 »“To plan, scale-up, and support the implementation of a syndemic approach to the prevention of HIV/AIDS, viral hepatitis, STD and TB through PCSI activities as described……”Enhancing the Prevention and Control of HIV/AIDS, viral hepatitis, STD and TB in the United States” Eligibility (2007 Surveillance Data) Eligibility (2007 Surveillance Data) »630 AIDS Cases »225 TB Cases »900 Syphilis (all stages) Cases »6760 Gonorrhea Cases »82 HBV Cases Webinar May 10th Webinar May 10th

8. Health Care Reform What does this mean for CDC, in general, and STD Prevention specifically?

9. Patient Protection and Affordable Care Act Mandatory Programs Mandatory Programs –Prevention and Public Health Fund »Up to 2 Billion dollars annually by 2015 »Can be spent on any prevention, wellness or public health activities authorized in the Public Health Services Act. Section 318 of the PHSA authorizes STD prevention (CSPS); section 318A authorizes IPP. –National Prevention, Health Promotion, and Public Health Council »Advisory in Nature- must create a National Prevention and Health Promotion Strategy

10. PPACA : New Prevention Programs CDC CDC –Community Transformation –Epidemiology and Laboratory Capacity –Healthy Aging Living Well –Prevention Research –Improvement of vaccine delivery systems –Office of Women’s Health HHS –State access to purchase vaccine at federally negotiated prices –Menu labeling (FDA) –Individual Wellness Plan evaluation at FQHCs –Grants to support School- based Health Centers –Evidence based teen pregnancy prevention –Evidence based Abstinence-only programs

11. PPACA: Other Provisions Insurance (private) Insurance (private) »Required to provide recommended clinical preventive benefits, including vaccinations without cost-sharing Medicaid and Medicare Medicaid and Medicare »Medicare preventative services and USPSTF recommended services (“A” level, maybe “B”) become no cost-sharing; coverage and cost sharing for vaccines unchanged »Tobacco cessation pharmaceuticals and expanded cessation services for pregnant woman are covered »Hospitals required to report rates of healthcare-associated infections (MRSA, VRE, etc) Public Health Workforce Public Health Workforce »Loan repayment program, expand fellowship programs (EIS) Monitoring Key National Health Indicators Monitoring Key National Health Indicators »Standardizes data collection related to health disparities

12. National Chlamydia Coalition Annual Meeting Annual Meeting »December 3-4, 2009 DC »Social Marketing »Sub-Committee Meetings Research Subcommittee Research Subcommittee What can you do? What can you do? –Chlamydia Screening Priority in Health Care Delivery Systems »Outreach to State Adolescent Health Coordinator »Child Health Indicators for Medicaid and CHIP »EMR Incentives for Medicaid and Medicare

13. National Chlamydia Coalition Mini Grants: To fund innovative strategies to increase CT screening and follow-up care including partner treatment College Health Program College Health Program »Old Dominion (VA) Sports Health Screenings Sports Health Screenings »Uplift School (IL) Academic Detailing Academic Detailing »Private Providers (IL) CT screening CT screening »Medicaid Managed Care (MI) Awareness and Screening Awareness and Screening »PP Greater Washington and North Idaho CT Model Protocol »AI/AN (Regions VIII & X) JDC Screenings »Baltimore JDC (MD) Targeted use of GIS »Adagio Health (PA) Provider Outreach »NYS providers (Region II) Plan Development »Coalition Building (MN)

14. DRIP, DRIP, DRIP

15. Gonorrhea “Incurable gonorrhea may be next superbug” “Incurable gonorrhea may be next superbug” »MSNBC 4-8-2010 “Emergence of Antibiotic-resistant gonorrhea ” “Emergence of Antibiotic-resistant gonorrhea ” »Time (blog) 3-31-2010 “Gonorrhea mutating into superbug especially in SEAsia” “Gonorrhea mutating into superbug especially in SEAsia” »Pattaya Daily News 4-1-2010 “Sex Infection gonorrhea becoming drug-resistant” “Sex Infection gonorrhea becoming drug-resistant” »BBC News 3-29-2010

16. Gonorrhea AR GC Laboratory Activities AR GC Laboratory Activities »GISP »Enhanced surveillance in the Far East with WHO Documented Clinical Cases of resistance to oral cephalosporins Documented Clinical Cases of resistance to oral cephalosporins WHO-WPRO Consultations (Manila in April; Bali in May) WHO-WPRO Consultations (Manila in April; Bali in May) »Basic research to develop a molecular test that could indicate resistance in NAAT-positive specimens AR GC Outbreak response plan development AR GC Outbreak response plan development »Consultation Atlanta September 14-15 »State-level Outbreak Response Plan Development and Pilots California, Hawaii, Illinois, New York State and Washington state California, Hawaii, Illinois, New York State and Washington state Regional Meetings Regional Meetings »Monitoring Action Plan progress »Meetings Report Development

17. Performance Measures CSPS Project started 1999 CSPS Project started 1999 Pilot project 2001 Pilot project 2001 Set of 12 measures 2005 Set of 12 measures 2005 »Timeliness of Treatment CT and GC in FP clinics »STD Clinics added 2007 »GC Interviews modified 2009 NCSD Survey Optional Measures NCSD Survey Optional Measures –Feasibility. Usefulness and Intent to Use –All CT male and females 15-24 –All Gonorrhea

18. Performance Measure Data Timeliness of Treatment for CT (14 Days) Prevalence Monitoring Family Planning Sites 20052006200720082009 ChicagoN/A 0.30 Illinois0.700.710.660.710.98 Indiana0.510.640.680.730.77 Michigan0.560.740.710.600.57 Minnesota0.910.900.880.820.84 Ohio0.400.280.690.160.30 Wisconsin0.760.720.760.700.74 Region V 0.630.630.700.580.64 National0.620.660.640.640.67

19. Performance Measure Data Timeliness of Treatment for GC (14 Days) Prevalence Monitoring Family Planning Sites 20052006200720082009 ChicagoN/A 0.15 Illinois0.680.710.720.670.89 Indiana0.610.790.870.780.79 Michigan0.770.760.610.630.65 Minnesota0.930.920.710.870.65 Ohio0.410.270.670.140.32 Wisconsin0.670.560.670.560.60 Region V 0.610.630.670.550.59 National0.620.660.640.640.67

20. Performance Measure Data Timeliness of Treatment CT and GC (14 Days) STD Sites: 2007-2009 CT2007CT2008CT2009GC2007GC2008GC2009 ChicagoN/A 0.17N/A 0.18 Illinois0.570.740.790.500.750.80 Indiana0.700.870.890.790.890.90 Michigan0.670.730.810.680.840.86 Minnesota0.790.770.780.770.800.86 Ohio0.890.170.280.900.220.21 Wisconsin0.670.660.690.650.520.54 Region V 0.670.590.660.660.610.54 National0.690.720.690.700.730.67

21. Performance Measure and Morbidity Data Chlamydia- All Females STD Sites: 2008 Total CT Cases NETSS CT STD Cases NETSS%Cases PM Data Chicago1813015788.7N/A Illinois2498217837.11752 Indiana1651312347.51119 Michigan3371920706.1879 Minnesota102664314.2380 Ohio3502113743.91850 Wisconsin15229180.1548 National8930048994310.0067074

22. Performance Measure and Morbidity Data Gonorrhea- All Females STD Sites: 2008 Total GC Cases NETSS GC STD Cases GC STD CasesNETSS%Cases GC STD Cases PM Data Chicago538881615.00N/A Illinois595473812.4732 Indiana505667913.4445 Michigan100477587.5313 Minnesota16571478.9140 Ohio97846046.2782 Wisconsin3744110.3188 National1825772782515.002600

23. Questions?