1. Innovative STD Screening Projects in Indian Country Lori de Ravello, MPH CDC Assignee National STD Program Indian Health Service May 9, 2006

2. Objective To describe AI/AN-focused STD screening projects developed by IHS and Tribal health programs

3. Screening Venues  School-Based Screening  Seasonal Firefighter Exams  Community Outreach  Jail-based

4. School-Based Screening  Public High School (grades 9-12) on a small Northern Plains reservation  STD 101 session followed by voluntary urine-based chlamydia and gonorrhea screening  All students seen for 1-on-1 follow- up counseling, regardless of result  Positives referred for usual partner services

5. Results of School-Based Screening  67% (388/577) attended STD 101  95% (367/388) accepted specimen cup  73% (269/370) provided specimen  5% overall chlamydia positivity  0% gonorrhea

6. Chlamydia Positivity, by sex

7. Chlamydia Positivity, by age

8. Evaluation Findings (80% response rate, 5-point scale) Information was adequate and helpful4.1 Testing at school a good idea4.3 Screening procedure was private4.2 Giving of results was private4.3 Want to see repeated83%yes Received info on how to contact nurse70% yes

9. Seasonal Firefighter Exams  Popular job option in rural areas  Annual physical exam required  Some health facilities voluntarily include chlamydia screen  Data compare women screened or tested in clinic and male firefighters (FF) screened at physical

10. Sites  Site 1:  Located in western U.S.  IHS facility  Began CT screening of FFs in 1998  In 2002 ran 1800 CT tests  Site 2:  Also located in western U.S.  Tribal facility  Began CT screening of FFs in 1999  In 2002 ran 812 CT tests

11. Site 1 - Number of Chlamydia Tests, by sex and year

12. Site 1 - Chlamydia Positivity, by sex, 1998-2002

13. Site 1 – Chlamydia Positivity, by age and sex, 2002

14. Site 2 - Number of Chlamydia Tests, by sex and year

15. Site 2 – Chlamydia Positivity, by sex, 1998-2002

16. Site 2 – Chlamydia Positivity, by age and sex, 2002

17. Community-Based Outreach  Large southwestern tribe  Ongoing syphilis outbreak since 2001  Screening interventions in community:  Local bars  Busy commercial areas  Community fairs

18. 2004 Syphilis Screening Data EventTotal RPRsReactorsNew Cases 16331 24111 32500 46510 54400 Total23852

19. Jail-Based Syphilis Screening Pilot Project  Large southwestern reservation  Syphilis outbreak since 2001  Large tribal jail  2004 Epi Aid determined many cases passed through jail  6-month pilot project  STD 101 followed by screening

20. Tribal Jail Screening Results 314 300 14 268 254 14 114 112 2 0 0 0

21. Conclusions  A variety of promising screening interventions being done in Indian Country  Yield of positive cases varies  Effort required may not be offset by yield  How to factor in other screening benefits (e.g. community awareness)  Further efforts are needed to evaluate and improve screening activities in Indian Country

22. Acknowledgements  CDC  David Wong  Lydia Blasini- Alcivar  IHS  James Cheek  Pam McCloud  Sandeep Patel  Tribal Health  Janet Runnion  Larry Foster  Mae Gilene Begay  State Health Dept.  Susie Zantos  IPP  Yvonne Hamby