1. Infertility Prevention Project Region I June 1, 2009 Wells Beach, Maine Infertility Prevention Project Region I June 1, 2009 Wells Beach, Maine 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 Strategic Goals  Priority Activities  Gonorrhea  Performance Measures  CSPS  Infrastructure  NCQA and HEDIS  GYT 09

4. Strategic Goals Division of STD Prevention Strategic Plan October 2008 Division of STD Prevention Strategic Plan October 2008 –Prevent STD-related infertility »Screening and Treatment; Partner Services –Prevent adverse outcomes of pregnancy –Prevent STD-related cancers –Prevent STD-related HIV transmission and acquisition –Strengthen STD prevention capacity and infrastructure –Reduce STD health disparities –Address effects of social and economic determinants and costs of STDs and associated sequelae among specific populations

5. Infrastructure Funding and Activities CDC-OPA IAA Coordinate Regional Meetings Coordinate Regional Meetings –Assure Equal Partnership Regional IPP Plan Regional IPP Plan Conduct Site Visits Conduct Site Visits Support National CT Prevention Activities Support National CT Prevention Activities Evaluate and Disseminate Data Evaluate and Disseminate Data Data Quality Assurance Data Quality Assurance Collaboration Special Projects Infrastructure Performance Measures Data Management Collection Quality Assurance Analysis Dissemination Attend Regional Coordinators Meetings

6. Project Area Funding and Activities CSPS IPP 09-902 Ensure CT and GC Screening and Treatment Ensure CT and GC Screening and Treatment Support Lab Testing Support Lab Testing Ensure Collection and Reporting of all core CDC data elements Ensure Collection and Reporting of all core CDC data elements Provide Program Management Provide Program Management Ensure Provider Training Ensure Provider Training Grant Development Grant Development Use Data to plan programs –Prevalence Monitoring –Surveillance –Performance Measures 50% Rule Male Screening –Up to 15% of IPP funds Targeted GC Screening –Up to 10% of IPP funds –GC Burden Calculation

7. CSPS-IPP 2009 Gonorrhea Burden Calculation Gonorrhea Burden Calculation »Portion of Total IPP funds to be used to target GC screening »Total GC women <26/Total CT GC women <26 »Up to 10% of funds available »Identify venues/providers –High morbidity with limited screening coverage –In geographic catchment areas with high morbidity »Shift resources to those areas

8. GC Burden Calculation Example Project Area X Project Area X »Total IPP funds = $500,000 »Among women 25 and younger 500 Gonorrhea and 10,000 Chlamydia 500 Gonorrhea and 10,000 Chlamydia GC Burden = [500/(10000+500)]X100= 4.76% GC Burden = [500/(10000+500)]X100= 4.76% »IPP Funds to be used $500,000 X 4.76% = $23,800 $500,000 X 4.76% = $23,800 @ $10/test = 2380 tests available for targeting @ $10/test = 2380 tests available for targeting

9. WHY GONORRHEA?

10. Gonorrhea rates, U.S., 1941- 2007* *Preliminary 2007 data

11. Gonorrhea — Rates by county, 2007 Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

12. Gonorrhea rates by age and sex, 2007 69% 15-24 years 48% 15-24 years

13. Gonorrhea rates by race/ethnicity, 1981-2007* *Preliminary 2007 data

14. STD Surveillance Network (SSuN) Purpose: to improve national capacity to detect, monitor, and respond to emerging trends in STDs and related behaviors Purpose: to improve national capacity to detect, monitor, and respond to emerging trends in STDs and related behaviors Population-based enhanced gonorrhea surveillance Population-based enhanced gonorrhea surveillance –Sample of patients reported with gonorrhea in selected counties »Excludes patients who attend the primary STD clinic(s) –Analysis of data from Feb 2006 – June 2008

15. San Francisco San Francisco Co. STD Surveillance Network (SSuN) project areas (n=5) & participating counties and independent cities (n=11), 2006-2008 SSuN project areas Participating counties and independent cities Washington King Co. Pierce Co. Snohomish Co. Virginia Chesterfield Co. Henrico Co. Richmond City Colorado Adams Co. Arapaho Co. Denver Co. Minnesota Hennepin Co. New York City

16. San Francisco Washington. VirginiaColorado Chicago* New York City Baltimore* Philadelphia* Alabama* Louisiana* Los Angeles/CA* Connecticut* ~ 100 counties ~ 40 STD clinics SSuN Laboratory Sites SSuN Cycle 2: Participating project areas (n=12) and labs (n=6), 2009 – 2013 New Sites *

17. Gonorrhea rates per 100,000 population in African American and white counties, U.S., 2005 Gonorrhea rate per 100,000 population < = 19.0 19.1 – 100.0 >100.0 Counties > = 15% African American 0.5%3.9%95.6% Counties > = 80% White75.8%23.7%0.5%

18. Percent of Neisseria gonorrhoeae isolates with resistance or intermediate resistance to ciprofloxacin, 1990–2005 Note: Resistant isolates have ciprofloxacin MICs ≥ 1 µg/ml. Isolates with intermediate resistance have ciprofloxacin MICs of 0.125 - 0.5 µg/ml. Susceptibility to ciprofloxacin was first measured in GISP in 1990.

19. Resistance to Cephalosporins Oral Cephalosporins (Cefixime et al) Oral Cephalosporins (Cefixime et al) »2% Treatment Failure »Increasing MICs since 2003 »Increasing number of GC strains with decreased susceptibility Injectable Cephalosporins (Ceftriaxone) Injectable Cephalosporins (Ceftriaxone) »No documented treatment failures to date »Increasing MICs since 2003 »Recommended treatment doses increasing

20. Past and Future Penicillins (larger and larger doses) Penicillins (larger and larger doses) Tetracyclines Tetracyclines Spectinomycins Spectinomycins Fluoroquinolones Fluoroquinolones Oral Cephalosporins Oral Cephalosporins Injectable Cephalosporins Injectable Cephalosporins Penems Penems New Drugs? New Drugs?

21. 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 2008 »GC Interviews modified 2009 Infrastructure Performance Measures Infrastructure Performance Measures »Among clients attending family planning clinics, the number of women screened for chlamydia, stratified by age. »Screening coverage estimate among sexually active 15-19 year old women in FP clinics

22. Performance Measure Data Timeliness of Treatment for CT (14 Days) Prevalence Monitoring Family Planning Sites 2005200620072008 Region I 14 Days 0.84(0.71-0.95)0.86(0.71-0.91)0.85(0.70-0.92)0.83(0.73-0.89) National 0.620.660.640.64

23. Performance Measure Data Timeliness of Treatment for GC (14 Days) Prevalence Monitoring Family Planning Sites 2005200620072008 Region I 14 Days 0.85(0.73-1.00)0.87(0.77-0.91)0.85(0.68-1.00)0.79(0.70-1.00) National 0.610.670.640.64

24. Performance Measure Data Timeliness of Treatment CT and GC (14 Days) STD Sites- 2007 and 2008 Chlamydia2007Chlamydia2008Gonorrhea2007Gonorrhea2008 Region I 14 Days 0.93(0.83-1.00)0.87(0.84-0.94)0.91(0.83-1.00)0.86(0.81-1.00) National 0.690.720.700.73

25. Performance Measures Gonorrhea Interviews Old Measure: Proportion of “priority” gonorrhea cases interviewed within 7, 14, and 30 days from date of specimen collection (2005-2008). Old Measure: Proportion of “priority” gonorrhea cases interviewed within 7, 14, and 30 days from date of specimen collection (2005-2008). –Programs receiving SE funds were not required to submit data for this measure. New Measure: Proportion of all gonorrhea cases interviewed within 7, 14, and 30 days from date of specimen collection. –HMA programs receiving SE funds are not required to submit data for this measure; non- HMAs receiving SE funds ARE required to submit data.

26. Infrastructure Performance Measures Estimated Screening Coverage (%) Females 15-19 years old Region2005200620072008 I36384346 II46465053 III50525153 IV53534650 V474747 No Data VI565558 VII59545557 VIII404140 IX556035 X343538 National505051N/A

27. Figure. Percentage of sexually active female enrollees aged 16−25 years who were screened for chlamydia, by health plan type and year ─ Healthcare Effectiveness Data and Information Set (HEDIS), 2000−2007

28. Infrastructure Performance Measures Proportion of Tests Females 15-24 years of age (%) Region2005200620072008 I61626164 II62636463 III67726870 IV73656362 V737169 No data VI676665 VII74727277 VIII747272 IX636664 X817874 National706967N/A

29. GYT ‘09 275,000 unique visitors to website 275,000 unique visitors to website »4X visitors compared to previous campaigns Planned Parenthood Affiliates Planned Parenthood Affiliates »24 out of 98 reported so far »STI testing increased 10%-103% over April 08 »Planned Parenthood Health Systems 103% »Planned Parenthood Rocky Mountains 1418 CT GC tests in two days 1418 CT GC tests in two days –Normally 78 tests per day Final Reports due May 30 Final Reports due May 30 Posted Summary Report by mid-July Posted Summary Report by mid-July

30. Questions?