1. STEP UP: NYC DOHMH STD School Screening Progress Meighan Rogers, MPH IPP Region II Mtg December, 2007

2. Background  Chlamydia – most commonly reported bacterial STD nationwide and in NYC (almost 40,000 cases – 2006)  Disproportionately affects adolescents  Chlamydia and gonorrhea (CT/GC) usually asymptomatic Up to 96% of men and women with CT have no symptoms  Both infections easily cured with antibiotics

3. NYC Chlamydia Cases by Age and Sex, 2006 AgeNumber of Cases FemalesMalesBoth 10-14 yrs35466420 15-19 yrs9,3802,77312,153 20-24 yrs9,4594,27813,737 25-29 yrs4,5432,6727,215 30-34 yrs2,0241,4153,439 All other Ages 2,5281,7414,269 TOTAL28,28812,94541,233

4. Behavioral Factors FemalesMales Grade Sexually Active Sexually Active 9 th 34%48% 10 th 43%52% 11 th 46%55% 12 th 58%59% All grades43%52% Youth Risk Behavior Survey of approximately 7,000 students, NYC 2005 % of NYC High School Students Who Have Ever Had Sexual Intercourse:

5. DOE & DOHMH Collaboration  Spring 2006 pilot – 5 schools, private grant  2006-2007 Expansion:  Educated 11,298 students (46 sites)  Tested 5420 (48%)  Total positivity 4.8% overall (n=262)  Treated 99% of students  2007-2008 Expansion:  Goal: Educate 30,000 NYC students, test ~15,000  Focus on high morb neighborhoods  Less focus on school-based health center (SBHC) schools

6. How Does STEP UP Work?  Education: 20-minute education presentation  Voluntary Testing: Students receive brown paper bag with urine cup, contact info sheet, and call-back card All students complete paperwork All students are brought to bathrooms for voluntary testing  Treatment and counseling: Conducted at schools, with DOHMH staff/SBHC staff

7. Screening Materials

8. Results Current 2007-08 School Year

9. NYC 2006-2007 Program August 2007 – November 2007Totals # of Schools/Programs Reached 25 # Students Attending Presentations ~7,000 # Students Tested3479 (50.0%) Total Positive CT/GC (%) CT = 250 (7.2%) GC = 22 (0.64%) Coinfections = 7 (.20%) Treated (%)92.5%

10. Testing Results STD Testing: Of the 7000 educated… Of the n=272 infections…

11. CT/GC Positivity Results, by sex * Difference between males & females significant at p<.0001

12. CT/GC Positivity by age, sex

13. Testing and results, by race Students Tested, by race Students Testing Positive, by race

14. Does Having an SBHC Significantly Affect CT/GC Positivity? * Results significant at p<.05

15. Treatment Rates and Partner Follow Up  Treatment rate: 93% (n=245/265); remainder undergoing follow-up  Locatable partner info elicited from 86 patients (total partners n=101)  Of partners elicited, 53% (53/101) have been treated, others being followed

16. Acknowledgments  Sophie Nurani, STEP UP team, Steve Rubin, Susan Blank, Kristen Harvey, Julie Schillinger, Robin Recant  Roger Platt, Julia Choe - School Health/NYC DOHMH  NYC Dept of Education colleagues  School-based health center partners  School administrations and students Contact information: Meighan Rogers: 212-788-4428 mrogers@health.nyc.gov