1. 1 STDs in Houston/Harris County TrendsInterventions Emerging Issues

2. 2 Why are STDs Important? Facilitate Transmission of HIV Infection Cause Infertility Cause PID Adverse Outcomes on Pregnancy 17 Billion Dollar Cost Annually in USA

3. 3 How Are We Doing in Houston? In 2002, Houston Ranked: 48th- Chlamydia (346.1/100,000) 45th- Gonorrhea (153.9/100,000) 31st- P&S Syphilis (3.3/100,000)

4. 4 Chlamydia EPIDEMIOLOGY

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10. 10 Gonorrhea EPIDEMIOLOGY

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16. 16 Syphilis EPIDEMIOLOGY

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20. 20 HDHHS STD Interventions ScreeningTreatmentEducationCounseling Partner Services

21. 21 Screening Syphilis, gonorrhea, chlamydia, hep C,HIV testing in 3 STD clinics Family Planning (no hep C) Prenatal (no hep C) Outreach Contractors (no gc)

22. 22 Screening Mobile Unit Outreach testing Collaboration with CBOs in outreach Bookstores, Bath houses, streets, bars Mobile clinic planned for 2003 Jail tanks Key HIV providers encouraged to test Contracts with 7 CBOs to do screening

23. 23 Treatment 3 STD Clinics Some treatment in Family Planning and Maternity Clinics except for syphilis Facilitate treatment with private providers - provide some meds Facilitate treatment with Harris Co. Jail

24. 24 Treatment DOT for chlamydia Recommend epi profile based preventive treatment around syphilis outbreak Encouraging stat RPR testing around outbreak Hope to provide on site treatment on mobile clinic in 2003

25. 25 Vaccine Hepatitis B vaccine in STD clinics Plans for Hep A vaccine in STD clinics

26. 26 Education Health Educators trained in STDs CDBG health ed in K-12; and in K-12 HIV/STD Info-line Contracts with 23 CBOs for education Work with CPG to emphasize STDs Provider alerts, media alerts, provider training Expanding education to web sites, chat rooms

27. 27 Counseling CliniciansDISContractors

28. 28 Partner Services DIS provide partner referrals and notification for syphilis and HIV Some chlamydia and gonorrhea Clustering and social network outreach Counseling and testing contractors

29. 29 Partner Services Pursuing web based self-interview Self-referral through internet/email DIS Liaison with Key Providers Working with CBOs on training DIS and DIS on training CBOs to improve and promote partner notification

30. 30 DIS Outcomes for Syphilis* 2002 488/546 Interviewed (89%) 442 contacts 515 were located (80%) 453 examined 62 refused exam 81 (18%) new cases brought to TX 229 preventive TX 457 clusters 4 new cases brought to TX * P&S, EL, Unk duration

31. 31 DIS Outcomes HIV 2002 Interviewed 303/349 (87%) 90% successful referrals to EIP 482 contacts 331Located/Counseled (69%) 81 previous positive (24%) 34 newly positive (10%) 183 (55%)negative 33 (10%) refused a test 323 clusters --- 30 positives = 9%

32. 32 Emerging Issues Syphilis Outbreaks HIV Co-Infection Resurgence in Risky Behavior Partner Services Innovation Internet and STDs Hepatitis