1. Community Embedded Disease Intervention Specialist (CEDIS): The Los Angeles Experience Ellen T. Rudy, PhD, 1 Johnny Cross, 2 Frank Ramirez, 1, Robert K. Bolan,MD, 2 Peter R. Kerndt, MD, MPH 1 1 Los Angeles County Dept. of Public Health Sexually Transmitted Disease Program (STDP) and the 2 LA Gay & Lesbian Center (LAGLC)

2. P&S SYPHILIS IN LAC

3. EPIDEMIOLOGY OF SYPHILIS IN LAC In 2008 62% (914 out of 1481) of Early Syphilis cases in LAC among MSM 14% of ES cases dx out of LAGLC –55% of these cases also HIV co-infected Partner Services recognized as key prevention strategy – MMWR Reports, 2008: 57 (RR-09)

4. TIME TO INTERVIEW Lost to follow-up: 4% (CEDIS) vs 28% (Trad) 20-fold increase in interview w/in 7 days

5. PARTNERS NAMED Partner Index: 2007 (0.56) 2009 (1.91) 3-fold increase

6. PARTNERS PREVENTIVELY TREATED Preventive Index: 2007 (0.22) 2009 (0.93) 4-fold increase

7. LAGLC EARLY LATENT CASES INCREASED 123% IN 2009

8. SUMMARY OF BENEFITS OF CEDIS PROGRAM Notification is by an employee of the trusted CBONotification is by an employee of the trusted CBO Reduced the time to interview of index case and lost to follow-upReduced the time to interview of index case and lost to follow-up Significant number of partners are being treated for syphilisSignificant number of partners are being treated for syphilis –interrupting the chain of transmission Reduced burden of cases at STDP

9. BENEFITS SEEN FROM CEDIS PROGRAM 25 fold improvement in time to interview within 7 days and 4-fold decrease in lost to follow-up 50% increase in the partners index and 4- fold improvement in partners preventatively treated index Reduced burden of cases at STDP

10. CHANGING SOCIAL NORMS

11. Thanks… To the diligent staff at LAGLCTo the diligent staff at LAGLC To our collaborators at LAC STD ProgramTo our collaborators at LAC STD Program Contact Information: Johnny Cross jcross@lagaycenter.org