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Infertility Prevention ProjectInfertility Prevention ProjectRegion I Region I
June 14-15, 2010June 14-15, 2010Wells Beach, MaineWells Beach, Maine
Steven J. ShapiroSteven J. ShapiroInfertility Prevention Project CoordinatorInfertility Prevention Project Coordinator
CDC/NCHHSTP/DSTDP/PTBCDC/NCHHSTP/DSTDP/PTB
Disclaimer: The findings and conclusions in this presentation are those of the author and do not necessarily 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.represent the views of the Centers for Disease Control and Prevention.
TopicsTopics
National Infertility Prevention Project:National Infertility Prevention Project:
Budget and FundingBudget and FundingDivision UpdatesDivision UpdatesPSCIPSCIHealth Care ReformHealth Care ReformChlamydiaChlamydia
National Chlamydia CoalitionNational Chlamydia Coalition
Gonorrhea Gonorrhea Performance MeasuresPerformance Measures
13.7
16.617.9
23.1
27.4 27.5 27.329
28.1 28.1 27.6 27.6
0
5
10
15
20
25
30
35
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Mill
ion
s (D
olla
rs)
National IPP Funding Allocations 1998-2009
Funding ApplicationsFunding Applications
CSPS 2011CSPS 2011» Guidance under developmentGuidance under development» IPPIPP
Progress on 3% CT PositivityProgress on 3% CT Positivity Targeted GC Burden Calculation and plansTargeted GC Burden Calculation and plans Progress on general objectivesProgress on general objectives Progress on GC meeting action itemsProgress on GC meeting action items
IPP-OPA IAA 2010-2011IPP-OPA IAA 2010-2011» IPP Regional Infrastructure ObjectivesIPP Regional Infrastructure Objectives
Pregnancy-test OnlyPregnancy-test Only AI/AN Health Care Delivery SystemsAI/AN Health Care Delivery Systems
DSTDP UpdateDSTDP Update
STD Treatment GuidelinesSTD Treatment Guidelines» Recommended treatment for uncomplicated GC will be Recommended treatment for uncomplicated GC will be
increased to 250 mg Ceftriaxone.increased to 250 mg Ceftriaxone.» Cefixime 400 mg will remain as a recommended therapyCefixime 400 mg will remain as a recommended therapy» Combination therapy for GC+Combination therapy for GC+
STD Laboratory GuidelinesSTD Laboratory Guidelines» CT GC and syphilisCT GC and syphilis» Re-testing/Supplemental TestingRe-testing/Supplemental Testing
GYTGYT» 190K Unique visitors; average time 3 minutes190K Unique visitors; average time 3 minutes» Just under 40K Toolkit DownloadsJust under 40K Toolkit Downloads
PCSIPCSI
Funding Opportunity AnnouncementFunding Opportunity Announcement» Grants.gov CDC-PS10-10175Grants.gov CDC-PS10-10175
» ““To plan, scale-up, and support the implementation of a To plan, scale-up, and support the implementation of a syndemic approach to the prevention of HIV/AIDS, viral syndemic approach to the prevention of HIV/AIDS, viral hepatitis, STD and TB through PCSI activities as hepatitis, STD and TB through PCSI activities as described……”Enhancing the Prevention and Control of described……”Enhancing the Prevention and Control of HIV/AIDS, viral hepatitis, STD and TB in the United States”HIV/AIDS, viral hepatitis, STD and TB in the United States”
Eligibility (2007 Surveillance Data)Eligibility (2007 Surveillance Data)» 630 AIDS Cases630 AIDS Cases» 225 TB Cases225 TB Cases» 900 Syphilis (all stages) Cases900 Syphilis (all stages) Cases» 6760 Gonorrhea Cases6760 Gonorrhea Cases» 82 HBV Cases82 HBV Cases
Webinar May 10thWebinar May 10th
Health Care ReformHealth Care Reform
What does this mean for CDC, in general, and STD Prevention specifically?
Patient Protection and Patient Protection and Affordable Care ActAffordable Care Act
Mandatory ProgramsMandatory Programs– Prevention and Public Health FundPrevention and Public Health Fund
» Up to 2 Billion dollars annually by 2015Up to 2 Billion dollars annually by 2015» Can be spent on any prevention, wellness or public health Can be spent on any prevention, wellness or public health
activities authorized in the Public Health Services Act. activities authorized in the Public Health Services Act. Section 318 of the PHSA authorizes STD prevention Section 318 of the PHSA authorizes STD prevention (CSPS); section 318A authorizes IPP.(CSPS); section 318A authorizes IPP.
– National Prevention, Health Promotion, and National Prevention, Health Promotion, and Public Health CouncilPublic Health Council
» Advisory in Nature- must create a National Prevention and Advisory in Nature- must create a National Prevention and Health Promotion StrategyHealth Promotion Strategy
PPACA : New Prevention ProgramsPPACA : New Prevention Programs
CDC CDC – Community TransformationCommunity Transformation
– Epidemiology and Epidemiology and Laboratory Capacity Laboratory Capacity
– Healthy Aging Living Well Healthy Aging Living Well
– Prevention ResearchPrevention Research
– Improvement of vaccine Improvement of vaccine delivery systemsdelivery systems
– Office of Women’s HealthOffice of Women’s Health
HHSHHS– State access to purchase State access to purchase
vaccine at federally vaccine at federally negotiated prices negotiated prices
– Menu labeling (FDA)Menu labeling (FDA)
– Individual Wellness Plan Individual Wellness Plan evaluation at FQHCsevaluation at FQHCs
– Grants to support School-Grants to support School-based Health Centersbased Health Centers
– Evidence based teen Evidence based teen pregnancy preventionpregnancy prevention
– Evidence based Evidence based Abstinence-only programsAbstinence-only programs
PPACA: Other ProvisionsPPACA: Other Provisions Insurance (private)Insurance (private)
» Required to provide recommended clinical preventive benefits, Required to provide recommended clinical preventive benefits, including vaccinations without cost-sharingincluding vaccinations without cost-sharing
Medicaid and MedicareMedicaid and Medicare» Medicare preventative services and USPSTF recommended services Medicare preventative services and USPSTF recommended services
(“A” level, maybe “B”) become no cost-sharing; coverage and cost (“A” level, maybe “B”) become no cost-sharing; coverage and cost sharing for vaccines unchanged sharing for vaccines unchanged
» Tobacco cessation pharmaceuticals and expanded cessation services Tobacco cessation pharmaceuticals and expanded cessation services for pregnant woman are coveredfor pregnant woman are covered
» Hospitals required to report rates of healthcare-associated infections Hospitals required to report rates of healthcare-associated infections (MRSA, VRE, etc)(MRSA, VRE, etc)
Public Health WorkforcePublic Health Workforce» Loan repayment program, expand fellowship programs (EIS)Loan repayment program, expand fellowship programs (EIS)
Monitoring Key National Health IndicatorsMonitoring Key National Health Indicators» Standardizes data collection related to health disparitiesStandardizes data collection related to health disparities
Chlamydia — Rates: Total and by sex: United States, 1989–2008Chlamydia — Rates: Total and by sex: United States, 1989–2008
Note: As of January 2000, all 50 states and the District of Columbia had regulations requiring the reporting of chlamydia cases.
0
120
240
360
480
600
1989 91 93 95 97 99 2001 03 05 07
Rate (per 100,000 population)
MenWomenTotal
Chlamydia — Rates by state: United States and outlying areas, 2008Chlamydia — Rates by state: United States and outlying areas, 2008
Note: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 398.5 per
100,000 population.
Rate per 100,000population
Guam 396
Puerto Rico 174
Virgin Is. 535
<=300
300.1-400
>400
(n= 13)
(n= 17)
(n= 24)
VT 192NH 160MA 271RI 314CT 357NJ 258DE 447MD 439DC 1177
535
711
391499
407 395
389
447
466
280
460 349
314
332287
528
198
446
276
728
422
324
314377
470
458
414
300
411
409
287
340
597
371
455
422
228
405
331
183
375
302
Chlamydia — Age- and sex-specific rates: United States, 2008Chlamydia — Age- and sex-specific rates: United States, 2008
Men Rate (per 100,000 population) Women
Age3500 2800 2100 1400 700 0 0 700 1400 2100 2800 3500
13.9 129.910-14701.6 3275.815-19
1056.1 3179.920-24565.9 1240.625-29
271.7 498.930-34140.8 205.635-39
78.3 85.840-4434.4 30.945-5410.4 8.455-64
2.7 2.165+211.7 585.6Total
Chlamydia — Rates by race/ethnicity: United States, 1999–2008Chlamydia — Rates by race/ethnicity: United States, 1999–2008
0
340
680
1020
1360
1700
1999 2000 01 02 03 04 05 06 07 08
Rate (per 100,000 population)
American Indian/AK NativeAsian/Pacific IslanderBlackHispanicWhite
Chlamydia — Prevalence by age group and race/ethnicity fromChlamydia — Prevalence by age group and race/ethnicity froma national survey, 1999–2002a national survey, 1999–2002
Note: Error bars indicate 95% confidence intervals.
SOURCE: National Health and Nutrition Examination Survey. Ann Intern Med 2007;Jul 17;147(2):89-96.
Prevalence
Non-Hispanic White
Non-Hispanic Black
Mexican-American
0
4
8
12
16
14-19 20-29 30-39
Chlamydia — Positivity among 15- to 24-year-old women tested in family Chlamydia — Positivity among 15- to 24-year-old women tested in family planning clinics by state: United States and outlying areas, 2008planning clinics by state: United States and outlying areas, 2008
Note: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged 15-24 years screened during
2008.
DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease Control and Prevention
Positivity (%)
Puerto Rico 7.4
Virgin Is. 15.0
<5.0
5.0-9.9
>=10.0
(n= 5)
(n= 39)
(n= 9)
VT 3.7NH 3.9MA 5.1RI 7.6CT 7.4NJ 8.4DE 8.6MD 5.8DC 9.5
11.3
5.4
8.7 10.3
5.9 7.5
9.3
10.8
9.3
5.9
7.3 8.4
6.1
7.04.7
12.3
6.2
6.9
6.5
13.8
7.4
5.9
7.17.6
8.1
5.0
7.9
8.4
7.9
6.8
4.7
6.5
11.8
6.4
6.2
12.4
12.57.3
7.2
3.1
8.5
6.9
Chlamydia — Trends in positivity among 15- to 24-year-old women tested Chlamydia — Trends in positivity among 15- to 24-year-old women tested in family planning clinics by HHS region, 2004–2008in family planning clinics by HHS region, 2004–2008
DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs,
Local and State STD Control Programs, Centers for Disease Control and Prevention
Region I
Region II
Region III
Region IV
Region V
Region VIRegion VII
Region VIII
Region IX
Region X
4.6
04
4.7
05
4.7
06
4.8
07
5.2
08
7.1
04
5.7
05
5.6
06
5.9
07
6.2
08
6.0
04
5.8
05
5.4
06
5.5
07
6.3
08
8.4
04
8.8
05
9.0
06
9.6
07
9.6
08
7.5
04
7.7
05
7.6
06
7.6
07
7.6
08
7.4
04
7.4
05
7.9
06
8.8
07
10.2
08
5.8
04
5.8
05
6.5
06
6.5
07
6.8
08
6.3
04
6.3
05
7.2
06
7.3
07
7.8
08
6.7
04
6.4
05
6.8
06
7.3
07
7.5
08
5.9
04
5.6
05
5.7
06
5.8
07
6.0
08
IV
VIIIX
IIIX
III
VI
VVIII
National Chlamydia CoalitionNational Chlamydia Coalition
Annual MeetingAnnual Meeting» December 3-4, 2009 DCDecember 3-4, 2009 DC» Social MarketingSocial Marketing» Sub-Committee MeetingsSub-Committee Meetings
Research Subcommittee Research Subcommittee What can you do?What can you do?
– Chlamydia Screening Priority in Health Care Delivery Chlamydia Screening Priority in Health Care Delivery SystemsSystems
» Outreach to State Adolescent Health CoordinatorOutreach to State Adolescent Health Coordinator» Child Health Indicators for Medicaid and CHIPChild Health Indicators for Medicaid and CHIP» EMR Incentives for Medicaid and MedicareEMR Incentives for Medicaid and Medicare
National Chlamydia CoalitionNational Chlamydia CoalitionMini Grants: To fund innovative strategies to increase CT screening and Mini Grants: To fund innovative strategies to increase CT screening and
follow-up care including partner treatmentfollow-up care including partner treatment
College Health ProgramCollege Health Program» Old Dominion (VA)Old Dominion (VA)
Sports Health ScreeningsSports Health Screenings» Uplift School (IL)Uplift School (IL)
Academic DetailingAcademic Detailing» Private Providers (IL)Private Providers (IL)
CT screeningCT screening» Medicaid Managed Care Medicaid Managed Care
(MI)(MI) Awareness and ScreeningAwareness and Screening
» PP Greater Washington PP Greater Washington and North Idahoand North Idaho
CT Model ProtocolCT Model Protocol» AI/AN (Regions VIII & X)AI/AN (Regions VIII & X)
JDC ScreeningsJDC Screenings» Baltimore JDC (MD)Baltimore JDC (MD)
Targeted use of GISTargeted use of GIS» Adagio Health (PA)Adagio Health (PA)
Provider OutreachProvider Outreach» NYS providers (Region II)NYS providers (Region II)
Plan Development Plan Development » Coalition Building (MN)Coalition Building (MN)
Gonorrhea — Rates: United States, 1941–2008Gonorrhea — Rates: United States, 1941–2008
0
100
200
300
400
500
1941 46 51 56 61 66 71 76 81 86 91 96 2001 06
Rate (per 100,000 population)
Gonorrhea — Rates by race/ethnicity: United States, 1999–2008Gonorrhea — Rates by race/ethnicity: United States, 1999–2008
0
180
360
540
720
900
1999 2000 01 02 03 04 05 06 07 08
Rate (per 100,000 population)
American Indian/AK NativeAsian/Pacific IslanderBlackHispanicWhite
GonorrheaGonorrhea
““Incurable gonorrhea may be next superbug”Incurable gonorrhea may be next superbug”» MSNBC 4-8-2010MSNBC 4-8-2010
““Emergence of Antibiotic-resistant gonorrheaEmergence of Antibiotic-resistant gonorrhea””» Time (blog) 3-31-2010Time (blog) 3-31-2010
““Gonorrhea mutating into superbug especially in Gonorrhea mutating into superbug especially in SEAsia”SEAsia”
» Pattaya Daily News 4-1-2010Pattaya Daily News 4-1-2010
““Sex Infection gonorrhea becoming drug-resistant”Sex Infection gonorrhea becoming drug-resistant”» BBC News 3-29-2010BBC News 3-29-2010
GonorrheaGonorrhea
AR GC Laboratory ActivitiesAR GC Laboratory Activities» GISPGISP
» Enhanced surveillance in the Far East with WHOEnhanced surveillance in the Far East with WHO Documented Clinical Cases of resistance to oral cephalosporinsDocumented Clinical Cases of resistance to oral cephalosporins WHO-WPRO Consultations (Manila in April; Bali in May)WHO-WPRO Consultations (Manila in April; Bali in May)
» Basic research to develop a molecular test that could indicate Basic research to develop a molecular test that could indicate resistance in NAAT-positive specimensresistance in NAAT-positive specimens
AR GC Outbreak response plan developmentAR GC Outbreak response plan development» Consultation Atlanta September 14-15Consultation Atlanta September 14-15
» State-level Outbreak Response Plan Development and PilotsState-level Outbreak Response Plan Development and Pilots California, Hawaii, Illinois, New York State and Washington stateCalifornia, Hawaii, Illinois, New York State and Washington state
Regional MeetingsRegional Meetings» Monitoring Action Plan progressMonitoring Action Plan progress
» Meetings Report DevelopmentMeetings Report Development
Performance MeasuresPerformance Measures
CSPS Project started 1999CSPS Project started 1999 Pilot project 2001Pilot project 2001 Set of 12 measures 2005Set of 12 measures 2005
» Timeliness of Treatment CT and GC in FP clinicsTimeliness of Treatment CT and GC in FP clinics» STD Clinics added 2007STD Clinics added 2007» GC Interviews modified 2009GC Interviews modified 2009
NCSD Survey Optional MeasuresNCSD Survey Optional Measures– Feasibility. Usefulness and Intent to UseFeasibility. Usefulness and Intent to Use– All CT male and females 15-24All CT male and females 15-24– All GonorrheaAll Gonorrhea
Performance Measure DataPerformance Measure DataTimeliness of Treatment for CT (14 Days)Timeliness of Treatment for CT (14 Days)
Prevalence Monitoring Family Planning SitesPrevalence Monitoring Family Planning Sites
20052005 20062006 20072007 20082008 20092009
Conn 0.71 0.88 0.88 0.81 0.85
Maine 0.93 0.91 0.92 0.89 0.87
Mass 0.83 0.88 0.87 0.86 0.74
NH 0.90 0.87 0.87 0.86 0.91
RI 0.80 0.71 0.75 0.73 0.84
Vermont 0.95 0.89 0.70 0.87 0.91
Region IRegion I 0.840.84 0.860.86 0.850.85 0.830.83 0.840.84
NationalNational 0.620.62 0.660.66 0.640.64 0.640.64 0.670.67
Performance Measure DataPerformance Measure DataTimeliness of Treatment for GC (14 Days)Timeliness of Treatment for GC (14 Days)
Prevalence Monitoring Family Planning SitesPrevalence Monitoring Family Planning Sites
20052005 20062006 20072007 20082008 20092009
Conn 0.78 0.90 0.82 0.84 0.88
Maine 1.00 0.83 1.00 1.00 0.70
Mass 0.79 0.87 0.91 0.70 0.76
NH 1.00 0.91 0.92 0.75 1.00
RI 0.73 0.77 0.68 0.80 0,94
Vermont 1.00 0.89 0.90 1.00 1.00
Region IRegion I 0.850.85 0.870.87 0.850.85 0.790.79 0.860.86
NationalNational 0.620.62 0.660.66 0.640.64 0.640.64 0.670.67
Performance Measure DataPerformance Measure DataTimeliness of Treatment CT and GC (14 Days)Timeliness of Treatment CT and GC (14 Days)
STD Sites: 2007-2009STD Sites: 2007-2009
CTCT
20072007
CTCT
20082008
CTCT
20092009
GCGC
20072007
GCGC
20082008
GCGC
20092009Conn 0.91 0.88 0.81 0.83 0.81 0.82
Maine 1.00 0.94 1.00 1.00 1.00 0.67
Mass 0.93 0.94 0.90 1.00 1.00 1.00
NH 0.83 0.84 0.94 1.00 1.00 0.95
RI 1.00 0.86 0.94 0.90 1.00 1.00
Vermont 0.98 0.00 0.00 0.90 0.00 0.00
Region IRegion I 0.930.93 0.870.87 0.910.91 0.910.91 0.860.86 0.860.86
NationalNational 0.690.69 0.720.72 0.690.69 0.700.70 0.730.73 0.670.67
Performance Measure and Morbidity DataPerformance Measure and Morbidity DataChlamydia- All FemalesChlamydia- All Females
STD Sites: 2008STD Sites: 2008
Total CT CasesTotal CT Cases
NETSSNETSS
CT STD CasesCT STD Cases
NETSS NETSS
% %
CasesCases
CT STD CasesCT STD Cases
PM DataPM Data
Conn 9239 417 4.5 268
Maine 1847 41 2.2 35
Mass 12646 323 2.6 128
NH 1548 58 3.7 273
RI 2400 66 2.8 65
Vermont 896 57 6.4 0
NationalNational 893004893004 8994389943 10.0010.00 6707467074
Performance Measure and Morbidity DataPerformance Measure and Morbidity DataGonorrhea- All FemalesGonorrhea- All Females
STD Sites: 2008STD Sites: 2008
Total GC CasesTotal GC Cases
NETSSNETSS
GC STD CasesGC STD Cases
NETSS NETSS
% %
CasesCases
GC STD CasesGC STD Cases
PM DataPM Data
Conn 1686 106 6.3 73
Maine 43 3 7.0 3
Mass 1100 55 5.0 13
NH 49 0 0 4
RI 135 7 5.2 7
Vermont 19 3 16.00 0
NationalNational 182577182577 2782527825 15.0015.00 2445824458
CSPS-IPP 2009CSPS-IPP 2009
Gonorrhea Burden CalculationGonorrhea Burden Calculation» Portion of Total IPP funds to be used to target Portion of Total IPP funds to be used to target
GC screeningGC screening» Total GC women <26/Total CT GC women <26Total GC women <26/Total CT GC women <26» Up to 10% of funds availableUp to 10% of funds available» Identify venues/providers Identify venues/providers
– High morbidity with limited screening coverageHigh morbidity with limited screening coverage– In geographic catchment areas with high In geographic catchment areas with high
morbiditymorbidity
» Shift resources to those areasShift resources to those areas
GC Burden Calculation GC Burden Calculation ExampleExample
Project Area XProject Area X» Total IPP funds = $500,000Total IPP funds = $500,000» Among women 25 and youngerAmong women 25 and younger (all venues)(all venues)
500 Gonorrhea and 10,000 Chlamydia500 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 usedIPP 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
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