11

STDs in STDs in Houston/Harris Houston/Harris

CountyCountyTrendsTrends

InterventionsInterventions

Emerging IssuesEmerging Issues

22

Why are STDs Important?Why are STDs Important?

Facilitate Transmission of HIV InfectionFacilitate Transmission of HIV Infection

Cause InfertilityCause Infertility

Cause PIDCause PID

Adverse Outcomes on PregnancyAdverse Outcomes on Pregnancy

17 Billion Dollar Cost Annually in USA17 Billion Dollar Cost Annually in USA

33

How Are We Doing inHow Are We Doing in Houston?Houston?

In 2002, Houston Ranked:In 2002, Houston Ranked:

48th- Chlamydia (346.1/100,000)48th- Chlamydia (346.1/100,000)

45th- Gonorrhea (153.9/100,000)45th- Gonorrhea (153.9/100,000)

31st- P&S Syphilis (3.3/100,000)31st- P&S Syphilis (3.3/100,000)

44

ChlamydiaChlamydiaEPIDEMIOLOGYEPIDEMIOLOGY

55

Chlamydia Crude Rates

75459126

10818 1156510478

121441130011728

10558

0

2000

4000

6000

8000

10000

12000

14000

1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

# C

ases

050100150200250300350400

Rat

e pe

r 10

0,00

0

# Cases Rate per 100,000

66

Chlamydia: US to Houston/Harris County

050

100150200250300350400

1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

0,00

0

Harris County Rates US Rates

77

Chlamydia Gender-Specific Rates

0

100

200

300

400

500

600

700

1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

Rat

e pe

r 10

0,00

0

Male Rate Female Rate

88

Chlamydia 2003 Rates by Age and Gender

0

500

1000

1500

2000

2500

3000

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+

Age Category

Rat

e p

er 1

00,0

00

Female Rates Male Rates

99

Chlamydia Case Report Sources 2002-2003

0

1000

2000

3000

4000

5000

6000

7000

City Private Hospitals/ER Jail Other

Case Report Source

# C

ases

2002 2003

1010

GonorrheaGonorrheaEPIDEMIOLOGYEPIDEMIOLOGY

1111

Gonorrhea Crude Rates

68916125

66537245

5907 59275505 5212

4268

0

1000

2000

3000

4000

5000

6000

7000

8000

1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

# C

ases

0

50

100

150

200

250

Rat

e p

er 1

00,0

00

# Cases Rate

1212

Gonorrhea: US to Houston/Harris County

0

50

100

150

200

250

1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e p

er 1

00,0

00

Harris County Rates US Rates

1313

Gonorrhea Gender-Specific Rates

0

50

100

150

200

250

300

1995 1996 1997 1998 1999 2000 2001 2001 2003

Year

Rat

e p

er 1

00,0

00

Male Rates Female Rates

1414

Gonorrhea 2003 Rates by Age and Gender

0

100

200

300

400

500

600

700

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+

Age Category

Ra

te p

er

10

0,0

00

Female Rates Male Rates

1515

Gonorrhea Case Report Sources 2002-2003

0

500

1000

1500

2000

2500

City Private Hospitals/ER Jail Other

Case Report Source

# C

ases

2002 2003

1616

SyphilisSyphilisEPIDEMIOLOGYEPIDEMIOLOGY

1717

Syphilis Crude Rates

24212259

1936

14051103

851 923 1002 1060

0

500

1000

1500

2000

2500

3000

1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

# C

ases

0

20

40

60

80

100

Ra

te p

er

10

0,0

00

# Cases Rate

1818

Syphilis: US to Houston/Harris County

0

20

40

60

80

100

1995 1996 1997 1998 1999 2000 2001 2002

Year

Ra

te p

er

10

0,0

00

Harris County Rates US Rates

1919

Syphilis: Primary and Secondary

0

50

100

150

200

250

300

350

400

1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

# C

ases

2020

HDHHSHDHHSSTD InterventionsSTD Interventions

ScreeningScreening

TreatmentTreatment

EducationEducation

CounselingCounseling

Partner ServicesPartner Services

2121

ScreeningScreening

Syphilis, gonorrhea, chlamydia, hep Syphilis, gonorrhea, chlamydia, hep C,HIV testing in 3 STD clinicsC,HIV testing in 3 STD clinics

Family Planning (no hep C)Family Planning (no hep C)

Prenatal (no hep C)Prenatal (no hep C)

Outreach Contractors (no gc)Outreach Contractors (no gc)

2222

ScreeningScreening

Mobile Unit Outreach testingMobile Unit Outreach testing

Collaboration with CBOs in outreach Collaboration with CBOs in outreach

Bookstores, Bath houses, streets, barsBookstores, Bath houses, streets, bars

Mobile clinic planned for 2003Mobile clinic planned for 2003

Jail tanksJail tanks

Key HIV providers encouraged to testKey HIV providers encouraged to test

Contracts with 7 CBOs to do screeningContracts with 7 CBOs to do screening

2323

TreatmentTreatment

3 STD Clinics3 STD Clinics

Some treatment in Family Planning and Some treatment in Family Planning and Maternity Clinics except for syphilisMaternity Clinics except for syphilis

Facilitate treatment with private Facilitate treatment with private providers - provide some medsproviders - provide some meds

Facilitate treatment with Harris Co. JailFacilitate treatment with Harris Co. Jail

2424

TreatmentTreatment

DOT for chlamydiaDOT for chlamydia

Recommend epi profile based preventive Recommend epi profile based preventive treatment around syphilis outbreaktreatment around syphilis outbreak

Encouraging stat RPR testing around Encouraging stat RPR testing around outbreakoutbreak

Hope to provide on site treatment on Hope to provide on site treatment on mobile clinic in 2003mobile clinic in 2003

2525

VaccineVaccine

Hepatitis B vaccine in STD clinicsHepatitis B vaccine in STD clinics

Plans for Hep A vaccine in STD clinicsPlans for Hep A vaccine in STD clinics

2626

EducationEducation

Health Educators trained in STDsHealth Educators trained in STDsCDBG health ed in K-12; and in K-12 CDBG health ed in K-12; and in K-12 HIV/STD Info-line HIV/STD Info-line Contracts with 23 CBOs for educationContracts with 23 CBOs for educationWork with CPG to emphasize STDsWork with CPG to emphasize STDsProvider alerts, media alerts, provider Provider alerts, media alerts, provider trainingtrainingExpanding education to web sites, chat Expanding education to web sites, chat roomsrooms

2727

CounselingCounseling

Clinicians Clinicians

DISDIS

ContractorsContractors

2828

Partner ServicesPartner Services

DIS provide partner referrals and DIS provide partner referrals and notification for syphilis and HIVnotification for syphilis and HIV

Some chlamydia and gonorrheaSome chlamydia and gonorrhea

Clustering and social network outreachClustering and social network outreach

Counseling and testing contractors Counseling and testing contractors

2929

Partner ServicesPartner Services

Pursuing web based self-interviewPursuing web based self-interview

Self-referral through internet/emailSelf-referral through internet/email

DIS Liaison with Key ProvidersDIS Liaison with Key Providers

Working with CBOs on training DIS and Working with CBOs on training DIS and DIS on training CBOs to improve and DIS on training CBOs to improve and promote partner notificationpromote partner notification

3030

DIS Outcomes for Syphilis*DIS Outcomes for Syphilis*20022002

488/546 Interviewed (89%)488/546 Interviewed (89%)

442 contacts442 contacts

515 were located (80%)515 were located (80%)453 examined453 examined62 refused exam62 refused exam81 (18%) new cases brought to TX81 (18%) new cases brought to TX229 preventive TX229 preventive TX457 clusters 457 clusters 4 new cases brought to TX4 new cases brought to TX

**P&S, EL, Unk durationP&S, EL, Unk duration

3131

DIS Outcomes HIVDIS Outcomes HIV20022002

Interviewed 303/349 (87%)Interviewed 303/349 (87%)90% successful referrals to EIP 90% successful referrals to EIP 482 contacts482 contacts331Located/Counseled (69%)331Located/Counseled (69%)81 previous positive (24%)81 previous positive (24%)34 newly positive (10%)34 newly positive (10%)183 (55%)negative183 (55%)negative33 (10%) refused a test33 (10%) refused a test323 clusters --- 30 positives = 9% 323 clusters --- 30 positives = 9%

3232

Emerging IssuesEmerging Issues

Syphilis OutbreaksSyphilis Outbreaks

HIV Co-InfectionHIV Co-Infection

Resurgence in Risky BehaviorResurgence in Risky Behavior

Partner Services InnovationPartner Services Innovation

Internet and STDsInternet and STDs

HepatitisHepatitis