infertility prevention project region i june 1, 2009 wells beach, maine infertility prevention...
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Infertility Prevention ProjectInfertility Prevention ProjectRegion I Region I
June 1, 2009June 1, 2009Wells 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 Strategic GoalsDivision Strategic GoalsPriority ActivitiesPriority ActivitiesGonorrheaGonorrheaPerformance MeasuresPerformance Measures
CSPSCSPS InfrastructureInfrastructure NCQA and HEDISNCQA and HEDIS
GYT 09GYT 09
National IPP Funding Allocations
1998-2008
13.7
16.617.9
23.1
27.4 27.5 27.3
2928.1 28.1 27.6
0
5
10
15
20
25
30
35
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Year
Mill
ion
s
Strategic GoalsStrategic Goals
Division of STD Prevention Strategic Plan October 2008Division of STD Prevention Strategic Plan October 2008
– Prevent STD-related infertilityPrevent STD-related infertility» Screening and Treatment; Partner ServicesScreening and Treatment; Partner Services
– Prevent adverse outcomes of pregnancyPrevent adverse outcomes of pregnancy– Prevent STD-related cancersPrevent STD-related cancers– Prevent STD-related HIV transmission and acquisitionPrevent STD-related HIV transmission and acquisition– Strengthen STD prevention capacity and infrastructureStrengthen STD prevention capacity and infrastructure– Reduce STD health disparitiesReduce STD health disparities– Address effects of social and economic determinants and Address effects of social and economic determinants and
costs of STDs and associated costs of STDs and associated sequelaesequelae among specific among specific populationspopulations
Infrastructure Funding and ActivitiesInfrastructure Funding and ActivitiesCDC-OPA IAACDC-OPA IAA
Coordinate Regional Coordinate Regional MeetingsMeetings– Assure Equal Assure Equal
PartnershipPartnership Regional IPP PlanRegional IPP Plan Conduct Site VisitsConduct Site Visits Support National CT Support National CT
Prevention ActivitiesPrevention Activities Evaluate and Evaluate and
Disseminate DataDisseminate Data Data Quality AssuranceData Quality Assurance
Collaboration Special Collaboration Special ProjectsProjects
Infrastructure Infrastructure Performance MeasuresPerformance Measures
Data ManagementData Management CollectionCollection Quality AssuranceQuality Assurance Analysis Analysis DisseminationDissemination
Attend Regional Attend Regional Coordinators MeetingsCoordinators Meetings
Project Area Funding and ActivitiesProject Area Funding and ActivitiesCSPS IPP 09-902CSPS IPP 09-902
Ensure CT and GC Ensure CT and GC Screening and TreatmentScreening and Treatment
Support Lab TestingSupport Lab Testing Ensure Collection and Ensure Collection and
Reporting of all core CDC Reporting of all core CDC data elementsdata elements
Provide Program Provide Program ManagementManagement
Ensure Provider TrainingEnsure Provider Training Grant DevelopmentGrant Development
Use Data to plan programsUse Data to plan programs– Prevalence MonitoringPrevalence Monitoring
– SurveillanceSurveillance
– Performance MeasuresPerformance Measures 50% Rule50% Rule Male ScreeningMale Screening
– Up to 15% of IPP fundsUp to 15% of IPP funds Targeted GC ScreeningTargeted GC Screening
– Up to 10% of IPP fundsUp to 10% of IPP funds
– GC Burden CalculationGC Burden Calculation
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
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
WHY GONORRHEA?
Gonorrhea rates, U.S., 1941-Gonorrhea rates, U.S., 1941-2007*2007*
*Preliminary 2007 data
Rate (per 100,000 population)
Gonorrhea2010 Target
0
100
200
300
400
500
1941 46 51 56 61 66 71 76 81 86 91 96 2001 06
Gonorrhea — Rates by county, Gonorrhea — Rates by county, 20072007
Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.
Rate per 100,000population
<=19.0 (n= 1,305)
19.1-100.0 (n= 1,099)
>100.0 (n= 736)
Men Rate (per 100,000 population) Women
Age750 600 450 300 150 0 0 150 300 450 600 750
5.9 33.110-14286.0 647.915-19
450.1 614.520-24305.1 287.125-29
181.5 125.230-34119.5 60.535-39
86.6 30.840-4450.2 12.145-54
17.7 3.055-644.0 0.465+
113.9 123.8Total
Gonorrhea rates by age and sex, Gonorrhea rates by age and sex, 20072007
69%15-24 years
48%15-24 years
Gonorrhea rates by Gonorrhea rates by race/ethnicity, 1981-2007*race/ethnicity, 1981-2007*
*Preliminary 2007 data
Rate (per 100,000 population)
American Indian/AK NativeAsian/Pacific IslanderBlackHispanicWhite2010 Target
0
500
1,000
1,500
2,000
2,500
1981 83 85 87 89 91 93 95 97 99 2001 03 05 07
STD Surveillance Network STD Surveillance Network (SSuN)(SSuN)
Purpose: to improve national capacity to Purpose: to improve national capacity to detect, monitor, and respond to emerging detect, monitor, and respond to emerging trends in STDs and related behaviorstrends in STDs and related behaviors
Population-based enhanced gonorrhea Population-based enhanced gonorrhea surveillancesurveillance– Sample of patients reported with gonorrhea in Sample of patients reported with gonorrhea in
selected countiesselected counties» Excludes patients who attend the primary STD Excludes patients who attend the primary STD
clinic(s)clinic(s)
– Analysis of data from Feb 2006 – June 2008Analysis of data from Feb 2006 – June 2008
San Francisco San Francisco Co.
STD Surveillance Network (SSuN) project areas (n=5) & participating counties and independent
cities (n=11), 2006-2008
SSuN project areas
Participating counties and independent cities
WashingtonKing Co.Pierce Co.Snohomish Co.
Virginia Chesterfield Co.Henrico Co.Richmond City
ColoradoAdams Co.Arapaho Co.Denver Co.
MinnesotaHennepin Co.
New York City
San Francisco
Washington.
Virginia Colorado
Chicago*
New York City
Baltimore*
Philadelphia*
Alabama*
Louisiana*
Los Angeles/CA*
Connecticut*
~ 100 counties~ 40 STD clinics
SSuN Laboratory Sites
SSuN Cycle 2: Participating project areas SSuN Cycle 2: Participating project areas (n=12) and labs (n=6), 2009 – 2013(n=12) and labs (n=6), 2009 – 2013
New Sites*
Gonorrhea rates per 100,000 Gonorrhea rates per 100,000 population in African American and population in African American and
white counties, U.S., 2005white counties, U.S., 2005
Gonorrhea rate per 100,000 Gonorrhea rate per 100,000 populationpopulation
< = 19.0< = 19.0 19.1 – 100.019.1 – 100.0 >100.0>100.0Counties > = Counties > = 15% African 15% African
AmericanAmerican 0.5%0.5% 3.9%3.9% 95.6%95.6%Counties > = Counties > =
80% 80% WhiteWhite 75.8%75.8% 23.7%23.7% 0.5%0.5%
Percent of Percent of Neisseria gonorrhoeaeNeisseria gonorrhoeae isolates with isolates with resistance or intermediate resistance to resistance or intermediate resistance to
ciprofloxacin, 1990–2005ciprofloxacin, 1990–2005
Note: Resistant isolates have ciprofloxacin MICs ≥ 1 µg/ml. Isolates with intermediate resistance have ciprofloxacin MICs of 0.125 - 0.5 µg/ml. Susceptibility to ciprofloxacin was first measured in GISP in 1990.
Percent
Resistant
Intermediate resistance
0.0
3.0
6.0
9.0
12.0
1990 91 92 93 94 95 96 97 98 99 2000 01 02 03 04 05
Resistance to CephalosporinsResistance to Cephalosporins
Oral Cephalosporins (Cefixime et al)Oral Cephalosporins (Cefixime et al)» 2% Treatment Failure2% Treatment Failure» Increasing MICs since 2003Increasing MICs since 2003» Increasing number of GC strains with Increasing number of GC strains with
decreased susceptibilitydecreased susceptibility
Injectable Cephalosporins (Ceftriaxone)Injectable Cephalosporins (Ceftriaxone)» No documented treatment failures to dateNo documented treatment failures to date» Increasing MICs since 2003Increasing MICs since 2003» Recommended treatment doses increasingRecommended treatment doses increasing
Past and FuturePast and Future
Penicillins (larger and larger doses)Penicillins (larger and larger doses) TetracyclinesTetracyclines SpectinomycinsSpectinomycins FluoroquinolonesFluoroquinolones Oral CephalosporinsOral Cephalosporins Injectable CephalosporinsInjectable Cephalosporins PenemsPenems New Drugs?New Drugs?
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 2008STD Clinics added 2008» GC Interviews modified 2009GC Interviews modified 2009
Infrastructure Performance MeasuresInfrastructure Performance Measures» Among clients attending family planning clinics, the number of Among clients attending family planning clinics, the number of
women screened for chlamydia, stratified by age.women screened for chlamydia, stratified by age.
» Screening coverage estimate among sexually active 15-19 year Screening coverage estimate among sexually active 15-19 year old women in FP clinicsold women in FP clinics
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
Region IRegion I
14 Days14 Days
0.840.84
(0.71-0.95)(0.71-0.95)
0.860.86
(0.71-0.91)(0.71-0.91)
0.85 0.85
(0.70-0.92)(0.70-0.92)
0.830.83
(0.73-0.89)(0.73-0.89)
NationalNational
14 Days14 Days
0.620.62 0.660.66 0.640.64 0.640.64
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
Region IRegion I
14 Days14 Days
0.850.85
(0.73-1.00)(0.73-1.00)
0.870.87
(0.77-0.91)(0.77-0.91)
0.850.85
(0.68-1.00)(0.68-1.00)
0.790.79
(0.70-1.00)(0.70-1.00)
NationalNational
14 Days14 Days
0.610.61 0.670.67 0.640.64 0.640.64
Performance Measure DataPerformance Measure DataTimeliness of Treatment Timeliness of Treatment
CT and GC (14 Days)CT and GC (14 Days)STD Sites- 2007 and 2008STD Sites- 2007 and 2008
ChlamydiaChlamydia
20072007
ChlamydiaChlamydia
20082008
GonorrheaGonorrhea
20072007
GonorrheaGonorrhea
20082008
Region IRegion I
14 Days14 Days
0.930.93
(0.83-1.00)(0.83-1.00)
0.870.87
(0.84-0.94)(0.84-0.94)
0.910.91
(0.83-1.00)(0.83-1.00)
0.860.86
(0.81-1.00)(0.81-1.00)
NationalNational
14 Days14 Days
0.690.69 0.720.72 0.700.70 0.730.73
Performance MeasuresPerformance MeasuresGonorrhea InterviewsGonorrhea Interviews
Old Measure: Old Measure: Proportion of “priority” Proportion of “priority” gonorrhea cases gonorrhea cases interviewed within 7, 14, interviewed within 7, 14, and 30 days from date and 30 days from date of specimen collection of specimen collection (2005-2008). (2005-2008).
– Programs receiving SE Programs receiving SE funds were not required funds were not required to submit data for this to submit data for this measure.measure.
New Measure: New Measure: Proportion of all Proportion of all gonorrhea cases gonorrhea cases interviewed within 7, 14, interviewed within 7, 14, and 30 days from date and 30 days from date of specimen collection. of specimen collection.
– HMA programs receiving HMA programs receiving SE funds are not SE funds are not required to submit data required to submit data for this measure; non-for this measure; non-HMAs receiving SE funds HMAs receiving SE funds ARE required to submit ARE required to submit data.data.
Infrastructure Performance MeasuresInfrastructure Performance MeasuresEstimated Screening Coverage (%)Estimated Screening Coverage (%)
Females 15-19 years old Females 15-19 years old
RegionRegion 20052005 20062006 20072007 20082008
II 3636 3838 4343 4646
IIII 4646 4646 5050 5353
IIIIII 5050 5252 5151 5353
IVIV 5353 5353 4646 5050
VV 4747 4747 4747 No DataNo Data
VIVI 5656 5555 5858 No DataNo Data
VIIVII 5959 5454 5555 5757
VIIIVIII 4040 4141 4040 No DataNo Data
IXIX 5555 6060 3535 No DataNo Data
XX 3434 3535 3838 No DataNo Data
NationalNational 5050 5050 5151 N/AN/A
Figure. Percentage of sexually active female enrollees aged 16Figure. Percentage of sexually active female enrollees aged 16−25 years −25 years who who were screened for chlamydia, by health plan type and year were screened for chlamydia, by health plan type and year ─ Healthcare ─ Healthcare Effectiveness Data and Information Set (HEDIS), 2000−2007Effectiveness Data and Information Set (HEDIS), 2000−2007
0
20
40
60
80
100
2000 2001 2002 2003 2004 2005 2006 2007
Year
Per
cen
tag
e
Medicaid
Commercial
Infrastructure Performance MeasuresInfrastructure Performance Measures Proportion of Tests Proportion of Tests
Females 15-24 years of age (%)Females 15-24 years of age (%)
RegionRegion 20052005 20062006 20072007 20082008
II 6161 6262 6161 6464
IIII 6262 6363 6464 6363
IIIIII 6767 7272 6868 7070
IVIV 7373 6565 6363 6262
VV 7373 7171 6969 No dataNo data
VIVI 6767 6666 6565 No dataNo data
VIIVII 7474 7272 7272 7777
VIIIVIII 7474 7272 7272 No dataNo data
IXIX 6363 6666 6464 No dataNo data
XX 8181 7878 7474 No dataNo data
NationalNational 7070 6969 6767 N/AN/A
GYT ‘09GYT ‘09
275,000 unique visitors to website275,000 unique visitors to website» 4X visitors compared to previous campaigns4X visitors compared to previous campaigns
Planned Parenthood AffiliatesPlanned Parenthood Affiliates» 24 out of 98 reported so far24 out of 98 reported so far» STI testing increased 10%-103% over April 08STI testing increased 10%-103% over April 08» Planned Parenthood Health Systems 103%Planned Parenthood Health Systems 103%» Planned Parenthood Rocky MountainsPlanned Parenthood Rocky Mountains
1418 CT GC tests in two days 1418 CT GC tests in two days – Normally 78 tests per dayNormally 78 tests per day
Final Reports due May 30Final Reports due May 30 Posted Summary Report by mid-JulyPosted Summary Report by mid-July
Questions?Questions?