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ILLINOIS STATE REPORT

ILLINOIS STATE REPORT. March 2011 Chicago. Topics. IDPH Laboratory Update Rescreening Treatment Timeliness SBHC/JDC Chlamydia Screening Initiative SBHC-Sports Physical Project Special CT/GC testing initiative EPT Survey and Findings. IDPH Laboratory Update. Oral/Rectal Study

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ILLINOIS STATE REPORT

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  1. ILLINOIS STATE REPORT March 2011 Chicago

  2. Topics IDPH Laboratory Update Rescreening Treatment Timeliness SBHC/JDC Chlamydia Screening Initiative SBHC-Sports Physical Project Special CT/GC testing initiative EPT Survey and Findings

  3. IDPH Laboratory Update Oral/Rectal Study Pooling

  4. DETECTION OF NG/CT IN NON-GENITAL SITESBY NAATOral-PharyngealAnal-Rectal

  5. IRB Study To Compare the Performance of the GenProbe versus BD Qx Assays • Howard Brown Clinic Clinic staff • Illinois Department of Public Health John Nawrocki, Ph.D. (BD Qx Assay) Gary Boyce • University of Illinois William Janda, Ph.D. (GenProbe Assay)

  6. Results:295 Patients tested to date….. • Testing positive for CT by both assays • 3 oral & 7 rectal specimens • Testing positive for GC by both assays • 17 oral; 6 rectal

  7. Pooling • Objective: to determine the sensitivity of the BD Qx assay for the detection of known positive specimens (NG/CT) in pools of 4 specimens. • Specimens identified as positive for either or both agents were re-tested in pools with 3 known negative specimens.

  8. RESULTS Dual positives – picked up one of the positive test results

  9. RESCREENING

  10. Why Rescreen? • Gaydos et al: CT Reinfection Rates Among Female Adolescents Seeking Rescreening AT SBHCs • 236 of 897 (26.3%) females students reinfected • Broussard et al: Screening Adolescents in a JDC for GC/CT: Prevalence and Reinfection Rates • Reinfection rates: 10 % for GC and 28.9% for CT • IDPH STD Section: Jan – May 2009, 1,714 females tested positive for chlamydia at a family planning or SBHCs. • A total of 746 (43.5%) females returned for rescreening within two to 12 months • CT re-infection rate was 22.3% (166 of 746)

  11. Rescreening • Reinfection increases risk of: • Pelvic inflammatory disease • Ectopic pregnancy • Chronic pelvic pain • Majority of post-treatment infections result from reinfection • Sex partners not treated • Patient resumes sex with a new partner infected with CT/GC • Recommendation: • Clinicians should advise clients treated for CT/GC to be retested 3 months after treatment

  12. Rescreening Females Testing Positive for Chlamydia, Jan-Jun 2009

  13. Rescreening • IDPH STD Section developed “Rescreening” reports using Access • Reports by: • Age, Ethnicity, Race, and Sex • Provider type • Working on reports to determine positivity rate of those rescreened • RVIPP Data subcontractors • Developing similar reports for each state

  14. Treatment Timeliness

  15. Treatment Timeliness • CDC Performance Measure • Among female clients, the proportion of women with positive chlamydia/gonorrhea tests that are treated within 14 and 30 days of the date of specimen collection. • Prompt treatment of chlamydia and gonorrhea will reduce the duration of infectiousness and further transmission of infection in the community • Aimed at preventing sequelae such as pelvic inflammatory disease (PID), ectopic pregnancy and infertility

  16. IIPP Treatment Timeliness Outcomes (Chlamydia) By Provider Type

  17. Treatment Timeliness Activities ID clinics receiving test result via mail and set them up for FAX transmittal if feasible Focus on clinics with greatest number of cases and the lowest rates Collaborate with IDHS nurse consultants and program managers for clinics with low rates Provide constructive criticism and positive feedback Develop a corrective action plan with clinics and follow up with quarterly data

  18. SBHC Chlamydia Screening Initiativeand JDC Chlamydia Screening Initiative

  19. SBHC Chlamydia Screening Initiative • OBJECTIVE: increase CT/GC screening at SBHCs • Collaboration • IDPH STD Section • IDHS SBHC Program • IDHS Bureau of Community Nursing • Individual SBHCs • Prioritized: Largest SBHCs with highest CT positivity rate

  20. SBHC Chlamydia Screening Initiative • Teleconference/Powerpoint with SBHCs • Sexual behavior data for adolescents resulting in high incidence of disease • Prevalence and incidence data showing high rates of infection in adolescents • Site specific CT/GC screening data: all students and female students • Clinical fusion data compared to testing data • Barriers • Recommendations • Q/A and brainstorming

  21. SBHC Chlamydia Screening Initiative • Outcome: • 41 SBHCs participated between March 2009 thru May 2010 • CT Testing: Jan-Dec 2010 vs 2009 • CT screening increased 28% (additional 2,099 CT tests submitted) • 249 (30%) additional CT positive tests identified • 36 (18%) additional GC positive tests identified

  22. SBHC Chlamydia Screening Initiative • Future plans: • Continued monitoring of site specific data • Quarterly data sent to SBHCs • IDHS Bureau of Nursing • SBHC intervention if CT screening decreases

  23. Get Yourself Tested/Talking www.gytnow.org

  24. Get Yourself Tested/Talking • Collaboration: • CDC • MTV • Kaiser Family Foundation • Planned Parenthood Federation of American • April STD Awareness Month • Public Information campaign • targeting young people who may be uncomfortable or uncertain about asking providers for sexual health services or talking to their partners or friends about testing

  25. Get Yourself Tested/Talking

  26. JDC Chlamydia Screening Initiative

  27. JDC Chlamydia Screening Initiative • Objective: increase CT/GC screening at JDCs • Unique challenges • Safety first – secure facility and movement of residents is often difficult • Residents often angry and don’t want to participate • County budget cuts e.g. hours for one JDC nurse cut to 10 hrs/week or 2 hrs/day • JDC “buy in” – convincing JDC staff of the importance of CT screening

  28. JDC Chlamydia Screening Initiative • Outcome: • 12 JDCs participated in teleconference calls during 2010 • CT Testing: Jan – Dec 2010 vs 2009 • 9 JDCs provided CT screening in 2009 • 12 JDCs in 2010 • Overall, during 2010: • CT screening increased 34% (additional 449 CT tests submitted Jan-Dec 2010) • 33 (28%) additional CT positive tests identified

  29. SBHC –Sports Physical Project

  30. SBHC –Sports Physical Project • National Chlamydia Coalition Grantee • Four School Based Health Centers • Provide free CT/GC screening at the time of male & female athletes’ pre-participation sports physicals • For many students, sports physical exam may be their only visit with a provider during the year • Jun-Dec 2010 • CT Pos rates range: 0% - 21.8% • Overall: 16 of 186 (8.6%) • Study is ongoing

  31. Special CT/GC Testing Initiatives

  32. Special CT/GC Testing Initiatives-Urine Based • Jan – Dec 2010: CT screening at WIC Clinics and Pregnancy Testing Centers • 9 Non-health department pregnancy testing ctrs • CT pos rate: 5.6% to 22.2% • Overall: 47 of 346 (13.6%) • Local Health Dept (Many STD clinic clients are also WIC clients) • 1 Pregnancy Testing Clinic: 17 of 204 (8.3%) • 2 WIC Clinics: 56 of 816 (6.9%)

  33. Special CT/GC Testing Initiatives-Urine Based • CDPH and Chicago Public Schools • CT screening initiative similar to the Philadelphia initiative • Future presentation at the RVIPP Chicago meeting

  34. EPT Survey and Findings

  35. EPT Implementation • EPT law effective date: January 1, 2010 • IDPH Web site (www.idph.state.il.us) • Guidance for Illinois Health care professionals • Partner information sheets • Health care professional Fact Sheet • IDPH provides EPT Meds: • Cefixime (single prepackaged doses) • Azithromycin (single prepackaged doses)

  36. EPT SurveysLocal Health Department (LHD) • Emailed to LHDs - outreach to HCP regarding EPT • 41 responses • 23 (56%) indicated 1-5 HCP using EPT • 4 (10%) indicated > 5 HCP using EPT • 14 (34%) none, or uncertain how many HCP • Primary concern for not using EPT was liability • 17 LHD no outreach to HCP regarding EPT • Lack of staff and time • 24 LHD outreach to HCP regarding EPT • Educational mailings, in-services, faxes, phone calls • Primary recommendation for ISP to provide simplified handouts for HCP

  37. EPT SurveysHCP getting ISP STD medications • Family planning (28) – • 21 (75%) provide EPT; • 7 (25%) no; main issue liability followed by perceived need for patient education • STD (13) – • 8 (62%) provide EPT; • 5 (38%) no; issue is liability and lack of standing orders • SBHC (16) – 16 (100%) provide EPT; 0 no • Other type of clinic (35) – • 12 detention centers (0 EPT); • 4 pregnancy testing centers (4 EPT); • 19 other - 13 provide EPT; 6 no

  38. EPT Follow up • Collaborate with a LHD physician to publish EPT information in professional newsletter, e.g. Illinois State Medical Society and others • Stress EPT law and reduce fears of professional liability • Develop and distribute less technical partner/patient handouts

  39. Questions Richard Zimmerman IDPH STD Section 217-782-2517 richard.zimmerman@illinois.gov

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