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Innovative STD Screening Projects in Indian Country

Innovative STD Screening Projects in Indian Country. Lori de Ravello, MPH CDC Assignee National STD Program Indian Health Service May 9, 2006. Objective. To describe AI/AN-focused STD screening projects developed by IHS and Tribal health programs. Screening Venues. School-Based Screening

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Innovative STD Screening Projects in Indian Country

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  1. Innovative STD Screening Projects in Indian Country Lori de Ravello, MPH CDC Assignee National STD Program Indian Health Service May 9, 2006

  2. Objective To describe AI/AN-focused STD screening projects developed by IHS and Tribal health programs

  3. Screening Venues • School-Based Screening • Seasonal Firefighter Exams • Community Outreach • Jail-based

  4. School-Based Screening • Public High School (grades 9-12) on a small Northern Plains reservation • STD 101 session followed by voluntary urine-based chlamydia and gonorrhea screening • All students seen for 1-on-1 follow-up counseling, regardless of result • Positives referred for usual partner services

  5. Results of School-Based Screening • 67% (388/577) attended STD 101 • 95% (367/388) accepted specimen cup • 73% (269/370) provided specimen • 5% overall chlamydia positivity • 0% gonorrhea

  6. Chlamydia Positivity, by sex

  7. Chlamydia Positivity, by age

  8. Evaluation Findings(80% response rate, 5-point scale)

  9. Seasonal Firefighter Exams • Popular job option in rural areas • Annual physical exam required • Some health facilities voluntarily include chlamydia screen • Data compare women screened or tested in clinic and male firefighters (FF) screened at physical

  10. Sites • Site 1: • Located in western U.S. • IHS facility • Began CT screening of FFs in 1998 • In 2002 ran 1800 CT tests • Site 2: • Also located in western U.S. • Tribal facility • Began CT screening of FFs in 1999 • In 2002 ran 812 CT tests

  11. Site 1 - Number of Chlamydia Tests, by sex and year

  12. Site 1 - Chlamydia Positivity, by sex, 1998-2002

  13. Site 1 – Chlamydia Positivity, by age and sex, 2002

  14. Site 2 - Number of Chlamydia Tests, by sex and year

  15. Site 2 – Chlamydia Positivity, by sex, 1998-2002

  16. Site 2 – Chlamydia Positivity, by age and sex, 2002

  17. Community-Based Outreach • Large southwestern tribe • Ongoing syphilis outbreak since 2001 • Screening interventions in community: • Local bars • Busy commercial areas • Community fairs

  18. 2004 Syphilis Screening Data

  19. Jail-Based Syphilis Screening Pilot Project • Large southwestern reservation • Syphilis outbreak since 2001 • Large tribal jail • 2004 Epi Aid determined many cases passed through jail • 6-month pilot project • STD 101 followed by screening

  20. Tribal Jail Screening Results 314 300 268 254 112 114 14 14 0 0 0 2

  21. Conclusions • A variety of promising screening interventions being done in Indian Country • Yield of positive cases varies • Effort required may not be offset by yield • How to factor in other screening benefits (e.g. community awareness) • Further efforts are needed to evaluate and improve screening activities in Indian Country

  22. Acknowledgements • Tribal Health • Janet Runnion • Larry Foster • Mae Gilene Begay • State Health Dept. • Susie Zantos • IPP • Yvonne Hamby • CDC • David Wong • Lydia Blasini-Alcivar • IHS • James Cheek • Pam McCloud • Sandeep Patel

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