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?