STDs in Houston/Harris County
description
Transcript of STDs in Houston/Harris County
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STDs in STDs in Houston/Harris Houston/Harris
CountyCountyTrendsTrends
InterventionsInterventions
Emerging IssuesEmerging Issues
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Reportable STDsReportable STDs
ChlamydiaChlamydia
ChancroidChancroid
GonorrheaGonorrhea
HIV/AIDSHIV/AIDS
SyphilisSyphilis
ChlamydiaChlamydia
ChancroidChancroid
GonorrheaGonorrhea
HIV/AIDSHIV/AIDS
SyphilisSyphilis
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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
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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
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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)
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ChlamydiaChlamydiaEPIDEMIOLOGYEPIDEMIOLOGY
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Chlamydia: Crude Rate
8018
9092
10635
11499
10443
12144
11304
11793
0
2000
4000
6000
8000
10000
12000
14000
1995 1996 1997 1998 1999 2000 2001 2002
Ca
ses
0
50
100
150
200
250
300
350
400
Ra
te P
er
10
0,0
00
No. Rate
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Chlamydia: U.S. to Houston
0
50
100
150
200
250
300
350
400
1995 1996 1997 1998 1999 2000 2001
Ra
te p
er
10
0,0
00
US Houston
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Chlamydia: Gender-Specific Rates
0
2000
4000
6000
8000
10000
12000
1995 1996 1997 1998 1999 2000 2001 2002
Num
be
r o
f C
ase
s
0.0
100.0
200.0
300.0
400.0
500.0
600.0
700.0
Rat
e p
er
10
0,0
00
Female No. Male No.
Male Rate Female Rate
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Chlamydia: Average (1995-2001) Rates by Age
0
500
1000
1500
2000
2500
3000
3500
15-19 20-24 25-29 30-34 35-39 40-44 >44
Ra
te p
er
10
0,0
00
Male Female
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Chlamydia: Percent of Cases Identified
0
200
400
600
800
1000
1200
1400
1600
1800
City STD City FamilyPlanning/Maternity
Teen Clinics District Clinics CountyClinics/County
Family Planning
Jail
Cases
2001 2002
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GonorrheaGonorrheaEPIDEMIOLOGYEPIDEMIOLOGY
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Gonorrhea: Crude Rate
7191
6046
6633
7164
5905 6033
55015243
0
1000
2000
3000
4000
5000
6000
7000
8000
1995 1996 1997 1998 1999 2000 2001 2002
Cas
es
0.0
50.0
100.0
150.0
200.0
250.0
Rat
e pe
r 100
,000
No. Rate
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Gonorrhea: U.S. to Houston
0
100
200
300
1995 1996 1997 1998 1999 2000 2001
Ra
te p
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0,0
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U.S Houston
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Gonorrhea: Gender-Specific Rates
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1995 1996 1997 1998 1999 2000 2001 2002
Num
ber o
f Cas
es
0.0
50.0
100.0
150.0
200.0
250.0
300.0
Rat
e pe
r 100
,000
Male No. Female No. Male Rate Female Rate
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Gonorrhea: Average (1995-2001) Rates by Age Group
0
200
400
600
800
1000
1200
15-19 20-24 25-29
Ra
te p
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10
0,0
00
Male
Female
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Gonorrhea: Percent of Total Cases from Providers
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
City STD Clinics Private Clinics & HMOs All other Sites
2001 2002
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SyphilisSyphilisEPIDEMIOLOGYEPIDEMIOLOGY
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SyphilisSyphilisHouston/Harris CountyHouston/Harris County
Syphilis: Crude Rate
0
500
1000
1500
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2500
3000
1995 1996 1997 1998 1999 2000 2001 2002
Cases
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Ra
te p
er
10
0,0
00
No. Rate
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Syphilis Syphilis Houston/Harris County vs U.S.Houston/Harris County vs U.S.
Syphilis: U.S. to Houston
0
10
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90
1995 1996 1997 1998 1999 2000 2001
Ra
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0,0
00
U.S Houston
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Syphilis: Primary and SecondarySyphilis: Primary and SecondaryHouston/Harris CountyHouston/Harris County
Syphilis: Primary and Secondary Houston/Harris County
1995-2002
0
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1995 1996 1997 1998 1999 2000 2001 2002
Nu
mb
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Ca
se
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HDHHSHDHHSSTD InterventionsSTD Interventions
ScreeningScreening
TreatmentTreatment
EducationEducation
CounselingCounseling
Partner ServicesPartner Services
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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)
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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
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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
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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
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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
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EducationEducation
9 Health Educators trained in STDs9 Health 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 Infoline HIV/STD Infoline 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 trainingProvider alerts, media alerts, provider trainingExpanding education to web sites, chat roomsExpanding education to web sites, chat rooms
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CounselingCounseling
Clinicians Clinicians
DISDIS
ContractorsContractors
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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
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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