Transcript Region V IPP PM UPdate

Infertility Prevention Project
Region I
June 1, 2009
Wells Beach, Maine
Steven J. Shapiro
Infertility Prevention Project Coordinator
CDC/NCHHSTP/DSTDP/PTB
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.
Topics
National Infertility Prevention Project:
Budget and Funding
Division Strategic Goals
Priority Activities
Gonorrhea
Performance Measures
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CSPS
Infrastructure
NCQA and HEDIS
GYT 09
National IPP Funding Allocations
1998-2008
35
29
30
Millions
25
27.4
27.5
27.3
2002
2003
Year
2004
28.1
28.1
2006
2007
27.6
23.1
20
17.9
16.6
15
13.7
10
5
0
1998
1999
2000
2001
2005
2008
Strategic Goals

Division of STD Prevention Strategic Plan October 2008
– Prevent STD-related infertility
» Screening and Treatment; Partner Services
–
–
–
–
–
–
Prevent adverse outcomes of pregnancy
Prevent STD-related cancers
Prevent STD-related HIV transmission and acquisition
Strengthen STD prevention capacity and infrastructure
Reduce STD health disparities
Address effects of social and economic determinants and
costs of STDs and associated sequelae among specific
populations
Infrastructure Funding and Activities
CDC-OPA IAA

Coordinate Regional
Meetings
– Assure Equal Partnership

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Regional IPP Plan
Conduct Site Visits
Support National CT
Prevention Activities
Evaluate and
Disseminate Data
Data Quality Assurance
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Collaboration Special
Projects
Infrastructure
Performance Measures
Data Management
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Collection
Quality Assurance
Analysis
Dissemination
Attend Regional
Coordinators Meetings
Project Area Funding and Activities
CSPS IPP 09-902

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Ensure CT and GC
Screening and Treatment
Support Lab Testing
Ensure Collection and
Reporting of all core CDC
data elements
Provide Program
Management
Ensure Provider Training
Grant Development

Use Data to plan programs
– Prevalence Monitoring
– Surveillance
– Performance Measures


50% Rule
Male Screening
– Up to 15% of IPP funds

Targeted GC Screening
– Up to 10% of IPP funds
– GC Burden Calculation
CSPS-IPP 2009

Gonorrhea Burden Calculation
» Portion of Total IPP funds to be used to target
GC screening
» Total GC women <26/Total CT GC women <26
» Up to 10% of funds available
» Identify venues/providers
– High morbidity with limited screening coverage
– In geographic catchment areas with high
morbidity
» Shift resources to those areas
GC Burden Calculation
Example

Project Area X
» Total IPP funds = $500,000
» Among women 25 and younger


500 Gonorrhea and 10,000 Chlamydia
GC Burden = [500/(10000+500)]X100= 4.76%
» IPP Funds to be used


$500,000 X 4.76% = $23,800
@ $10/test = 2380 tests available for targeting
WHY GONORRHEA?
Gonorrhea rates, U.S., 19412007*
Rate (per 100,000 population)
500
Gonorrhea
2010 Target
400
300
200
100
0
1941
46
51
56
61
66
71
76
81
86
91
96
2001
*Preliminary 2007 data
06
Gonorrhea — Rates by county,
2007
Rate per 100,000
population
<=19.0
(n= 1,305)
19.1-100.0
(n= 1,099)
>100.0
(n= 736)
Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000
population.
Gonorrhea rates by age and sex,
2007
Men
750
Rate (per 100,000 population)
600
450
300
150
0
5.9
286.0
450.1
305.1
181.5
48%
15-24 years
119.5
86.6
50.2
17.7
4.0
113.9
Age
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-54
55-64
65+
Total
0
Women
150
300
450
600
750
33.1
647.9
614.5
287.1
125.2
69%
60.5
30.8
15-24 years
12.1
3.0
0.4
123.8
Gonorrhea rates by
race/ethnicity, 1981-2007*
Rate (per 100,000 population)
2,500
American Indian/AK Native
Asian/Pacific Islander
Black
Hispanic
White
2010 Target
2,000
1,500
1,000
500
0
1981
83
85
87
89
91
93
95
97
99
2001
03
05
*Preliminary 2007 data
07
STD Surveillance Network
(SSuN)


Purpose: to improve national capacity to
detect, monitor, and respond to emerging
trends in STDs and related behaviors
Population-based enhanced gonorrhea
surveillance
– Sample of patients reported with gonorrhea in
selected counties
» Excludes patients who attend the primary STD
clinic(s)
– Analysis of data from Feb 2006 – June 2008
STD Surveillance Network (SSuN) project areas
(n=5) & participating counties and independent
cities (n=11), 2006-2008
Washington
King Co.
Pierce Co.
Snohomish Co.
Minnesota
Hennepin Co.
New York City
San Francisco
San Francisco Co.
Colorado
Adams Co.
Arapaho Co.
Denver Co.
SSuN project areas
Participating counties
and independent cities
Virginia
Chesterfield Co.
Henrico Co.
Richmond City
SSuN Cycle 2: Participating project areas
(n=12) and labs (n=6), 2009 – 2013
Washington
.
Connecticut*
Chicago*
Philadelphia*
New York City
Baltimore*
San Francisco
Colorado
Virginia
Los
Angeles/CA*
Alabama*
Louisiana*
SSuN Laboratory Sites
*
New Sites
~ 100 counties
~ 40 STD clinics
Gonorrhea rates per 100,000
population in African American and
white counties, U.S., 2005
Gonorrhea rate per 100,000
population
< = 19.0 19.1 – 100.0
Counties > =
15% African
American
Counties > =
80%
White
>100.0
0.5%
3.9%
95.6%
75.8%
23.7%
0.5%
Percent of Neisseria gonorrhoeae isolates with
resistance or intermediate resistance to
ciprofloxacin, 1990–2005
Percent
12.0
Resistant
Intermediate resistance
9.0
6.0
3.0
0.0
1990
91
92
93
94
95
96
97
98
99
2000
01
02
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.
03
04
05
Resistance to Cephalosporins

Oral Cephalosporins (Cefixime et al)
» 2% Treatment Failure
» Increasing MICs since 2003
» Increasing number of GC strains with
decreased susceptibility

Injectable Cephalosporins (Ceftriaxone)
» No documented treatment failures to date
» Increasing MICs since 2003
» Recommended treatment doses increasing
Past and Future
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Penicillins (larger and larger doses)
Tetracyclines
Spectinomycins
Fluoroquinolones
Oral Cephalosporins
Injectable Cephalosporins
Penems
New Drugs?
Performance Measures
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CSPS Project started 1999
Pilot project 2001
Set of 12 measures 2005
» Timeliness of Treatment CT and GC in FP clinics
» STD Clinics added 2008
» GC Interviews modified 2009

Infrastructure Performance Measures
» Among clients attending family planning clinics, the number of
women screened for chlamydia, stratified by age.
» Screening coverage estimate among sexually active 15-19 year
old women in FP clinics
Performance Measure Data
Timeliness of Treatment for CT (14 Days)
Prevalence Monitoring Family Planning Sites
2005
2006
2007
2008
Region I
14 Days
0.84
(0.71-0.95)
0.86
(0.71-0.91)
0.85
(0.70-0.92)
0.83
(0.73-0.89)
National
14 Days
0.62
0.66
0.64
0.64
Performance Measure Data
Timeliness of Treatment for GC (14 Days)
Prevalence Monitoring Family Planning Sites
2005
2006
2007
2008
Region I
14 Days
0.85
(0.73-1.00)
0.87
(0.77-0.91)
0.85
(0.68-1.00)
0.79
(0.70-1.00)
National
14 Days
0.61
0.67
0.64
0.64
Performance Measure Data
Timeliness of Treatment
CT and GC (14 Days)
STD Sites- 2007 and 2008
Chlamydia
2007
Chlamydia
2008
Gonorrhea
2007
Gonorrhea
2008
Region I
14 Days
0.93
(0.83-1.00)
0.87
(0.84-0.94)
0.91
(0.83-1.00)
0.86
(0.81-1.00)
National
14 Days
0.69
0.72
0.70
0.73
Performance Measures
Gonorrhea Interviews

Old Measure:
Proportion of “priority”
gonorrhea cases
interviewed within 7, 14,
and 30 days from date
of specimen collection
(2005-2008).
– Programs receiving SE
funds were not required
to submit data for this
measure.

New Measure:
Proportion of all
gonorrhea cases
interviewed within 7, 14,
and 30 days from date
of specimen collection.
– HMA programs receiving
SE funds are not
required to submit data
for this measure; nonHMAs receiving SE funds
ARE required to submit
data.
Infrastructure Performance Measures
Estimated Screening Coverage (%)
Females 15-19 years old
Region
2005
2006
2007
2008
I
36
38
43
46
II
46
46
50
53
III
50
52
51
53
IV
53
53
46
50
V
47
47
47
No Data
VI
56
55
58
No Data
VII
59
54
55
57
VIII
40
41
40
No Data
IX
55
60
35
No Data
X
34
35
38
No Data
National
50
50
51
N/A
Figure. Percentage of sexually active female enrollees aged 16−25 years who
were screened for chlamydia, by health plan type and year ─ Healthcare
Effectiveness Data and Information Set (HEDIS), 2000−2007
100
Medicaid
Commercial
Percentage
80
60
40
20
0
2000
2001
2002
2003
2004
Year
2005
2006
2007
Infrastructure Performance Measures
Proportion of Tests
Females 15-24 years of age (%)
Region
2005
2006
2007
2008
I
61
62
61
64
II
62
63
64
63
III
67
72
68
70
IV
73
65
63
62
V
73
71
69
No data
VI
67
66
65
No data
VII
74
72
72
77
VIII
74
72
72
No data
IX
63
66
64
No data
X
81
78
74
No data
National
70
69
67
N/A
GYT ‘09

275,000 unique visitors to website
» 4X visitors compared to previous campaigns

Planned Parenthood Affiliates
»
»
»
»
24 out of 98 reported so far
STI testing increased 10%-103% over April 08
Planned Parenthood Health Systems 103%
Planned Parenthood Rocky Mountains
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1418 CT GC tests in two days
– Normally 78 tests per day
Final Reports due May 30
Posted Summary Report by mid-July
Questions?