Transcript Region II Infertility Prevention Project New York City

Region II
Infertility Prevention Project
New York City, New York
May 31, 2006
Richard Steece, Ph.D., D(ABMM)
National Infertility Prevention Project
[email protected]
Region II
Infertility Prevention Project
New York City, New York
May 31, 2006
Supplemental Testing (Repeat Testing)
Alternate Specimens (vaginal, rectal and
pharyngeal)
CDC/APHL 2004 National STD Laboratory
Survey
Supplemental Testing
• Zanto, et.al.; Region VIII
– Gen-Probe ACT and AGC reagents can be used
effectively as a supplemental test
– Supplemental testing (repeat Gen-Probe AC2) is
equally as effective as an alternate target (ACT)
– Reporting the initial positive AC2 screening result in
this low prevalence (7.5%) population had a greater
than 95% positive predictive value (PPV) for CT
– Reporting the initial positive AC2 screening result in
this low prevalence (1.6%) population had a 91.3%
PPV for GC
– Based on these PPVs, supplemental or repeat testing
need not be routinely performed with NAAT screening,
resulting in cost savings.
Alternate Specimens (vaginal,
rectal and pharyngeal)
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References
California Action Coalition (CAA)
CDC/FDA – Dr. Papp
Workshop NIAID (June 28-29, 2006)
Sexually Transmitted Diseases
Laboratory Survey, 2004
Methods: Laboratory Survey
• Surveyed 162 public, private and university
laboratories in February 2005
– All members of the Association of Public Health
Laboratories (APHL)
– All laboratories that participate in CDC’s Regional
Infertility Prevention Project
• An on-line survey was developed that requested
the following information for calendar year 2004:
– Volume and type of testing for chlamydia and gonorrhea
– Volume and type of testing for HSV, Trichomonas,
Syphilis, Bacterial Vaginosis, HPV, and Pap Smears
Methods: Laboratory Survey
• An e-mail was sent to each laboratory director
with link to survey
– 34/162 e-mails not successfully transmitted; corrected
some addresses and resent.
– 25/34 e-mails failed to transmit again; FAXes sent to
those lab directors with the link to the survey.
• Asked for responses in two weeks
• Non-responder follow-up
– 2 follow-up e-mails were sent at the end of weeks 1 & 2
– Additional e-mails and phone calls were made after 3
weeks
Results: Laboratory Survey Response
• Survey was completed by 119 laboratories (73% response
rate)
• Responding laboratories were from 49 states and two U.S.
territories:
– 51% state laboratories (n=61)
– 34% county laboratories (n=41)
– 10% city laboratories (n=12)
– 2% U.S. territory laboratories (n=2)
– 2% university laboratories (n=2)
– 1% private laboratories (n=1)
• Focused on public health laboratories (95% of responding
laboratories)
• Survey was completed by 114 of 144 public health
laboratories (79% response rate)
Testing for Chlamydia and Gonorrhea
Public Health Laboratories
2000 vs. 2004
Sexually
% of Labs that
% of all Tests that
Transmitted
Reported Doing
were NAATs
Disease
NAATs
2000
2004
2000
2004
Chlamydia
58.0
87.0
24.5
63.5
Gonorrhea
38.4
78.7
11.7
60.8
Status of Gonorrhea Culture
Public Health Laboratories
2000 vs. 2004
Sexually
% of Labs that
% of all Tests done
Transmitted
Reported Doing
that were Culture
Disease
Gonorrhea
GC Culture
2000
2004
2000
2004
79.8
77.8
18.0
8.5
Laboratory Survey: Next Steps
• Compiled and distributed survey results
– Available via the APHL website
– Distributed to IPP Coordinators (Word)
• Chlamydia and Gonorrhea data was
presented in a poster at ISSTDR, July 2005
• Collected information from test kit
manufacturers
– Number of CT & GC test kits sold in 2004
– % or # sold to public health laboratories
• Prepared and submitted manuscript on
survey results to JSTD (July)
Male Chlamydia Screening
Consultation
March 28-29, 2006
• Urine is the specimen of choice when
screening males (NAATS)
• Leukocyte Esterase Test (LET) is not
recommended in any venue.
• Pooling should strongly be considered in
low prevalence populations (<10%).