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Region II IPP Screening Among Females Age 30 Years and Older Region II IPP Advisory Meeting November 1, 2006 Kelly Opdyke, MPH Cicatelli Associates Inc.

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Presentation on theme: "Region II IPP Screening Among Females Age 30 Years and Older Region II IPP Advisory Meeting November 1, 2006 Kelly Opdyke, MPH Cicatelli Associates Inc."— Presentation transcript:

1 Region II IPP Screening Among Females Age 30 Years and Older Region II IPP Advisory Meeting November 1, 2006 Kelly Opdyke, MPH Cicatelli Associates Inc.

2 Why Worry About Targeting Screening for Chlamydia Infection? “Screening is the testing of apparently well people to find those at increased risk of having a disease or disorder” “Inappropriate screening harms healthy individuals and squanders precious resources” “Inappropriate screening harms healthy individuals and squanders precious resources” Source: Grimes, Schulz: Uses and Abuses of Screening Tests, Lancet 2002

3 Region II IPP Strategic Plan PRIORITY 1: Target/Expand Chlamydia Screening to Young Sexually Active Women and Men at Risk for Infection in Public and Private Settings. PRIORITY 1: Target/Expand Chlamydia Screening to Young Sexually Active Women and Men at Risk for Infection in Public and Private Settings. –GOAL: All at risk men and women under the age of 25 will be screened at least annually.  OBJECTIVE 1C: By December 2007, decrease routine CT and GC screening by 50% in women >30 years of age in FP clinics where the prevalence of CT is less than 2%.

4 Screening Trends in FP Clinics, Region II IPP N (2003) = 46,077 22,691 41,609 4,684 2, ,091 N (2004) = 36,825 21,995 26,050 6,503 2,019 93,392 N (2005) = 47,54220,871 95,9577, ,390

5 Chlamydia Positivity in Females by Age, FP Clinics, Region II IPP, CY2005 Data Source: CY2005 Region II IPP Prevalence Monitoring Database Positivity N=917 N=41,818N=64,801N=32,373N=32,481 82% of cases identified 94% of cases identified Age (Years) (N = 172,390)

6 Screening Trends in STD Clinics, Region II IPP N (2003) =6,51320,470 8,5181, ,200 N (2004) =4,69321,17310, ,049 N (2005) =6,36720,79110,3193, ,142

7 Chlamydia Positivity in Females by Age, STD Clinics, Region II IPP, CY2005 Data Source: CY2005 Region II IPP Prevalence Monitoring Database Positivity N=138 N=7,376N=13,227N=7,867N=12,534 78% of cases identified 91% of cases identified Age (Years) (N = 41,142)

8 Screening Trends in Clinics Other than FP/STD, Region II IPP N (2003) =11,6561,4814,45714, ,021 N (2004) = 7,5914,0744,826 9,2191,44727,157 N (2005) = 8,7165,2374,39912,4641,52932,345

9 Chlamydia Positivity in Females by Age, †Other Sites, Region II IPP, CY2005 Data Source: CY2005 Region II IPP Prevalence Monitoring Database Positivity N=529 N=8,820 N=9,135 N=5,270N=8,591 81% of cases identified 93% of cases identified Age (Years) (N = 32,345) †All sites other than FP/STD clinics

10 Chlamydia Positivity Among Females Age 30+ Yrs Region II IPP, CY2005 Project Area FP # Tests% Pos NJ7,9672.3% NYC6,4561.0% NYS16,3371.0% PR1,4792.2% USVI2426.2% Reg II Total32,4811.4% All Other # Tests% Pos 2,7451.5% % % 4,3561.4% % 8,5911.7% STD # Tests% Pos 1,4953.5% 6,7622.7% 3,1482.1% 1,0643.4% % 12,5342.7% (N = 53,606)

11 Ct Positivity by Reason for Test Among Females Age 30+ Yrs Region II IPP, CY2005 Reason for testFPSTDAll Other # Tests% Pos# Tests% Pos# Tests% Pos Routine Exam11,0041.9%9,1902.7%6,0241.5% Symptoms/Signs5213.1%2,1312.5%1890.5% Contact to STD842.4%2156.5%525.8% Screening Test3,2781.1%830.0%7582.1% Pregnancy Test7681.6%40.0%7802.1% Prenatal1,7850.7%80.0%1964.1% Contraceptive Service12,9881.1%80.0%492.0% T.O.C166.3%922.2%702.9% Other/Unknown7441.3%882.3%2562.3% Total31,1881.4%11,7362.7%8,3741.7% # Records Missing Data1,293n/a798n/a217n/a

12 Ct Positivity by Patient Risk Hx Among Females Age 30+ Yrs Region II IPP, CY2005 Patient Risk History FPSTDAll Other # Tests% Pos# Tests% Pos# Tests% Pos Multiple sex ptrs in last 90 days %644.7%923.3% New sex ptr in last 90 days %238.7%583.4% STD in past year1034.9%358.6%422.4% Other5,4541.8%0n/a0 Total6,4441.8%1226.6%1923.1% # Records Missing Data26,037n/a12,412n/a8,399n/a

13 Process for Changing Ct Screening Practices in Selected Sites Sample strategies employed nationally: Test allotment system – provider receives a pre-determined # test kits/mo. based on anticipated need for target pop. (Region Ill) Test allotment system – provider receives a pre-determined # test kits/mo. based on anticipated need for target pop. (Region Ill) Charge providers for tests conducted outside of screening criteria (PA) Charge providers for tests conducted outside of screening criteria (PA) Laboratory rejects tests conducted on clients who do not meet screening criteria (WV) Laboratory rejects tests conducted on clients who do not meet screening criteria (WV)

14 Defining The Next Set of Questions

15 Region II IPP Strategic Plan PRIORITY 1: Target/Expand Chlamydia Screening to Young Sexually Active Women and Men at Risk for Infection in Public and Private Settings. PRIORITY 1: Target/Expand Chlamydia Screening to Young Sexually Active Women and Men at Risk for Infection in Public and Private Settings. –GOAL: All at risk men and women under the age of 25 will be screened at least annually.  OBJECTIVE 1A: Revise regional screening criteria for females so that screening is targeted to the most at-risk populations by Oct 2006.

16 Region II IPP Minimum Screening Criteria Title X Family Planning Clinics All women ≤ 24 years of age attending the clinic for an initial or annual visit will be screened for chlamydia. All women ≤ 24 years of age attending the clinic for an initial or annual visit will be screened for chlamydia. STD Clinics All women ≤ 29 years of age attending the STD clinic will be screened for chlamydia. All women ≤ 29 years of age attending the STD clinic will be screened for chlamydia.

17 Region II IPP Minimum Screening Criteria Regional minimum criteria do not address: Screening among in FP with no pelvic exam Screening among in FP with no pelvic exam Screening in other clinic types Screening in other clinic types Male screening Male screening Screening for gonorrhea Screening for gonorrhea Screening among pregnant females Screening among pregnant females Screening for reinfection Screening for reinfection Testing among symptomatic individuals Testing among symptomatic individuals Screening thresholds based on local prevalence Screening thresholds based on local prevalence

18 Region II IPP minimum screening criteria for FP include only those women who have an initial or annual (i.e. pelvic) exam Region II IPP minimum screening criteria for FP include only those women who have an initial or annual (i.e. pelvic) exam In the past, chlamydia testing required the collection of a cervical specimen. In the past, chlamydia testing required the collection of a cervical specimen. Highly-sensitive urine-based NAATs (nucleic acid amplification tests) provide an opportunity for expanded screening to additional high-risk clients. Highly-sensitive urine-based NAATs (nucleic acid amplification tests) provide an opportunity for expanded screening to additional high-risk clients. Region II IPP Minimum Screening Criteria

19 Current Use of Urine Specimen for Ct Testing Among Females Region II IPP, CY2005 Project Area FPSTDAll Other # Tests% Urine# Tests% Urine# Tests% Urine NJ % % % NYC % % % NYS % % % PR % % % USVI9660.0% % % Reg II Total % % %

20 Is Providing a Chlamydia Test During a Pelvic Exam Enough? Nebraska IPP Program implemented urine- based chlamydia screening among women seeking pregnancy testing only in FP clinics: Nebraska IPP Program implemented urine- based chlamydia screening among women seeking pregnancy testing only in FP clinics: –Screening from October 2002 – March 2005 –1200 females age yrs seeking pregnancy testing only services were screened for chlamydia with a 13% (average) positivity rate. –Overall positivity rate in women age yrs receiving speculum exam was 4.9%. Pilot projects in Arizona, Pennsylvania, and New Mexico yielded similar results. Pilot projects in Arizona, Pennsylvania, and New Mexico yielded similar results. SOURCE: Chlamydia Positivity among Women coming into Title X Family Planning Clinics for Pregnancy Testing Only: A summary of demonstration projects conducted in the Regional IPP, L Dicker, D Middleton, A James, K Johnson, P. Blackburn et al. February 2006.


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