1. STD Surveillance Network (SSuN) Cycle 2 Objectives Lori Newman & Kristen Mahle SSuN Principal Collaborators Meeting Atlanta, GA December 2, 2008

2. Overview  SSuN Cycle 2 Objectives General Activity-specific  Genital Wart and HPV Vaccine Monitoring  HIV Testing Coverage  MSM Prevalence Monitoring  Population-based Gonorrhea Surveillance  Trichomonas Resistance Monitoring

3. SSuN Cycle 2 – Part A General Objectives 1.Establish an integrated network of STD clinics and health departments that Serve a diverse population Have as strong clinical as well as analytic capacity, and Follow common protocols to implement surveillance activities 2.Improve capacity of national, state, and local STD programs to detect, monitor, and respond rapidly, flexibly, and with greater effectiveness to established and emerging trends in STDs and related risk behaviors 3.Identify and evaluate the effectiveness of public health interventions to reduce STD morbidity

4. SSuN Cycle 2 – Part B General Objectives 1.To establish a network STD clinics with high quality laboratory and clinical capacity to implement a broad range of STD surveillance activities First Part B activity: trichomonas resistance monitoring 2.Future activities Depend on public health importance and availability of funding

5. SSuN Cycle 2 – What does this look like? Integrated systems  Surveillance projects (SSuN Cycle 1, MSM Prevalence Monitoring Project, future projects)  Surveillance and program monitoring  Disease programs (e.g., STD, HIV, Hepatitis) Robust platform  Develop strong data management and analytic capacity  Ensure access to high quality, informative data at the local and national level Create a database that can be queried  Ensure that systems are flexible and timely

6. SSuN Cycle 2 – How do we get there?  Expand range of activities STD clinic surveillance STD clinic laboratory surveillance Population-based surveillance Program service evaluation  Expand data management and analytical capacity Increase local data management resources Encourage analyses at local level Identify additional ways to disseminate and use data  Improve geographic representativeness Bring 7 new sites on board

7. San Francisco Washington. VirginiaColorado 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 (n=12) and labs (n=6), 2009 – 2013 New Sites *

8. SSuN Cycle 2 – Activities STD Clinic Lab - T. vaginalis resistance monitoring - Monitor etiology of STD syndromes? STD Clinic - Genital warts - Syphilis, GC, CT in MSM - HIV testing coverage - Monitor Hepatitis B vaccine coverage? Population-based - Gonorrhea - Treatment of PID in private sector?

9. Genital Wart (GW) and HPV Vaccine Monitoring – Objectives 1.Develop standardized methodology for monitoring GW disease and HPV vaccine coverage in STD clinics 2.Describe demographic & clinical characteristics of patients with GW attending STD clinics Monitor trends in characteristics over time 3.Monitor the impact of GW diagnosis & treatment on STD clinic resources Monitor trends over time 4.Monitor HPV vaccine coverage of eligible populations 5.Monitor trends in off-label use of HPV vaccine Goal 3, Objective 3a.1: Monitor vaccine impact on HPV related outcomes, including monitoring prevalence of genital warts

10. 1.Develop standardized methodology for monitoring prevalence of STD, HIV, & risk factors among MSM in STD clinics 2.Assess prevalence of & trends in STDs, HIV, & risk behaviors among MSM 3.Enhance local & national prevention & control efforts for STDs/HIV among MSM 4.Describe demographic & clinical characteristics of MSM attending STD clinics Monitor trends over time MSM Prevalence Monitoring Project – Objectives Goal 1, Objective 1c.2: Increase GC screening among target populations Goal 6, Objective 6b.2: Improve evidence-based use of prevention strategies among MSM

11. Monitoring HIV Testing – Objectives 1.Develop standardized methodology for monitoring HIV testing coverage in STD clinics 2.Monitor HIV testing coverage in STD clinics 3.Monitor receipt of results by patients tested for HIV in STD clinics (?) Goal 4, Objective 4d.2: Develop approaches to support & measure implementation of opt-out HIV testing in HIV clinics

12. Population-based Gonorrhea Surveillance - Objectives 1.Establish network of health departments working collaboratively with standardized methodology 2.Collect demographic, behavioral, and clinical data on patients with gonorrhea Monitor trends over time 3.Use data to guide local, state, and national STD programs and policies Goal 1, Objective 1c.5: Assess, enhance, develop, & evaluate data to monitor & inform strategies & activities to reduce GC incidence

13. Trichomonas Resistance Monitoring: Objectives  To improve control of Trichomonas vaginalis infection through: Describing the prevalence, sociodemographic, and clinical characteristics of women with trichomoniasis infection attending STD clinics Identifying the prevalence of in vitro resistance in this population Goal 2: To prevent STI-related adverse outcomes of pregnancy Goal 4: To prevent STI-related HIV transmission & acquisition

14. Discussion Questions  Any modifications to these objectives? General Specific activities  How should SSuN do these activities?