1. Infrastructure Update Jennifer Kawatu Kim Watson Andee Krasner 11-15-2010

2. Ongoing Projects Lab Slip Changes Provider Materials Cost Analysis tool New Member Orientation GIS Maps PTO Profile and AI/AN Profile Coordinators’ Meeting Upcoming assessment of Project Area Program Design

3. Screening Criteria in Project Areas Our region does not have regional screening criteria but do have state-specific guidelines. NH, VT, and ME screen all sexually active women <25 and all women 25 and older with new or multiple sex partners since last tested and or who had an STD in the previous 12 months. MA and RI screen all sexually active women <26 and all women 26 and older with new or multiple sex partners since last tested and or who had an STD in the previous 12 months. Connecticut screens all sexually active women <26.

4. Risk Definition Screening criteria in 5 of 6 project areas specify: –New Partner –Multiple Partners –STD in last 12 months

5. Data Collected There is a discrepancy between screening criteria in Project Areas and the variable collected as part of the regional dataset. The STD variable that is part of our regional dataset is defined: –STD contact in the past 60 days It is useful for surveillance purposes but does not provide information about screening guidelines.

6. How is Risk Defined by CDC and USPSTF? USPSTF Assessment of Risk In addition to sexual activity and age, other risk factors for chlamydial infection include a history of chlamydial or other sexually transmitted infection, new or multiple sexual partners, inconsistent condom use, and exchanging sex for money or drugs. Risk factors for pregnant women are the same as for non-pregnant women. The CDC recommends at least annual screening for women at increased risk. USPSTF do not spell it out *exactly* 12 months - they simply say, "a history of sexually transmitted infection"...and CDC says "at least" annually....

7. Next Steps: Options 1.Redefine the STD field to mean “STD in previous 12 months” 2. Keep “STD contact in past 60 days” and add “STD in previous 12 months” Both options would involve changing the lab slips as well as provider education

8. Adoption New Variables State Type of Test: Re-screening Type of Test: PTO Clinical Assessment: No Exam Done Gender: Other RIYes No VT MEYes CT No (Have method to collect using EMR) Already HaveNoTransgender NH MAAlready haveNo Already have

9. Definitions of Variables Added to Lab Slips PTO Visit - Primary reason for visit was pregnancy test; staff offered additional STD testing when patient arrived but patient's reason for visit was the pregnancy test and not STD screening. No physical exam was conducted. Re-Screening - Screening patient who previously had a positive Chlamydia test within the past 10 months or less and is being screened a second time because of that initial positive. Not annual re-screen. Other Sex - Transexual, Transgender or Intersex. Not identifying as Male or Female.

10. Next Steps Changes to Lab Slips Changes to Database Provider Education: –Suggest Web-based conference calls to walk providers through new variables and response options for each project area –The Infrastructure can assist

11. Facility Positivity At June meeting, Project Areas were encouraged to obtain and use facility positivity rates instead of IPP rate for determining minimum 3% positivity Infrastructure talked with CDC about the expectations for determining 3% positivity. The intent is that sites should be screening all their clients with the same screening guidelines. IPP funding is simply to subsidize this screening for clients without coverage. The minimum 3% positivity should be used to engage site in conversation about targeting resources and screening high risk populations.

12. Facility Positivity Kim and Jaya conducted interviews with each state STD Director to determine the capacity to collect site positivity data. States and sites have different abilities to report site positivity. The Infrastructure will work with Advisory Board Members to get permission to collect non-IPP testing data from state labs and private labs. This data will not meet CDC minimum Core data requirements. It will be limited data set: age, gender, state, test type, and result. The Infrastructure will develop a system for collecting non-IPP data semi-annually or annually and importing the data into state prevalence monitoring databases.

13. Site Positivity CDC and the Infrastructure know that it may not be possible to get all the data for each IPP site We are aware of resource limitations and will do everything we can to make the process streamlined

14. Overall Testing Numbers Trend in Region I is that testing numbers are falling From 2006 to 2010, testing dropped 40% Nationally, they are rising Reasons: –Unlike other regions report only IPP tests –Others

15. Total Number Tested by Year Projected annual data for 2010

16. State Meetings Do you plan to adopt new STD definition? Discuss Performance Measures 1.1 and 2.1 from handouts Discuss Falling Testing Numbers- is it possible to increase them? Utilizing Provider Materials Interest in Developing Unique ID Headline News (e.g. EPT, staffing changes, etc.)