1. Targeting Chlamydia Screening Resources Region II IPP Advisory Meeting May 31, 2006 Kelly Opdyke, MPH Cicatelli Associates Inc.

2. 2007 Proposed CDC IPP “Measures of Effectiveness” Measure 1 “Proportion of Family Planning clinics adhering to regional screening criteria” Measure 2 “Chlamydia screening coverage estimate for 15-19 year old sexually active women seen in Family Planning Clinics”

3. Region II IPP Strategic Plan 2005-2009  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. GOAL: All at risk men and women under the age of 25 will be screened at least annually. OBJECTIVE 1B: By December 2006, 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%OBJECTIVE 1B: By December 2006, 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. Region II IPP 2005 Screening “Audit” Purpose:  To estimate chlamydia screening coverage among eligible female patients according to Region II IPP minimum screening criteria Methodology:  Analyze a statistically significant number of randomly selected eligible patient charts from CY2005  Compare observed vs. expected proportion screened Expect 90% screening coverage in STD Expect 90% screening coverage in STD Expect 85% screening coverage in FP Expect 85% screening coverage in FP

5. Region II IPP 2005 Screening “Audit” (cont’d) Progress to Date (since November 2005)  Screening Audit Task force reviewed/modified tool and instructions  Projects provided CY2005 eligible patient volume for participating sites for sample size calculation Sites other than STD & FP grouped based on criteria observed Sites other than STD & FP grouped based on criteria observed Data not available for USVI STD or Puerto Rico (STD & FP) Data not available for USVI STD or Puerto Rico (STD & FP) USVI FP excluded from regional sample size calculations USVI FP excluded from regional sample size calculations  Preeti calculated required sample sizes based on given parameters  Projects working with providers to begin data collection using random/systematic samples

6. Region II IPP 2005 Screening “Audit” (cont’d) Next Steps  Projects to report on sampling method used for all sites  Projects to ensure that sample volume is proportionate to patient volume by site Timeframe  June 30, 2006 - Data collection completed by sites  July 31, 2006 - Projects submit data to Infrastructure  November 2006 - Summary report to be presented at next Regional meeting

7. 2007 Proposed CDC IPP “Measures of Effectiveness” Measure 1 “Proportion of Family Planning clinics adhering to regional screening criteria” Measure 2 “Chlamydia screening coverage estimate for 15-19 year old sexually active women seen in Family Planning Clinics”

8. 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. STD Clinics  All women ≤ 29 years of age attending the STD clinic will be screened for chlamydia.

9. Female Positivity for Chlamydia by Age Group and Provider Type

10. Region II IPP Minimum Screening Criteria Regional minimum criteria do not address:  Screening in other clinic types  Male screening  Screening for gonorrhea  Screening among pregnant females  Screening for reinfection  Testing among symptomatic individuals  Screening thresholds based on local prevalence

11. FP Female Ct Testing & Positivity by Project Area and Age Group Project Area < 25 Yrs25-29 Yrs30+ YrsTotal # Tests% Pos# Tests% Pos# Tests% Pos# Tests% Pos NJ24,2027.7%5,1374.0%5,8332.3%35,1726.3% NYC9,0114.1%5,4061.8%6,4561.0%20,8732.5% NYS61,6874.8%17,9322.5%16,3371.0%95,9563.7% PR3,9345.3%1,6413.5%1,4792.2%7,0544.3% USVI54620.3%17810.7%2426.2%96615.0% Region II Total99,3805.6%30,2942.8%30,3471.4%160,0214.2% Region II IPP CY2005

12. STD Female Ct Testing & Positivity by Project Area and Age Group Project Area < 30 Yrs30+ YrsTotal # Tests% Pos# Tests% Pos# Tests% Pos NJ 3,573 3,57313.1%1,0683.7%4,64111.0% NYC13,56811.8%6,5552.7%20,1238.8% NYS7,16311.6%3,1482.1%10,3118.7% PR2,3568.4% 1,064 1,0643.4% 3,420 3,4206.8% USVI18025.0%6510.8%24521.2% Region II Total26,84011.7%11,9002.7%38,7409.0% Region II IPP CY2005

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)  Charge providers for tests conducted outside of screening criteria (PA)  Laboratory rejects tests conducted on clients who do not meet screening criteria (WV)

14. Questions/Considerations 1)Can we characterize tests being done outside minimum screening criteria? 2)Are patients/clients at highest risk being screened for chlamydia?

15. 2007 Proposed CDC IPP “Measures of Effectiveness” Measure 1 “Proportion of Family Planning clinics adhering to regional screening criteria” Measure 2 “Chlamydia screening coverage estimate for 15-19 year old sexually active women seen in Family Planning Clinics”