1. Implementing a Gonorrhea and Chlamydia Screening Program in Philadelphia Public High Schools Melinda Salmon Philadelphia Department of Public Health

2. Why? How?

3. Reported Cases of Chlamydia: Philadelphia, 1991-2003* (*2003 data are provisional) Year Number of cases *Chlamydia reportable as of October 1991 1994: Infertility Prevention Project (IPP) 1999 data analysis: shows high re-infection rates in women 1997 & 1998: Increasingly sensitive laboratory technologies Youth Study Center Adult prisons Citywide HS screening & 5 HRC HS 2000 – present: New surveillance programs Nov 2001: 2 HRC high schools (HS)

4. Chlamydia - Case Rates by Age and Sex, 2003 Age Group Figure 6. Rate of Chlamydia per 100,000 Population by Age and Gender: Philadelphia, 2002. Rate per 100,000 Population MenWomen

5. CY 2000 Report Card 2000 issued – Phila. Coalition For Kids –STD’s given a failing grade School District Legal Opinion (8/21): –No Screening in schools Safe and Sound Initiative addresses all Report Card issues –Various Organizations on Committee – STD Program states key to control is school- based screening School District Legal Opinion (12/19): –Screening in school-based HRC’s OK

6. CY 2001 Meetings with PDPH/FPC/School District November: Screening initiated in 1 st Health Resource Center December: Screening initiated in 2 nd Health Resource Center

7. Health Resource Center STD Screening (2 schools) 2001-2002 Male TestsFemale TestsTotal Total # of tests5366831219 Total positives (%)28/536 (5.2%) 110/683 (16.1%) 138/1219 (11.3%) Positive for CT only26/536 (4.9%) 87/663 (12.7%)113/1219 (9.3%) Positive for GC only0/536 (0.0%)10/683 (1.5%)10/1219 (0.8%) Dual Infection Rate2/536 (0.4%)13/683 (1.9%)15/1219 (1.2%)

8. CY 2002 January: Commissioner’s Forum on STD’s Held Adolescent STD’s described as “EPIDEMIC” February: New Health Commissioner Appointed: Mr. John Domzalski February-June: HRC data presented to Commissioner and others

9. CY 2002 Cont’d. October: New CEO @ School District (Mr. Paul Vallas) & PDPH Commissioner Meet –Commissioner proposes screening in 10 schools; Mr. Vallas counters with 44; Mr. Domzalski accepts. (54,000 Students) November : Television and Newspaper Press Coverage –Generally positive; issue of “no parental consent” raised December: Meeting with All Principals –Letter Given to Principals –STD Program Presentation to Principals –Parent Letter Developed w. Joint Signatures

10. CY 2003 January 7 th : Testing Begins Meetings with: – Home & School Council Presidents – Individual School Councils Scheduling of Individual High Schools for Screening Days and Treatment Clinics Ongoing

11. Philadelphia Department of Public Health STD Control Program 2002-2003 High School Screening Program Summary Data # Male Tests# Female Tests Totals # of students tested 10,1989,51519,713 Total positives (%) 256 (2.5%)796 (8.4%)1,052 (5.3%) CT only positives (%)240 (2.4%)718 (7.5%)958 (4.9%) GC only positives (%) 9 (0.1%)30 (0.3%)39 (0.2%) Dual infections (%)7 (0.1%)48 (0.5%)55 (0.3%) Number (%) treated255/256 = 99.6% 795/796 = 99.9% 1050/1052 = 99.8%

12. How it all works…

13. Pre-meeting with the School Usually involves the assistant principal, nurse, roster chair Informational folder distributed Explanation by health department staff of what occurs

14. Pre-meeting with the School (cont’d) Communicate our needs to make screening work: –Commitment to see at least 300 students per day in classes of approximately 60 –A presentation room in proximity to rest rooms –Space to process specimens Tentative dates for screening set, as well as dates for the delivery of supplies, brochures, etc. Explanation of our need return to treat and see additional students and identification of a process and tentative date(s)

15. Screening Begins Presentation Bags Explanation of the process –All students receive a bag –All students complete the paperwork –All students go the bathroom –All bags must be returned Based upon the information in the presentation, each student makes a decision, on their own, whether or not to be screened

16. During Screening Specimens processed in separate room –Sort out empty specimen cups from those with urine –If time permits, aliquot specimens and create lab slips –Deal with other issues as they arise

17. At the close of the day Return to the Health Department with specimens –Any remaining specimens are aliquoted and/or lab slips created –Specimens are submitted to the lab –Information form with a copy of lab slip attached are submitted for data entry

18. In the days following Data entry of information slips with “pending” results indicated As lab results are received, pending results changed to positive or negative Test results given to students by telephone

19. Treatment List of students to be seen submitted to nurse 1 day prior to the arrival of medical staff Students issued call slips or called from class Oral medications administered Counseling, instructions for follow-up exams and partner referral cards given

20. Treatment For students not treated at school, we continue to work through school nurse to refer for treatment Use the “best way to contact” information

21. In summary…. Process takes a solid commitment from many, including: –School personnel –Health Department screening staff –All other staff for data entry –Staff giving results –Clinical staff to give treatment –Laboratory staff to process tests –Administrative staff But, most importantly…it takes the political will of those who have the power to make it happen