1. Infertility Prevention Project Region I June 14-15, 2010 Wells Beach, Maine Infertility Prevention Project Region I June 14-15, 2010 Wells Beach, Maine Steven J. Shapiro Infertility Prevention Project Coordinator CDC/NCHHSTP/DSTDP/PTB Disclaimer: The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.

2. Topics National Infertility Prevention Project:  Budget and Funding  Division Updates  PSCI  Health Care Reform  Chlamydia  National Chlamydia Coalition  Gonorrhea  Performance Measures

4. Funding Applications CSPS 2011 CSPS 2011 »Guidance under development »IPP Progress on 3% CT Positivity Progress on 3% CT Positivity Targeted GC Burden Calculation and plans Targeted GC Burden Calculation and plans Progress on general objectives Progress on general objectives Progress on GC meeting action items Progress on GC meeting action items IPP-OPA IAA 2010-2011 IPP-OPA IAA 2010-2011 »IPP Regional Infrastructure Objectives Pregnancy-test Only Pregnancy-test Only AI/AN Health Care Delivery Systems AI/AN Health Care Delivery Systems

5. DSTDP Update STD Treatment Guidelines STD Treatment Guidelines »Recommended treatment for uncomplicated GC will be increased to 250 mg Ceftriaxone. »Cefixime 400 mg will remain as a recommended therapy »Combination therapy for GC+ STD Laboratory Guidelines STD Laboratory Guidelines »CT GC and syphilis »Re-testing/Supplemental Testing GYT GYT »190K Unique visitors; average time 3 minutes »Just under 40K Toolkit Downloads

6. PCSI Funding Opportunity Announcement Funding Opportunity Announcement »Grants.gov CDC-PS10-10175 »“To plan, scale-up, and support the implementation of a syndemic approach to the prevention of HIV/AIDS, viral hepatitis, STD and TB through PCSI activities as described……”Enhancing the Prevention and Control of HIV/AIDS, viral hepatitis, STD and TB in the United States” Eligibility (2007 Surveillance Data) Eligibility (2007 Surveillance Data) »630 AIDS Cases »225 TB Cases »900 Syphilis (all stages) Cases »6760 Gonorrhea Cases »82 HBV Cases Webinar May 10th Webinar May 10th

7. Health Care Reform What does this mean for CDC, in general, and STD Prevention specifically?

8. Patient Protection and Affordable Care Act Mandatory Programs Mandatory Programs –Prevention and Public Health Fund »Up to 2 Billion dollars annually by 2015 »Can be spent on any prevention, wellness or public health activities authorized in the Public Health Services Act. Section 318 of the PHSA authorizes STD prevention (CSPS); section 318A authorizes IPP. –National Prevention, Health Promotion, and Public Health Council »Advisory in Nature- must create a National Prevention and Health Promotion Strategy

9. PPACA : New Prevention Programs CDC CDC –Community Transformation –Epidemiology and Laboratory Capacity –Healthy Aging Living Well –Prevention Research –Improvement of vaccine delivery systems –Office of Women’s Health HHS –State access to purchase vaccine at federally negotiated prices –Menu labeling (FDA) –Individual Wellness Plan evaluation at FQHCs –Grants to support School- based Health Centers –Evidence based teen pregnancy prevention –Evidence based Abstinence-only programs

10. PPACA: Other Provisions Insurance (private) Insurance (private) »Required to provide recommended clinical preventive benefits, including vaccinations without cost-sharing Medicaid and Medicare Medicaid and Medicare »Medicare preventative services and USPSTF recommended services (“A” level, maybe “B”) become no cost-sharing; coverage and cost sharing for vaccines unchanged »Tobacco cessation pharmaceuticals and expanded cessation services for pregnant woman are covered »Hospitals required to report rates of healthcare-associated infections (MRSA, VRE, etc) Public Health Workforce Public Health Workforce »Loan repayment program, expand fellowship programs (EIS) Monitoring Key National Health Indicators Monitoring Key National Health Indicators »Standardizes data collection related to health disparities

11. Chlamydia

12. Chlamydia — Rates: Total and by sex: United States, 1989–2008 Note: As of January 2000, all 50 states and the District of Columbia had regulations requiring the reporting of chlamydia cases.

13. Chlamydia — Rates by state: United States and outlying areas, 2008 Note: The total rate of chlamydia for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 398.5 per 100,000 population.

14. Chlamydia — Age- and sex-specific rates: United States, 2008

15. Chlamydia — Rates by race/ethnicity: United States, 1999–2008

16. Chlamydia — Prevalence by age group and race/ethnicity from a national survey, 1999–2002 Note: Error bars indicate 95% confidence intervals. SOURCE: National Health and Nutrition Examination Survey. Ann Intern Med 2007;Jul 17;147(2):89-96.

17. Chlamydia — Positivity among 15- to 24-year-old women tested in family planning clinics by state: United States and outlying areas, 2008 Note: Includes states and outlying areas that reported chlamydia positivity data on at least 500 women aged 15-24 years screened during 2008. DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease Control and Prevention

18. Chlamydia — Trends in positivity among 15- to 24-year-old women tested in family planning clinics by HHS region, 2004–2008 DATA SOURCE: Prevalence Monitoring Project (Regional Infertility Prevention Projects), Office of Population Affairs, Local and State STD Control Programs, Centers for Disease Control and Prevention

19. National Chlamydia Coalition Annual Meeting Annual Meeting »December 3-4, 2009 DC »Social Marketing »Sub-Committee Meetings Research Subcommittee Research Subcommittee What can you do? What can you do? –Chlamydia Screening Priority in Health Care Delivery Systems »Outreach to State Adolescent Health Coordinator »Child Health Indicators for Medicaid and CHIP »EMR Incentives for Medicaid and Medicare

20. National Chlamydia Coalition Mini Grants: To fund innovative strategies to increase CT screening and follow-up care including partner treatment College Health Program College Health Program »Old Dominion (VA) Sports Health Screenings Sports Health Screenings »Uplift School (IL) Academic Detailing Academic Detailing »Private Providers (IL) CT screening CT screening »Medicaid Managed Care (MI) Awareness and Screening Awareness and Screening »PP Greater Washington and North Idaho CT Model Protocol »AI/AN (Regions VIII & X) JDC Screenings »Baltimore JDC (MD) Targeted use of GIS »Adagio Health (PA) Provider Outreach »NYS providers (Region II) Plan Development »Coalition Building (MN)

21. DRIP, DRIP, DRIP

22. Gonorrhea — Rates: United States, 1941–2008

23. Gonorrhea — Rates by race/ethnicity: United States, 1999–2008

24. Gonorrhea “Incurable gonorrhea may be next superbug” “Incurable gonorrhea may be next superbug” »MSNBC 4-8-2010 “Emergence of Antibiotic-resistant gonorrhea ” “Emergence of Antibiotic-resistant gonorrhea ” »Time (blog) 3-31-2010 “Gonorrhea mutating into superbug especially in SEAsia” “Gonorrhea mutating into superbug especially in SEAsia” »Pattaya Daily News 4-1-2010 “Sex Infection gonorrhea becoming drug-resistant” “Sex Infection gonorrhea becoming drug-resistant” »BBC News 3-29-2010

25. Gonorrhea AR GC Laboratory Activities AR GC Laboratory Activities »GISP »Enhanced surveillance in the Far East with WHO Documented Clinical Cases of resistance to oral cephalosporins Documented Clinical Cases of resistance to oral cephalosporins WHO-WPRO Consultations (Manila in April; Bali in May) WHO-WPRO Consultations (Manila in April; Bali in May) »Basic research to develop a molecular test that could indicate resistance in NAAT-positive specimens AR GC Outbreak response plan development AR GC Outbreak response plan development »Consultation Atlanta September 14-15 »State-level Outbreak Response Plan Development and Pilots California, Hawaii, Illinois, New York State and Washington state California, Hawaii, Illinois, New York State and Washington state Regional Meetings Regional Meetings »Monitoring Action Plan progress »Meetings Report Development

26. Performance Measures CSPS Project started 1999 CSPS Project started 1999 Pilot project 2001 Pilot project 2001 Set of 12 measures 2005 Set of 12 measures 2005 »Timeliness of Treatment CT and GC in FP clinics »STD Clinics added 2007 »GC Interviews modified 2009 NCSD Survey Optional Measures NCSD Survey Optional Measures –Feasibility. Usefulness and Intent to Use –All CT male and females 15-24 –All Gonorrhea

27. Performance Measure Data Timeliness of Treatment for CT (14 Days) Prevalence Monitoring Family Planning Sites 20052006200720082009 Conn0.710.88 0.810.85 Maine0.930.910.920.890.87 Mass0.830.880.870.860.74 NH0.900.87 0.860.91 RI0.800.710.750.730.84 Vermont0.950.890.700.870.91 Region I 0.840.860.850.830.84 National0.620.660.640.640.67

28. Performance Measure Data Timeliness of Treatment for GC (14 Days) Prevalence Monitoring Family Planning Sites 20052006200720082009 Conn0.780.900.820.840.88 Maine1.000.831.00 0.70 Mass0.790.870.910.700.76 NH1.000.910.920.751.00 RI0.730.770.680.800,94 Vermont1.000.890.901.00 Region I 0.850.870.850.790.86 National0.620.660.640.640.67

29. Performance Measure Data Timeliness of Treatment CT and GC (14 Days) STD Sites: 2007-2009 CT2007CT2008CT2009GC2007GC2008GC2009 Conn0.910.880.810.830.810.82 Maine1.000.941.00 0.67 Mass0.930.940.901.00 NH0.830.840.941.00 0.95 RI1.000.860.940.901.00 Vermont0.980.00 0.900.00 Region I 0.930.870.910.910.860.86 National0.690.720.690.700.730.67

30. Performance Measure and Morbidity Data Chlamydia- All Females STD Sites: 2008 Total CT Cases NETSS CT STD Cases NETSS%Cases PM Data Conn92394174.5268 Maine1847412.235 Mass126463232.6128 NH1548583.7273 RI2400662.865 Vermont896576.40 National8930048994310.0067074

31. Performance Measure and Morbidity Data Gonorrhea- All Females STD Sites: 2008 Total GC Cases NETSS GC STD Cases NETSS%Cases PM Data Conn16861066.373 Maine4337.03 Mass1100555.013 NH49004 RI13575.27 Vermont19316.000 National1825772782515.0024458

32. CSPS-IPP 2009 Gonorrhea Burden Calculation Gonorrhea Burden Calculation »Portion of Total IPP funds to be used to target GC screening »Total GC women <26/Total CT GC women <26 »Up to 10% of funds available »Identify venues/providers –High morbidity with limited screening coverage –In geographic catchment areas with high morbidity »Shift resources to those areas

33. GC Burden Calculation Example Project Area X Project Area X »Total IPP funds = $500,000 »Among women 25 and younger(all venues) 500 Gonorrhea and 10,000 Chlamydia 500 Gonorrhea and 10,000 Chlamydia GC Burden = [500/(10000+500)]X100= 4.76% GC Burden = [500/(10000+500)]X100= 4.76% »IPP Funds to be used $500,000 X 4.76% = $23,800 $500,000 X 4.76% = $23,800 @ $10/test = 2380 tests available for targeting @ $10/test = 2380 tests available for targeting

34. Questions?