1. SSuN Cycle 2 Conference call #5 Population-based gonorrhea surveillance Lori Newman & Kristen Mahle November 13, 2008

2. SSuN Conference Call #5 - Agenda  Misc admin topics  Population-based gonorrhea (GC) surveillance Objectives Sampling framework Data elements Data transmission Analysis and use of data

3. Misc Admin Topics  SSuN Collaborator’s Meeting room reservations by Friday, November 14 th  Draft meeting agenda sent out Any feedback?  Scheduling 30 min calls with new sites

4. SSuN: Population-based gonorrhea (GC) surveillance

5. DSTD Goals & Objectives  Goal 1: Prevent STI-related infertility Objective C: Reduce GC incidence  Goal 6: Reduce STD health disparities Objective C: Reduce GC in African Americans

6. Rationale for Population-based GC Surveillance  GC rates still far from Healthy People 2010 objectives, but we don’t understand why  Case report data at national level limited to sex, age, race/ethnicity, and crude provider type  Need a better understanding of patients with GC, especially those outside of the STD clinic setting

7. Objectives of Population-based GC Surveillance in SSuN Cycle 1 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

8. SSuN Cycle 1 Methodology – Sampling  Data collected on sample of patients reported with GC in selected counties Sample excludes patients who attend the primary STD clinic(s) Phone or in-person interview of first reported patients each month until completed 10 male and 10 female San Francisco: weekly sample adjusted for non-response for target of 100 men and 100 women per year

9. SSuN Cycle 1 Methodology – Data Transmission  Data transmitted with morbidity data for SSuN counties Supplement to case reporting, NOT in lieu of Assessment of representativeness, contact rate, etc.  Data collection initiated between Feb 2006 and Jan 2007  Initially monthly, now quarterly  Cumulative data file with each transmission  Data stored and transmitted independently of SSuN STD clinic data

10. SSuN Cycle 1 Population Size, Sample Size, and Interview Success Rate SFWACOMNVATotal Number of Case Reports (A) 5,2876,2214,3313,2432,48521,567 Number of Eligible Patients (B) 3,2936,1822,7562,3141,57916,124 Number Eligible & Selected for SSuN (C) 7542,0582,1871,5489777,534 Number Eligible, Selected, and Interviewed (D) 2099064564573072,335 Interview Success Rate (E = D/C) 27.4%44.0%20.9%29.5%31.4%31.0%

11. SSuN Cycle 1 Methodology - Collaborative Data Elements  Demographics  Sexual practices  Substance use  Partner characteristics  HIV history  STD history  Clinical history  Treatment  Census tract  Patient-provider distance  Provider point data

12. SSuN Cycle 1: Comparison between STD clinic & population-based data elements  Population-based data elements mirror STD clinic data elements whenever possible All population questions asked retrospectively (after GC diagnosis made) Allows for additional questions about provider type, most recent sex partner, spatial data, etc. No lab data (info obtained from patients)

13. SSuN Data dissemination  Quarterly reports Data quality review Data dissemination  Encouragement of joint analyses by local and CDC collaborators National STD Conference presentations Overview in OASIS special issue Ongoing analyses  Single site analysis & dissemination

14. SSuN Data Uses (1) MN, VA, CO: large numbers of GC patients not informed of GC diagnosis SF, WA: value in improving provider type categorization CO: need for additional STD clinic on eastern edge of city MN: identification & follow-up of HIV-GC co-infection in “real time”

15. SSuN Data Uses (2) CO & CDC: need to improve following of CDC recommendations in private, non-STD clinic settings CDC: how to focus GC control strategies? CDC: what data are useful for program guidance?

16. SSuN Cycle 1 - Limitations  Limited ability to generalize Only 5 geographic sites and 11 counties Excludes “primary” STD clinic patients  Possible response bias Only able to contact ~ 1/3 patients with GC due to poor contact information  Slight variability in methodology between sites since integrated into routine activities  No trends over time available yet  Lengthy interview (~ 8-10 minutes)

17. Moving from SSuN Cycle 1 to Cycle 2……..

18. Do the SSuN Cycle 1 objectives still hold? 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

19. Methodology changes?  Sampling population Non-STD clinic vs. all morbidity?  Sample size 10 men and 10 women per month?  Data elements Should we design a shorter interview? What to delete, add, or change?

20. San Francisco Washington. VirginiaColorado Chicago New York City Baltimore Philadelphia Alabama Louisiana Los Angeles/CA Connecticut ~ 100 counties: Range: 1 to 61 SSuN Cycle 2: Participating project areas (n=12) How to handle different numbers of counties per project area?

21. Increasing use and dissemination of population-based data  Quarterly report modifications?  How to foster more multisite analyses?  How to make data more useful for program?

22. Questions & Comments?