1. Region II Infertility Prevention Project Advisory Committee May 31-June 1, 2006 CDC Update:  Personnel  Budget and Program Changes  Reorganization  Ongoing Projects  Azithromycin  Performance Measures

2. PDSB Personnel Catherine Lindsey Satterwhite Catherine Lindsey Satterwhite David Johnson David Johnson Sheldon Black Sheldon Black David Byrum David Byrum Tracey Hardy Tracey Hardy Susan DeLisle Susan DeLisle Kathryn Koski Kathryn Koski

3. Budget 2006 Flat Funding for STD Prevention Flat Funding for STD Prevention –$161 Million FY 2006 »$106 million to grantees –50% funding awards FY 2006 Final Budget FY 2006 Final Budget –2.97% reduction in funds »CSPS and Infrastructure »1% Katrina Relief

4. Program Changes Internal- Internal- –Infrastructure Performance Measure(s) External- External- –However, new language in the congressional committee report for FY06 indicates possible future directions for the Infertility Prevention Project

5. 109 th Congress Committee The committee notes that CDC is charged legislatively with instituting programs to help prevent infertility. CDC’s current program activities in this matter are undertaken by the division of HIV/STD/TB and are limited to the prevention of venereal diseases. The Committee understands that there are numerous additional causes of infertility beyond sexually transmitted disease, such as delayed child bearing, smoking, low or excessive body weight, exposure to hazardous environmental toxins, drug and alcohol abuse, and particularly for men, exposure to high temperatures. The Committee encourages CDC to consider expanding the scope of this program and provide greater support to public education on the risks to fertility. The committee notes that CDC is charged legislatively with instituting programs to help prevent infertility. CDC’s current program activities in this matter are undertaken by the division of HIV/STD/TB and are limited to the prevention of venereal diseases. The Committee understands that there are numerous additional causes of infertility beyond sexually transmitted disease, such as delayed child bearing, smoking, low or excessive body weight, exposure to hazardous environmental toxins, drug and alcohol abuse, and particularly for men, exposure to high temperatures. The Committee encourages CDC to consider expanding the scope of this program and provide greater support to public education on the risks to fertility. Senate Report 109-103 Calendar #163 Senate Report 109-103 Calendar #163

6. Reorganization CDC CDC CoCID CoCID NCHHSTP NCHHSTP DSTDP DSTDP –PDSB and THCB merged into the Program and Training Branch (PTB)

7. Ongoing Projects Ongoing Projects Male Screening Consultation Male Screening Consultation –Questions of Interest »What is the effectiveness of screening men in various venues to identify undiagnosed chlamydia infection? »Can we identify behavioral or demographic characteristics such as age that can be used to target men at high risk for chlamydia infection? »What do models and cost-effectiveness studies on male chlamydia screening tell us? »What data are there on partner management practices for female partners of men found to have chlamydia?

8. Ongoing Projects Partner Management Partner Management –Expedited Partner Therapy »Dear Colleague Letter »Catalogue of state and local statutes, rules, and regulations GC Screening GC Screening »National GC Screening guidelines using a prevalence threshold should be established »Localize efforts in a “geographic core” »GISP/GASP

9. Ongoing Projects Infertility Prevention Workgroup Subcommittees – –Partner Services – –Client Counseling and Behavioral Interventions – –Diagnosis and Treatment – –Surveillance and Monitoring – –Screening 2 Page Outline – –Rationale for component – –Describe Status Quo – –Given existing evidence, what should we be doing? – –Identify critical issues and recommend strategies

10. Ongoing Projects Broad Action Areas Identified Broad Action Areas Identified –Twenty-six prioritized to eleven –Development of 3-5 page brief response paper using a common template –Discussion meeting June 16 –Subsequent Prioritization »3-5 presented to Dr. Douglas for consideration

11. Ongoing Projects Partnership for Prevention Partnership for Prevention »P4P is a national nonprofit dedicated to building evidence for strong disease prevention policies »Proposed Work Plan Promote the use of high-impact adolescent preventive services, including chlamydia screening; Promote the use of high-impact adolescent preventive services, including chlamydia screening; Develop an implementation guide to assist health systems and clinicians establish systems that encourage the delivery of chlamydia screening services; Develop an implementation guide to assist health systems and clinicians establish systems that encourage the delivery of chlamydia screening services; Promote delivery of the new HPV vaccine, especially to vulnerable populations Promote delivery of the new HPV vaccine, especially to vulnerable populations

12. Azithromycin FDA approval for generic AZ 11/11/05 FDA approval for generic AZ 11/11/05 »Greenstone (Pfizer) »Teva »Sandoz –340B sub-ceiling pricing for branded AZ ($95/10 doses) expires 6/30/06. Pfizer will not renew this contract with 340B –Kansas IPP Coordinator Jennifer Vandevelde 785-296-6544 Jennifer Vandevelde 785-296-6544

13. Performance Measures Activities PM Consultation January 2006 PM Consultation January 2006 –Established PM evaluation criteria –Reviewed current measures and evaluated possible future measures –Recommended guiding principles

14. PM Activities (2) PM Consultation (cont) PM Consultation (cont) –Made recommendations for each “new” measure »Tabled »Needs further discussion Proportion of family planning clinics adhering to regional chlamydia screening criteria (Infrastructure[?]) Proportion of family planning clinics adhering to regional chlamydia screening criteria (Infrastructure[?]) »Pilot-ready Timeliness of treatment for maternal syphilis during pregnancy Timeliness of treatment for maternal syphilis during pregnancy Screening coverage estimate among sexually active 15-19 year old women in FP clinics (Infrastructure [?]) Screening coverage estimate among sexually active 15-19 year old women in FP clinics (Infrastructure [?]) »Ready for Implementation

15. PM Activities (3) PM Consultation (cont) PM Consultation (cont) –Made recommendations for each “new” measure »Ready for Implementation Gender of Sex Partner information Gender of Sex Partner information Timeliness of treatment for gonorrhea and chlamydia in women who test positive in STD clinics Timeliness of treatment for gonorrhea and chlamydia in women who test positive in STD clinics –Made recommendations for current measures

16. PM Activities (4) Live Database March 6 Live Database March 6 –Continued development of Technical Assistance and Reports section –January-June 2005 data final β-est for data entry –MOU and User ID requests »Grantees »IPP regional coordinators –Three training Webinar for grantees –Database available for aggregate July-December 2005 data entry until April 30, 2006. Changes after 4-30-06 will be reviewed, approved, and entered by project area consultant.

17. Performance Measure IPP CS1 Among clients of IPP Family Planning clinics, the proportion of women with positive chlamydia tests treated within 14 and 30 days of the date of specimen collection.

18. IPP CS 1 (Chlamydia) Results Site20042005.12005.2 Region II- 14 Days (Average) 0.520.400.16 Region II- 30 Days (Average) 0.740.640.45 National- 14 Days (Average) 0.70.75 National- 30 Days (Average) 0.90.89

19. IPP-CS1 Proportion of positive chlamydia cases from family Planning clinics treated within 14 and 30 days U.S. and IPP median proportions (2005)

20. Performance Measure IPP CS2 Among clients of IPP Family Planning clinics, the proportion of women with positive gonorhea tests treated within 14 and 30 days of the date of specimen collection.

21. IPP CS 2 (Gonorrhea) Results Site20042005.12005.2 Region II- 14 Days (Average) 0.550.51N/A Region II- 30 Days (Average) 0.740.61N/A National- 14 Days (Average) 0.70.74 National- 30 Days (Average) 0.90.91

22. IPP-CS2 Proportion of positive gonorrhea cases from family Planning clinics treated within 14 and 30 days U.S. and IPP median proportions (2005)

23. Performance Measure CSPS MLS1 Proportion of female admittees to large juvenile detention centers tested for chlamydia.

24. CSPS MLS1 (JDC Screening) Results Site20042005.12005.2 Region II (Average) 0.690.870.54 National (Average) 0.630.60

25. CSPS-MLS1 Proportion of female juvenile detention center admittees that are screened for chlamydia Median proportions in U.S. and IPP regions (2005)

26. 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." "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."

27. Questions