1. The California Gonorrhea Surveillance System California Department of Public Health STD Control Branch Contact info: Rain Mocello, MPH rain.mocello@cdph.ca.gov (510) 620-3717 Michael C. Samuel, DrPH michael.samuel@cdph.ca.gov Gail Bolan, MD gail.bolan@cdph.ca.gov Denise Gilson – Data Manager denise.gilson@cdph.ca.gov

2. METHODS  Case selection  Goal – to interview at least 1500 (5%) of reported CA gonorrhea cases (including SF)  Jurisdictions chose sampling fraction - 10% random sample - 100% of all reported cases  Planned for minimum of 50% response rate; target response rate 80%  Data weighted for analysis

3. CIR initiated by local staff Case Selection and Flow of Data + GC reported to local health jurisdiction by lab report and/or CMR 100% Follow-Up n = 27 LHJs 10% Sample n = 34 LHJs Case Investigation Record (CIR) initiated by local staff Case reported to the State Weekly random sample taken at the State Patient and provider follow- up begin Pre-populated CIR sent to local health jurisdiction Data analyzed by State and returned to local jurisdictions Completed CIR mailed to State and entered 8 week interview window 8 contact attempts 2 on evenings 2 on weekend

4. Sample Pre-Populated Case Investigation Record

5. Response Rate  Response rate = % interviewed among all sampled and eligible cases with CIR on file  Increased from 56% in 2007 to 62% in 2008  Higher in jurisdictions following all cases  In 2008, 58% response rate in sampling jurisdictions  Compared to 71% in jurisdictions following all cases  Main reasons for non-interview  Inadequate case locating information  Case non-response  Once contacted, cooperation rate was 91%

6. Response Rate Sub-analyses  Among eligible cases in 2007-08  San Francisco excluded due to differing methodology  Case and provider-reported data for 47% of cases  Provider data only for 37% of cases  Case interview only for 3% of cases  Neither case nor provider data for 13% of cases  Analysis of 2009 data showed that 98% of interviews were completed within 6 contact attempts

7. System Performance  Feedback provided to jurisdictions monthly  Timeliness of reporting  List of active cases  Request for past due forms  Quality control  Demographics of sampled and interviewed cases are compared with those of all other reported GC cases  No meaningful differences were found in age, sex, and race/ethnicity

8. Uses of Data - Recent Analyses  Changes to the distribution of sexual orientation of interviewed cases over time  Greater proportion of MSM cases in 2009  Popper/meth use  Increases in popper use, especially among HIV+  Proper treatment  Over 10% of CA cases inappropriately treated or not treated by their diagnosing provider 

9. Uses of Data - Interventions & Publications  Data-to-Action Working Group  Notify private providers and urgent care clinics/ERs of current treatment guidelines  Manuscripts  Methods article in Public Health Reports  Manuscript on GC treatment practices in California submitted to Journal of Clinical Infectious Diseases  Quarterly reports  Statewide, regional, and county-level summary data  Data used in local quarterly STD updates