Forecast for the Federal Budget: Implications for STD Prevention

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Presented by Gail Bolan, MD, Director, Division of STD Prevention, CDC, at the 2012 National Chlamydia Coalition meeting

Presented by Gail Bolan, MD, Director, Division of STD Prevention, CDC, at the 2012 National Chlamydia Coalition meeting

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  • PCSI:Expand programmatic flexibility for PCSIAlign surveillance, policies, standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI
  • PCSI:Expand programmatic flexibility for PCSIAlign surveillance, policies, standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI
  • PCSI:Expand programmatic flexibility for PCSIAlign surveillance, policies,standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI
  • PCSI:Expand programmatic flexibility for PCSIAlign surveillance, policies, standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI
  • PCSI:Expand programmatic flexibility for PCSIAlign surveillance, policies, standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI
  • PCSI:Expand programmatic flexibility for PCSIAlign surveillance, policies, standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI
  • PCSI:Expand programmatic flexibility for PCSIAlign surveillance, policies, standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI
  • PCSI:Expand programmatic flexibility for PCSIAlign surveillance, policies, standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI
  • PCSI:Expand programmatic flexibility for PCSIAlign surveillance, policies, standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI
  • PICSI:Expand programmatic flexibility for PCSIAlign surveillance, policies, standards and procedures for PCSI Promote integrated trainingDevelop policies and activities to enhance PCSIConduct research and evaluation on PCSI

Transcript

  • 1. Forecast for the Federal Budget: Implications for STD Prevention Gail Bolan, M.D. Director, Division of STD PreventionNational Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention National Chlamydia Coalition Annual Meeting January 26, 2012 No conflicts of interest National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention Division of STD Prevention
  • 2. U.S. STD Prevention : The Approach Health education, promotion and behavior change Vaccination Identify and treat infected individuals through  Screening of asymptomatic individuals & linkage to care  STD clinics for symptomatic care  HD partner notification and treatment Individually-based interventions Public sector responsibility STD clinic and DIS focus
  • 3. STDs and their Consequences Most STDs HIV transmission e.g. ImpairedChlamydia fertility STDs Adverse pregnancy outcomes e.g. SyphilisGonorrhea HSV-2 Reproductive tract cancer19 million $17 billionestimated annual e.g. estimated annualnew cases HPV direct costs
  • 4. Estimated Annual Burden and Cost of STDs in the U.S. Estimated Annual Estimated Annual Direct Costs Reported Cases, 2009 New Cases** (millions)*** Chlamydia 1,244,180 2.8 million $701 Gonorrhea 301,174 718,000 $138 HIV* 42,959 60,000§ $8,900 Syphilis 13,997 70,000 $25 Hepatitis B* 4,033 80,000 $47 HPV NA 6.2 million $5,8 00 Genital Herpes NA 1.6 million $1,100 Trichomoniasis NA 7.4 million $198 Total 1,606,343 18.9 million $17 billion* HIV and Hepatitis B estimates include costs of sexually-acquired cases only**US annual estimated new cases (Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalenceestimates, 2000. Perspect Sex Reprod Health. 2004 Jan-Feb;36(1):6-10.)§ Annual new HIV cases, 2008 estimate ; all other annual cases are 2004 estimates (1Hall HI, Ruiguang S, Rhodes P, et al. Estimation of HIV incidence in theUnited States. JAMA. 2009;300:520-529.)***Updated to 2010 $US using medical care component of CPI. Total may differ from sum of all diseases due to rounding.Adapted from: Chesson HW, Blandford JM, Gift TL, Tao G, and Irwin KL. The estimated direct medical cost of sexually transmitted diseases among Americanyouth, 2000. Perspectives on Sexual and Reproductive Health 2004, 36(1): 11-19.
  • 5. Populations at Greatest Risk for STDs Youth  Nearly 50% of STDs estimated to occur in 15-24 year olds Men who have sex with men (MSM)  Account for 62% of syphilis cases in 2009  High rates of HIV co-infection Racial/ethnic minorities  STDs among highest of all racial/ethnic health disparities  African-Americans: 71% of gonorrhea, 48% chlamydia, 52% syphilis  Over last 5 years syphilis cases increased more than 150% among young African American men
  • 6. FY11 Appropriation State Allocation (CSPS) 3% 1% DA - PHA Field Staff 11% 1% Prevention Training Centers 3% 0% Demonstration Projects 4% State Surveillance Activities Partnerships 17% Research and Evaluation60% CDC Support DSTDP Staff/Operations Total = $154.666 million
  • 7. Rationale for Rethinking STDPrevention in a Transformed HealthSystem
  • 8. Drivers of Change: Opportunities Potential shift of vulnerable, at risk populations because of investment in the health care system  Increased proportion of people with insurance coverage  Expansion of community health centers and their likely role as primary care providers for priority STD populations  Interest in quality of care Investment in health information technology in the transformed health care system
  • 9. Drivers of Change: Challenges Federal emphasis on no duplication of effort or services Need to maximize efficiencies based on the most cost-effective and feasible approaches (FIT) and develop a business case for investment (the so what factor) Declining public health dollars and infrastructure and competing priorities
  • 10. Drivers of Change: The Declining STD Public Health Infrastructure In 2008-2009, majority (69%) of state/local STD programs experienced funding cuts and reduced services in:  Disease investigative services (26/65) 40%  Laboratory services (24/65) 37%  Clinical care and screening services (21/65) 32%  HIV tests or hepatitis B vaccinations (4/65) 5% In 2008-2009, state/local governments enacted:  Salary freezes and/or reductions (45/65) 69%  Furlough and/or shutdown days (32/65) 50%  Layoffs 17/65 (28%)
  • 11. Strategic Priorities Informing DSTDP Priorities National  National Prevention Strategy • 4 pillars: Health Equity • Six targeted priorities: Reproductive & Sexual Health  National HIV/AIDS Strategy • Health Equity  IOM Report on Women’s Preventive Services • Well-women visits • Counseling for STIs • Contraception methods and counseling • HIV, IPV, and HPV
  • 12. Strategic Priorities Informing DSTDP Priorities CDC  Winnable Battles- domestic (2/7) • HIV prevention • Teen Pregnancy Prevention  Winnable Battles- global (1/4) • Congenital Syphilis Elimination  Infrastructure • Surveillance • State/local Infrastructure • Ensure high quality data • Support population health approaches • Working toward measurable progress
  • 13. Strategic Priorities Informing DSTDP Priorities NCHHSTP: use a more holistic and combined prevention approach through:  Prevention through Healthcare  Program Collaboration and Service Integration (PCSI)  Promote health equity and address social determinants of health  Improve sexual health DSTDP: using NCHHSTP cross cutting frameworks  Reduce burden of STDs among adolescents and young women  Reduce burden of STDs among MSM  Address the threat of resistant gonorrhea  Eliminate congenital syphilis
  • 14. DSTDP Vision for STD Prevention in the United States1 A future in which all Americans regardless of gender, age, race/ethnicity, sexual orientation are knowledgeable, empowered, and have ready access to a network of culturally competent, high quality, evidence-based and confidential STD prevention services and highly trained professionals to prevent, treat and manage Sexually Transmitted Infections (STIs)1. Vision Statement: A succinct “elevator speech” which summarizes whatyou are working towards
  • 15. DSTDP Strategic Map for 2-3 Years Program Program Support Areas Support • Essential or core functions of national and Areas local STD programs • Allows for comprehensive strategic planning on strategic priorities • Helps organize programmatic response to Programmatic the STD urgent threats and realities Priorities ADOLESCENTS/YOUNG ADULTS GC RESISTANCE MSM SEXUAL HEALTH CONGENITAL SYPHILIS High Priority “PROGRAMMATIC PRIORITIES” PH • High burden, persistent and pervasive Workforce inequity •Urgent action needed to reduce burden and costs •Resistance and Urgent Threat Science & •Evidence of impact with targeted, scaled interventions EvidencePOLICY, STRUCTURAL AND HEALTH SYSTEM INTERVENTIONSENVIRONMENTAL ACTIONS AND SUPPORT
  • 16. Questions How should STD prevention take advantage of the changes that are occurring?  Expand access to comprehensive STD services  Improve quality and coverage of STD services  All by leveraging health care delivery resources What is STD prevention’s role in identifying and addressing gaps as a result of the changes?  Define safety net or unmet need  Provide services to vulnerable populations not served by the health care delivery system  Provide evidenced-based clinical and prevention interventions  Centers of excellence • PTCs, enhanced surveillance, program innovation and best practices
  • 17. Future of STD Prevention Programs Less direct service delivery if those services can be provided by the health care delivery system More investment in assessment, assurance and policy development to ensure quality STD screening, timely treatment and partner services are provided by the health care delivery system  Identify and address barriers  Provide guidance, tools, training and technical assistance Foster partnerships /collaboration between public health programs and health care providers serving at-risk populations
  • 18. Future of STD Prevention Programs Strengthen surveillance, assessment, assurance and CQI initiatives through HIT  Quality of care measures could be the basis for population STD prevention measures  Electronic health records provide comprehensive, longitudinal data on well-defined patient populations Monitor access to health care and identify STD prevention safety net needs Develop better STD prevention program impact metrics Enhance workforce capacity  Need for surveillance, quality improvement, evaluation and policy staff Incorporate cross cutting frameworks into STD Prevention approaches
  • 19. Cross Cutting Frameworks Advancing Prevention through Healthcare  Partnerships and collaboration between public health and healthcare  Leverage prevention priorities with HHS Operating Divisions  Monitor performance and quality of prevention services  Promote innovative systems and health-based approaches  Seek opportunities for a more holistic and combined prevention approach Improving Program Collaboration and Service Integration (PCSI)  A structural intervention to improve synergies between prevention programs and to provide more holistic services to clients
  • 20. Cross Cutting Frameworks Promoting Health Equity and Reducing Health Disparities  Incorporating social determinants of health and structural approaches to STD prevention such as: • Community engagement and mobilization • Policy interventions • Promoting science on disparities and social determinants of health Optimizing Sexual Health  Shifting from a disease-focus to a more positive health-based approach through emotional and mental wellbeing, healthy relationships, reproductive health, disease avoidance and violence avoidance  Normalizing conversations regarding contributions of sexuality and sexual behavior to overall health
  • 21. Advantages of Using Health Equity, Sexual Health, PCSI and PTHC Approaches More holistic Reduce stigma Use combined prevention approaches Leverage wider networks and resources Enhance involvement by new stakeholders Efficiency of resource utilization Evolving health and policy environments
  • 22. STDs as an Health Equity Issue Youth  Nearly 50% of STDs estimated to occur in 15-24 year olds Men who have sex with men (MSM)  Account for 62% of syphilis cases in 2009  High rates of HIV co-infection Racial/ethnic minorities  STDs among highest of all racial/ethnic health disparities  African-Americans: 71% of gonorrhea, 48% chlamydia, 52% syphilis  Over last 5 years syphilis cases increased more than 150% among young African American men
  • 23. Question What should STD prevention look like in 2014 and beyond?
  • 24. In Summary: Looking Forward PTHC is coming and provides an opportunity for scale up and more up stream, holistic approaches  Public private partnership are critical Assessment, assurance and policy development should be more of a focus Safety net services need to be defined and financed HIT should be more of a focus to strengthen surveillance, assessment and assurance activities STD prevention impact metrics are needed Our efforts must increasingly address sexual health and the underlying drivers of STD risk and vulnerability
  • 25. Thank you! Questions? gyb2@cdc.govFor more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the officialposition of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention Division of STD Prevention