John Douglas: Chlamydia Prevention in the US - Update from CDC


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An update on chlamydia screening in the US from John Douglas, Jr., MD, Director, Division of STD Prevention, CDC

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John Douglas: Chlamydia Prevention in the US - Update from CDC

  1. 1. Chlamydia Prevention in the US: Update from CDC <ul><li>National Chlamydia Coalition Meeting </li></ul><ul><li>4 December, 2009 </li></ul><ul><li>John M. Douglas, Jr., MD </li></ul><ul><li>Director, Division of STD Prevention </li></ul><ul><li>Centers for Disease Control and Prevention </li></ul>
  2. 2. Outline <ul><li>CDC priorities </li></ul><ul><li>CT surveillance status report </li></ul><ul><li>Priorities for 2010 and beyond </li></ul><ul><ul><li>National Chlamydia Coaltion </li></ul></ul><ul><ul><li>Other efforts at CDC </li></ul></ul>
  3. 3. CDC Under Dr. Frieden: New Priorities <ul><li>Strengthen </li></ul><ul><ul><li>Surveillance and epidemiology </li></ul></ul><ul><ul><li>Ability to support state and local public health </li></ul></ul><ul><li>Provide public health leadership in </li></ul><ul><ul><li>Global health </li></ul></ul><ul><ul><li>Health polices especially health reform </li></ul></ul><ul><ul><li>Better addressing leading causes of death and disability </li></ul></ul><ul><ul><li>Improve efficiency of day-to-day functioning (personnel, procurement) and save money </li></ul></ul>Organizational Improvement All Hands, 8/27/09
  4. 4. NCHHSTP Strategic Plan: 2009 – 2015 Goals <ul><li>Goal 1: Program Collaboration and Service Integration </li></ul><ul><li>Goal 2: Health Equity </li></ul><ul><li>Goal 3: Global Health Protection and Systems Strengthening </li></ul><ul><li>Goal 4: Partnerships </li></ul><ul><li>Goal 5: Workforce Development and Capacity Building </li></ul>
  5. 5. DSTDP Strategic Plan: Goals <ul><li>Reaffirmation of existing disease-focused goals </li></ul><ul><ul><li>1. Prevent STI related infertility </li></ul></ul><ul><ul><li>2. Prevent STI-related adverse outcomes of pregnancy </li></ul></ul><ul><ul><li>3. Prevent STI-related cancers </li></ul></ul><ul><ul><li>4. Prevent STI-related HIV transmission and acquisition </li></ul></ul><ul><li>Operational reality: declining public health infrastructure </li></ul><ul><li> 5. Strengthen STD prevention capacity and infrastructure </li></ul><ul><li>Unaddressed realities </li></ul><ul><li>6. Reduce STD health disparities across and within communities and populations </li></ul><ul><li>7. Address the effects of social and economic determinants of specific STDs and associated sequelae among specific populations </li></ul>
  6. 6. 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. Total Cases =1,210,523 B:W ratio= 8:1 % dx’d STD clinics= 15%
  7. 7. Chlamydia — Median state-specific positivity among 15- to 24-year-old women tested in family planning clinics: United States, 1997–2008 Note: As of 1997, all 10 DHHS regions, representing all 50 states, the District of Columbia, and outlying areas, reported chlamydia positivity 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
  8. 8. CT Prevention: Evidence of Progress <ul><li>NHANES studies </li></ul><ul><ul><li>Representative national sample of general population </li></ul></ul><ul><ul><li>Most recent wave indicates no evidence of increase </li></ul></ul><ul><li>National Job Training Program </li></ul><ul><ul><li>High-risk population, single lab </li></ul></ul><ul><ul><li>Significant declines 2003-7 for F (19%) and M (8%) </li></ul></ul><ul><li>Sentinel surveillance for PID </li></ul><ul><ul><li>NDTI surveys indicate geometric average annual declines of 10% 2002-2008. </li></ul></ul>
  9. 9. Annual Chlamydia Screening in Commercial and Medicaid Plans, HEDIS 2000 - 2008 Data from State of Health Care Quality reports from NCQA,, Healthcare Effectiveness Data and Information Set. 59% 53% 43% 40%
  10. 10. Challenge: NCSD Survey on STD Program Capacity and Infrastructure (Wong, 2009 NCSD mtg) <ul><li>Survey of states and selected health jurisdictions (n = 79) surveyed on impact of recession on STD programs; 81% response </li></ul><ul><li>Results </li></ul><ul><ul><li>Salary freezes/reductions: 64% </li></ul></ul><ul><ul><li>Furloughs/shutdown days: 47% </li></ul></ul><ul><ul><li>Staff layoffs: 25% </li></ul></ul><ul><ul><li>STD clinic closures: 25% of 39 (32 nationwide) </li></ul></ul><ul><ul><li>Services cut: clinical/lab 31%, DIS 36%, STD screening 27% </li></ul></ul><ul><ul><li>Major involvement in H1N1 (67% spring, 76% expected fall) </li></ul></ul><ul><li>Conclusion: </li></ul><ul><ul><li>severe erosion in capacity for STD and emergency response </li></ul></ul><ul><ul><li>capacity may be difficult to recover even with restored funds </li></ul></ul><ul><ul><li>greater need for collaboration with health care delivery system </li></ul></ul>
  11. 11. STD Prevention in the Era of Health Reform: Priorities <ul><li>Health system reform, rather than health care or health insurance reform would have been optimal </li></ul><ul><li>However, even HI reform with greater access presents new options </li></ul><ul><li>Scale-up of prevention interventions for population impact </li></ul><ul><ul><li>Will require a more intentional focus on “horizontal” health care delivery systems than STD prevention programs have traditionally done </li></ul></ul><ul><ul><li>Greater focus on assessment, assurance, policy than on direct services </li></ul></ul><ul><ul><li>This should clearly happen at national level (eg, National CT Coalition, collaboration with HRSA, CHCs) </li></ul></ul><ul><ul><li>What is role of local/state HD in such a horizontal re-alignment? (eg, how to enhance assessment, assurance, policy roles?) </li></ul></ul>
  12. 12. NCC: Key Partner for the Future <ul><li>Health Reform offers new opportunities to support implementation of key strategies </li></ul><ul><li>NCC is well positioned to support government goals and priorities </li></ul><ul><li>Local affiliates and chapters could partner with state and local STD programs to expand dissemination of tools and reach new audiences </li></ul><ul><li>With exemplary performance come high expectations for the future </li></ul><ul><li>Can engage new partners in the research community and pharmaceutical and laboratory industries. </li></ul>
  13. 13. NCC Early Returns: Key Accomplishments to Date <ul><li>NCC has evolved faster than expected for most coalitions </li></ul><ul><li>Key outcomes </li></ul><ul><ul><li>Development and dissemination of Implementation Guide </li></ul></ul><ul><ul><li>Publication of USPTF recommended services for adolescents </li></ul></ul><ul><ul><li>Compilation of resources for providers </li></ul></ul><ul><ul><li>Successful support of HEDIS accreditation measure </li></ul></ul><ul><ul><li>Engagement of wide variety of partners (providers, health plans, advocacy organizations, researchers, federal agencies and community-based organizations) </li></ul></ul>
  14. 14. NCC: New Developments to Come <ul><li>Launching mini-grants programs to implement innovative strategies to increase CT screening and follow-up care and partner treatment </li></ul><ul><li>Series of Roundtables to examine critical policy issues to </li></ul><ul><ul><li>expand implementation of EPT </li></ul></ul><ul><ul><li>increase coordination across federally-funded programs (including Medicaid, adolescent health, maternal and child health, school-based clinics and community health centers) </li></ul></ul><ul><li>Proactive outreach to media </li></ul><ul><li>Evaluating and documenting accomplishments of the NCC (CDC-P4P collaboration) </li></ul>
  15. 15. Tuesday, December 1, 2009 WETZSTEIN: STD exams needed early A prominent medical group recently suggested that American teenage girls and college-age women avoid getting gynecological exams for cervical cancer until they turn 21. I hate to second-guess this esteemed group, but when one in four U.S. teenage girls has a sexually transmitted disease (STD), the advice seems odd to me. I would think medical professionals would urge every American woman who is single and sexually active to run, not walk, to a doctor's office every few months for a genital checkup. This goes double for teens and college-age girls. Getting regular genital exams is just prudent these days - and with chlamydia cases reported at a record 1.2 million, there's no time to delay. Chlamydia is curable with antibiotics, said Susan Maloney of the National Chlamydia Coalition. The chlamydia test is easy to do (just a vaginal swab); some doctors are starting to ask women getting Pap smears whether they would like a chlamydia test too. Sexually active young women should ask their doctors for a chlamydia test whether they &quot;feel anything or not,&quot; Ms. Maloney said.
  16. 16. CT prevention: Other CDC Efforts <ul><li>CDC-HRSA collaboration </li></ul><ul><ul><li>Leadership meetings Nov 2009 </li></ul></ul><ul><ul><li>Range of possible synergies </li></ul></ul><ul><li>Evaluation of antenatal CT prevalence to monitor impact at state/local levels </li></ul><ul><li>Chlamydia Evaluation Initiative </li></ul><ul><ul><li>8 project areas funded to assess approaches to monitor screening coverage </li></ul></ul><ul><li>CT modeling </li></ul><ul><ul><li>Assesses impact of screening coverage and partner RX on prevalence </li></ul></ul><ul><li>“ Chlamydia Prevention and Control” selected as a topic for new monthly CDC PH Grand Rounds </li></ul><ul><li>Assessment of CT screening in high- and low-performing health plans </li></ul><ul><ul><li>Public awareness/demand thought to be critical </li></ul></ul>
  17. 17. Development of Children’s Healthcare Quality Measures <ul><li>Secretary will identify quality measures for Medicaid and CHIP </li></ul><ul><ul><li>Covers 45% of those < 19 </li></ul></ul><ul><li>Mandated by Title IV of CHIPRA </li></ul><ul><li>Subcommittee established by CMS and AHRQ scored over 120 </li></ul><ul><li>Submitted 25 to HHS and OMB </li></ul><ul><li>Chlamydia screening currently on the list </li></ul><ul><li>Comments will be solicited in Jan 2010 </li></ul><ul><ul><li>Opportunity for public input!! </li></ul></ul>
  18. 18. Evolving Landscape of EPT: Legal Status Summary EPT is Potentially Allowable EPT is Likely Prohibited EPT is Permissible Legislation Pending 2006—2009: Increase of 10 states Non-EPT states with >30 k reported cases: --FL, OH, MI, GA, NC, VA --23% all reported CT CA OR WA NV NM UT AZ WY CO NB KS MO AR OK FL GA AL MS LA TX WI IA MN ID MT ND SD NC VA WV KY TN OH MI IN IL VT AK HI ME NY PA RI MA NJ CT NH SC DE DC MD ( Baltimore only) CA OR WA NV NM UT AZ WY CO NB KS MO AR OK FL GA AL MS LA TX WI IA MN ID MT ND SD NC VA WV KY TN OH MI IN IL VT AK HI ME NY PA RI MA NJ CT NH SC DE DC MD 2006 2009
  19. 19. Current CDC EPT Efforts <ul><li>Continued technical assistance to states requesting policy assistance </li></ul><ul><ul><li>Needs to be more focused on high-morbidity states </li></ul></ul><ul><li>New project with Centers for Law and Public’s Health </li></ul><ul><ul><li>Identify range of policy/legal tools needed by states to implement EPT </li></ul></ul><ul><ul><li>Develop toolbox and make available to states </li></ul></ul><ul><ul><li>Project to be completed by October 2010 </li></ul></ul>
  20. 20. Public Outreach: Works in Progress <ul><li>GYTNOW: improving the process and extending the messages </li></ul><ul><ul><li>though GYT09 marketing methods were appropriate for the target audience, the process did not work well for our partners (eg, timing and availability of materials) </li></ul></ul><ul><ul><li>Extensive feedback being used to improve the next round of GYT, called GYTNOW </li></ul></ul><ul><ul><li>continued, constructive feedback by partners critical to produce successful long-term effort </li></ul></ul><ul><li>Infertility Prevention Social Marketing </li></ul><ul><ul><li>OMB clearance delayed project by 1 year </li></ul></ul><ul><ul><li>Concept & Message testing (Nov-Dec 09) </li></ul></ul><ul><ul><li>Next steps for campaign development, implementation & partner engagement </li></ul></ul>
  21. 21. Acknowlegements <ul><li>Amy Pulver </li></ul><ul><li>Raul Romaguera </li></ul><ul><li>Rhonda Perry </li></ul><ul><li>Stuart Berman </li></ul><ul><li>Catherine Satterwhite </li></ul><ul><li>The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC/ATSDR </li></ul>