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GC Outbreak in Philadelphia. Greta Anschuetz, MPH Philadelphia Department of Public Health greta.anschuetz@phila.gov. Reported Cases of GC: Philadelphia 1990 – 2010. 36% increase from 2009. Number of Cases. Year. GC Reports by Specimen Collection Date 2009-2011. 2 nd Increase.
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GC Outbreak in Philadelphia Greta Anschuetz, MPH Philadelphia Department of Public Health greta.anschuetz@phila.gov
Reported Cases of GC: Philadelphia1990 – 2010 36% increase from 2009 Number of Cases Year
GC Reports by Specimen Collection Date 2009-2011 2nd Increase 1st Increase Number of Cases Month, Year
Percent Increase by Age and Gender Percent Increase Age Group (Years)
Ongoing GC Control Efforts • Comprehensive city-wide GC/CT screening program (includes IPP funded sites, prison and High School screening) • 100K females annually (8% CT pos; 2% GC pos) • 65K males annually (8% CT pos; 3% GC pos) • Partner services & rescreening for GC/CT infected HS students • GISP • SSuN site since July 2009: interview subset of GC cases • 743 interviews (~7% of GC reports) • No changes in reported risk factors/markers over time • 22% of male GC cases identify as MSM • Anonymous partner in last 12 mos.: 35% MSM vs. 24% MSW vs. 10% among females
August 2009: Added screening for asymptomatic ED patients in a high GC prevalence area (ZIP 19143) Initially high CT positivity (6%) and GC positivity (4%) Very slow uptake by ED staff March 2011: Gained support of ED Director More specimens in past 3 weeks than in all of 2010! August 2010: Initiated Partner Services for all GC patients reported in same target area (ZIP 19143) for one month 2009-2010 GC Targeted Initiatives
2009/10 Area of Interest Includes ZIP codes with more than 50 cases reported in 2010
2011 GC Targeted Initiatives • March 2011: Approached ED in ZIP with high % increase (19124) about screening asymptomatic patients • Still in development • April 2011: Applied for CDC community approaches grant. Proposed case finding in social networks of the public high school • April 2011: Launched youth oriented intervention in collaboration with Philadelphia AIDS Activities Coordinating Office: • Comprehensive media campaign (including social media) targeting youth • Expansion of condom availability • HIV subsequent to teen STD data analysis
Media Campaign and Condom Availability • Launched Take Control Philly, a comprehensive youth targeted STD/HIV Prevention Initiative • Unveiling of a consumer designed Philly labeled condom • Adolescent oriented website (www.takecontrolphilly.org) • Educational component • Mail me condoms • ~800 condom orders shipped via USPS
HIV Subsequent to Teen STD Question: How many teens with an STD diagnosis are diagnosed with HIV in the future? Cohort Selection Females Males STD+: Case of CT/GC or Syphilis as a teen from any provider/lab received by PDPH STD-: >1 negative from HS Screening Program, never a case as a teen
HIV Risk by Teen STD HistoryRisk Ratios and 95% CIs All STDs CT GC All STDs CT GC *Adjusted for race/ethnicity and birth year
Conclusions • GC increase in 2010 is widespread and not localized to any group/region in Philadelphia • Small percent of increase can be explained by one lab not reporting in 2009 (~200 cases) • New initiatives focus on increasing condom availability and awareness among adolescents via media • Large cohort analysis shows that having an STD as a teen increases the risk of a subsequent HIV diagnosis