Project Stomp Out Syphilis (SOS)

1. Project Stomp Out Syphilis(SOS) Larry P. Foster, BS-STD Coordinator Antoine Thompson, MPA-CDC/PHA STD Interagency Team Members Navajo STD Project

2. Dine’ Be Keyah Southwest U.S. Four Corners Area 27,000 sq. mi./17.5 mil. acres NAIHS 2008 Population Reservation Area: 237,030 Reservation plus Navajos living in major border towns: 298,197

3. SCOPE OF SERVICESSocial Hygiene Branch To reduce STD transmission and prevent complications Monitor STD/HIV burdens and trends Identify the population with high risks Monitor and evaluate surveillance data Increase STD/HIV education and awareness MISSION: The STD Program will facilitate early detection, intervention and prevention of STD/syphilis transmission on/near the Indian Health Area and Reservation.

4. TARGET AREA • Year 2004: Report by CDC-David Wong,MD identified 50% of cases investigated are within 30-mile radius in Gallup Service Area. • Cases common factors include usage of alcohol,local bars, motels, social network; incarceration at the local detention and treatment centers.

5. South Central Navajo NationCommunity Location of syphilis case-patients (n=326) • syphilis case/patients are clustered within 30mile radius of Gallup Service Area (Apache Co., McKinley and San Juan Co.) = one syphilis case-patient

6. Adult Syphilis Cases By Service AreaCumulative Total: 502 Jan. 2001-Aug, 2009 1 19 2 46 2 49 29 30 16 08 11 12 277

7. Total Syphilis Cases 1980-2009

8. Project SOS(Stomp Out Syphilis) Background/Genesis: • Expansion from Window Rock and Shiprock Jail screening. • Review of Epi Case Data. • Coordinated with NM Department of Health Office, Navajo Social Hygiene, Navajo AIDS Network, Navajo HIV Prevention Program and CDC-Public Health Advisor. Dine’ Unity Screening Project Navajo Division of Health Funded by Centers for Disease Control and Prevention

9. OBJECTIVE • Community and Programs Mobilization • Targeted Screening • STD/syphilis education in the Gallup Service Area, and the 30-mile radius. Leading to a Reduction in SyphilisMorbidity

10. Mobilize The Navajo Nation/State/IHS Programs{Working Method} • Navajo Social Hygiene Program-Lead • State of NM/Az.--DIS and CDC-PHA • DINE’ Unity Screening Project • Navajo AIDS Network • Navajo HIV Prevention/Health Education Program • Navajo CHR

11. Interagency Team Members

12. Interagency and Disease Intervention Benefits{Working Method} 1. Build Relationships 2. Early detection 3. Rapid Treatment 4. Consistent Presence 5. Community Education 6. Partner Notification

13. Communication Increased interaction between interagency and organizations. Capacity Building Interagency gained knowledge on how to take primary responsibility. Project provides grounds and not to repeat mistakes. Helping detention centers get policies in place for arrestees. Provide recommendations for detention/Detox facilities on “how to improve medical units”. Staffing Gained knowledge and skills on multidisciplinary approach. Local bar owners and detention center very welcoming to increased Outreach Staff and PHA presence. “Happy Field Staff got involved because need acknowledgement”. Benefits of Collaboration{Working Method}

14. Perceived Benefits for Clients{Working Method} • Prevention/Education • Health information important for all. • Stimulates interest in other health issues. • Audiences receives health education that otherwise would not have. • Increased awareness of STD programs and services. • Public Health Outreach • High-risk “captive audience” found and tested. • Identify co-infections and improve services for clients. • Cultural • Address health literacy issues. • Promote prevention, which is often overlooked in Navajo Culture. • Social • Positive interactions with staff, clients, patrons and others. • Felt Outreach Staff cares and is following-up with needs.

15. STREET OUTREACHTeams • Representatives from the Navajo Social Hygiene, NM Department of Health Office, Navajo HIV Prevention Program, Navajo AIDS Network and Dine’ Unity Screening Project. • Areas covered were Hamburger Hill, Wally World Hill, Broke Back Mtn. Tent City, under bridges, arroyos, under trees, in non-public places, streets of Gallup/Gamerco and (burro) highway.

16. Processing of Specimen • Used the State of New Mexico Lab to process the specimens. • Used the New Mexico laboratory forms. • Performed quality check before specimen was sent to the State Lab. • Turn around time- about 10 days.

17. Recent OutcomesJuly 08’- June 09’ • Patients Educated 1546 • Screened 681 • Positive serology's 27 • Positivity Rate 4% • New Early Cases 09

18. Other SOS Activities • Halloween activities at Navajo AIDS Network Office. • Family Health Fair- Rio West Mall • UNM Gallup Branch-Health Fair • Walmart Outreach • Gallup Walkway Area

19. Barriers-Not Working • Slow process for patients and f/u-No phones. • 3-6 months to be found. • Patients having outdate address, divorced. • Transportation problems. • Patients “waiting-time” in clinics. • Substance abuse issues>Name each other. • Non-complainant, don’t want to come in.

20. Barriers Distances between communities and homes are great. Families live 10 to 50 miles to the nearest IHS facilities. Distance may be a dirt road and becomes impassible in weather changes.

21. Lines of Distinction • State Lines • County Lines • Service Area Lines • BIA Lines • Chapter Area lines • Agency • Intra-State Regional Lines • Reservation Line

22. Expand to Arizona Service Areas • The SOS Model has proven our capability, expansion will work in Western Navajo. • Need support from #638 Facilities and IHS • PHNs at these site areas. • Lab capacity and support at these Service Units. • Need interagency collaboration from State of Az. • Assist other Az. Tribes during outbreaks.

23. Challenges to Screening for Additional STDs • Communication • Concern about overwhelming clients with information. • May “dilute” syphilis screening efforts. • Work Process • Specimen collection issues with urine-based tests. • Patient privacy and counseling issues with HIV screening. • Additional requirements will be disruptive to facilities. • Resources • Commitment and time from State of Arizona, County and NSHP others. • Lab capacity

24. Future Plans • SOS and Department of Health Office will continue screening at NCI and the Gallup Detention Center. • SOS Project will continue Street Outreach Screening. • The case management sessions between the IHS, NM Department of Health Office, CDC Public Health Advisor and the Navajo Social Hygiene will continue. • Expand the use of NN CHRs in the Gallup Service Area who have been trained to provide preventive education and draw bloods.

25. Special Thanks To: • Social Hygiene and the assigned CDC- PHA • McKinley Co Health Dept. • Navajo AIDS Network • Navajo Health Education/HIV Prevention • State of Az.-CDI • DINE’ Unity Project • IHS, CHR, NAIHS Infection Control Officer

26. Interagency Outreach Team

27. Ahe’hee’ d’o Ha’goo’ee' • Gallup – (505) 722-1742/1773 • Shiprock – (505) 368-7404 • Crownpoint – (505) 786-2287 • Fort Defiance – (928) 729-3792 • Winslow/Dilkon – (928) 657-8020 • Tuba City – (928) 283-2815 • Kayenta – (928) 697-4046 • Chinle – (928) 674-2283 • Gallup-PHA@MCHO – (505) 722-4391 Gallup Social Hygiene Branch Telephone number: 505. 722.1740 Toll free number: 1. 866. 503.3074 fax number: 505. 863.4884