360 likes | 579 Views
Sexual Health Promotion Protecting Health & Improving Lives. Presenters: Prevention Services Tanisha Pettus , DIS II & Linkage to Care Julie Anderson, DIS II. Understanding Public Health. Identifying & addressing public health threats Enforcing laws that protect the public’s health
E N D
Sexual Health PromotionProtecting Health & Improving Lives Presenters: Prevention Services Tanisha Pettus, DIS II & Linkage to Care Julie Anderson, DIS II
Understanding Public Health • Identifying & addressing public health threats • Enforcing laws that protect the public’s health • Providing services to prevent & control disease
Sexual Health PromotionsPrevention Services • Comprised of a group of Disease Intervention Specialists (DIS) mandated by the state of Ohio to follow-up with all HIV/AIDS and Syphilis reportable conditions • Receives all positive lab findings relating to HIV/AIDS and Syphilis • Responsible for following up with reported cases in Franklin County • Works closely with the Ohio Department of Health (ODH) & their Ohio Disease Reporting System (ODRS) • Conduct field investigations & Interviews
HIPAA & ORC • Permitted Disclosure: A covered entity may disclose protected health information without the written consent of the patient, for the public health activities and purposes described in the following paragraph: “According to the Ohio Revised Code (ORC), HIV/AIDS and Syphilis must be reported and followed up by public health officials. The reporting system of syphilis or HIV/AIDS supersedes HIPAA guidelines” • House Bill 1 Changes to HIV testing/consent statute • R.C. 3701.242 Informed consent to HIV test; counseling; anonymous testing
HIPAA & ORC- Resources • Revised Recommendations for HIV testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings • HIPAAPrivacy Rule and Public Health • Documents can be found at the CDC MMWR website
Syphilis & HIV/AIDS Case Management & Reporting Lab & Provider Lab Report CPH ODH IDRS ODRS DIS Client Interview Provider F/U DIS Field Investigation
DIS ROLE • Prepare and follow the basic mission of STD control: To prevent the spread of disease and the development of complications • Interview patients infected with STDs • Perform investigative activities to locate & refer for examination and/ or treatment • Ensure that all people who have or have been exposed HIV and/or syphilis are promptly examined and adequately treated • Those who are unaware of their infection are the highest priority to receive disease intervention services
DIS ROLE • Once the client has been treated, the DIS will help the client with: • Management of infection • Prevention of future infections • Respond if infected in the future • If the disease is HIV or Acquired Immunodeficiency Syndrome (AIDS), the primary objective of the DIS is: • Prevent the transmission through education and changes in behaviors
Partner Services Principle • Client centered • Confidential • Voluntary & non-coercive • Free • Accessible to all people Goals • Provide support to ensure partners are informed in a confidential manner • Provide testing opportunity to partners and provide early L2C, prevention & other services • Reduce future rates of transmission by aiding in early diagnosis and treatment & prevention services (avoid transmission to others by offering partner services)
Partner Services • Challenges • Will the services be accepted by patients? • Potential for abuse resulting from partner notification • Potential of negative effects on relationships after partner notification Benefits • DIS can help with partner services • DIS can assist with coaching for persons who prefer to notify partners themselves • Partner services can benefit the community by reducing effects of previously undiagnosed STIs/HIV infection among its members • DIS can provide prevention counseling to reduce risk of acquiring new STIs or transmitting HIV to current or future partners
Syphilis Case Management • Avoid sexual contact for 1-4 week after treatment • Follow-up: Clinical and serological evaluation should be performed at 6, 12 and 24 months post treatment • Titer decline of at least fourfold [two dilutions] within 12-24 months of therapy • More frequent evaluation might be prudent if follow-up is uncertain
Syphilis Case Management • All sex partner testing/ treatment for those w/in 90 day critical period • All sex partner testing outside 90 day critical period • Increase condom use for future prevention • Out of jurisdiction (OOJ) lab report and partners
Scenario #1Patient comes to clinic with penile lesions, past history of syphilis & bed bugs. History of HIV NR in 2012. what do you do? • Order RPR & HIV test • Order HSV culture • Order Dark field • All of the above • Do nothing
Individuals with syphilis are at least 2-5 times more likely to acquire HIV if exposed to the virus through sexual contact Individuals with syphilis 2-5x Individuals without syphilis
STI’sHerpes VS Syphilis HERPES VS SYPHILIS
STI’sGenital Warts VS Secondary Syphilis SECONDARY SYPHILIS VS GENITAL WARTS Or HPV
Frequently Reported Risks • Anonymous Sex • Internet- social media- Facebook, Grindr, Adam4Adam, BGC [Black Gay Chat], parties, bathhouses or swingers clubs • Unprotected oral sex • Previous STI diagnosis • Sex with a HIV + person • Sex while intoxicated or high on drugs
EIA/CIA+ IgG/IgM+ Reverse Sequence Syphilis Screening Need Quantitative RPR or Other Nontreponermal Test RPR - RPR + Titer Provided RPR + Titer Not Provided Need Confirmatory Test (TPPA/FTA/MHA) Follow Syphilis Rector Grid Initiate Field Record TPPA/FTA/MHA - TPPA/FTA/MHA + • Initiate Field Record in the following situations: • Women of child-bearing age (14-44 years of age) • Patient between the ages of 0-39 regardless of gender • Patient with no previous history of syphilis treatment • Patient lives in area with high morbidity of syphilis, CT, or GC STOP Syphilis Unlikely
Scenario #2Mother delivered with +IgG, RPR 1:2 no history of syphilis in the past. NR RPR in 1st trimester. What do you do? • Call Health Dept. • Test & treat baby • Treat mom • Consult with ID • All of the above
How To Report IDRS HIV Reporting Form Syphilis Reporting Form
Prevention • Educate • Empower • Communication & Awareness • Routinely test for HIV/syphilis as apart of comprehensive health care
Ryan White Part A PrioritiesEarly Intervention Services • A service provided to those who are newly infected with HIV or individuals who have fallen out of care
Linkage to Care (L2C) • The goal of the Linkage to Care (L2C) Program is to assure persons living with HIV are able to access HIV medical care and medications. • People living with HIV who are in medical care and adherent to HIV antiretroviral therapy are less likely to be infectious to others.
Linkage to Care • Client completed two medical appointments that include HIV related lab work and a treatment plan • Medical Case Management
Anti-Retroviral Treatment and Access to Services (ARTAS) • An individual-level, multi-session, time-limited intervention to link individuals who have been recently diagnosed with HIV to medical care. • Strengths-based Case Management (SBCM) Model • Social Cognitive Theory (self-efficacy) • Humanistic Psychology
Barriers to Care • Transportation • Food • Homelessness • Substance Abuse • Mental iIlness • Fear • Financial Resources
Ryan White Part A Requirements: • HIV status • Residency • Franklin, Fairfield, Madison, Morrow, Licking, Pickaway, Union, Delaware counties • Income • 300% of the Federal Poverty Level
Maintaining Medical Care • Ryan White Medical Case Management • Maintain private health insurance • Market Place navigation
Linkage to Care • In 2013, 180 people were enrolled in the Linkage to Care program • 176 cases were closed in 2013 • 167 (95%) attended at least one medical appointment • 154 (88%) attended two medical appointments and were enrolled in medical case management
Linkage to Care • From January-March of 2014, 57 people were enrolled in the Linkage to Care program • 33 cases have been closed • 32 (97%) attended at least one medical appointment • 30 (91%) attended two medical appointments and were enrolled in medical case management
References • Centers for Disease Control and Prevention [CDC]. (2003). HIPAA privacy rule and public health. Morbidity and Mortality Weekly Report (MMWR), 52, 1-12. • Centers for Disease Control and Prevention [CDC]. (2008a). Partner services FAQs for the public and consumers of partner services activities. Retrieved from http://www.cdc.gov/nchhstp/partners/FAQ-public.html. • Centers for Disease Control and Prevention [CDC]. (2008b).Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydia infection. Morbidity and Mortality Weekly Report (MMWR),57(RR-09) 1-63. • Centers for Disease Control and Prevention [CDC]. (2010). Sexually transmitted diseases treatment guidelines, 2010. Morbidity and Mortality Weekly Report (MMWR),59(RR-12) 34-37. • Centers for Disease Control and Prevention [CDC]. (2012). Anti-retroviral treatment access to services (ARTAS) Fact Sheet. Retrieved from https://www.effectiveinterventions.org/Libraries/ARTAS_Materials/ARTAS_Fact_Sheetrev_12-0109.sflb.ashx. • Centers for Disease Control and Prevention [CDC]. (2013). Syphilis- CDC fact sheet. Retrieved from http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm. • Centers for Disease Control and Prevention [CDC]. (2014). Sexually Transmitted Diseases. Retrieved from http://www.cdc.gov/std/. • Columbus Public Health. (2008). Celebrating a rich history of public health in Columbus. Retrieved from http://columbus.gov/uploadedFiles/Columbus/Departments/Public_Health/New_Administrators/About_Us/About_CPH/HistoryBrochure.pdf. • Columbus Public Health (2014). Take care down there. Retrieved from http://takecaredowntherecolumbus.com/site/. • Ohio Department of Health STD Prevention Program. (2011). Syphilis physician pocket guide. 1-41. • Smith, W. (2014, March 14).NCDSD Weekly Update 3/10/14 – 3/14/14 [Electronic mailing list message].