Wisconsin State Report RVIPP Meeting March 4-5, 2009 Highlight Updates

1. Wisconsin State ReportRVIPP Meeting March 4-5, 2009 Highlight Updates • Screening Projects:Prevalence Evaluation Update; Expanded GC Screening in Milwaukee Update • Clinical Services:School Based Clinics;Dual Protection Update; EPT Update;; Medicaid Billing • Miscellaneous:WEDSS; Personnel

2. Screening Projects • Prevalence Evaluation • Universal screening in all 26 WI PPW clinics for chlamydia and gonorrhea • All sexually active males and females • In conjunction with April National STD Awareness Month

3. Prevalence Evaluation Clinician Survey Questions “Would you have tested outside SSC if patient did not meet current SSC and why”: • Concern about partners from high- prevalence areas • Risks exist outside the timeframe specified by SSC • Concern about reliability of history info provided _________________________________________ • Patient is a “Pregnancy Test Only” • Patient came into the clinic because of the STD Awareness Campaign

4. Clinical Services • School Based Clinics (Aurora) • 15 clinics in Milwaukee schools • Students take Youth Student Risk Assessment • Offer testing for ct/gc/HIV/Herpes if come in for sports physicals, student request or if symptomatic • If positive, treated and partner f/u initiated through LHD • Working on enabling pick up of condoms at alternate site (not yet acceptable practice in high school) and referred for further reproductive health care f/u • Results • Testing since mid-Dec • 13 urine specimens (tested for CT and GC): 10 females and 3 males; 1 CT positive (female)

5. Clinical Services • Dual Protection at Milw STD Clinic • Resumed/filled position November 2008 • $26,000 MA reimb from DP services directly to STD clinic • NP salary, training and infrastructure building • EPT Update • Wisconsin Medical Examining Board (MEB) position paper adopted by the board • Supports EPT as standard of care for STD Rx whose partners are not available or agreeable to direct examination and supports the passage of legislative authority to authorize provision of EPT Rx by WI licensed physicians • Medicaid Billing at Milw STD Clinic • $122,728 from 8 weeks of STD services to Milw City • Proposal to match WI DPH STD contract dollars with MA reimb for STD services to be earmarked for Milw STD Clinic

6. Miscellaneous • WEDSS • STD Program data import into WEDSS from STD-MIS • Personnel • STD Program Data Manager • Jackie Grayson CDC Federal Assignee • Laboratory • Bobbie’s at the Bench…(not the bar stool kind of bench…)! • New SALT and RVIPP members • Deb Austin from PPW • Deb Leschisin non-PPW FP

7. Expanded GC Screening in Milw FP Background Epidemiology • “Most” gonorrhea in WI is found in the SE • In 2006, 71% of WI GC cases were in Milwaukee • In 2007 at WSLH, Milwaukee accounted for 54% of FP GC specimens and 77% of FP GC positives • GC rates have been increasing in Milwaukee • Milwaukee ranked #6 in 2006 in US counties for GC • Number of cases has gone from 3311 in 2004 to 4031 in 2005 to 5006 in 2006

8. FP GC Screening in Milw • GC Screening data from Milwaukee showed a higher positivity rate off the GC SSC than other parts of the state ON the GC SSC • Decision to expand GC screening criteria to become “Universal” to Chlamydia criteria • Aim to test patients who did not meet GC SSC but did meet Chlamydia criteria • Anyone meeting CT criteria now meets GC criteria

9. Expanded GC Screening: Expectations • Projected an additional 6000 GC tests in Milwaukee in 12 months; ??? Positives ??? • Positivity rate in the “expanded GC SSC” group expected to be lower than in patients who met the previous GC SSC; • Those outside the ‘old’ GC SSC are lower risk; • Unless there is some new risk for GC in Milwaukee explaining the increased overall positivity, OR • Positivity has increased across all risk groups

10. Expanded GC ScreeningResults as Nov 2008 • Implementation not as simple as we hoped • Testing data from the first six months of 2007 vs. the first six months of 2008 gives a good picture before and after full implementation (July 2007) • Increase in testing was as expected, though the “expanded GC SSC” not used all of the time • Number of positives was…rather surprising!

11. Expanded GC Screening

12. Expanded GC Screening Data interpretation • At first glance, the data may seem a bit… well, disappointing. • GC testing tripled with fewer positives found! • The data suggests some interesting possibilities. • The increase in GC in Milwaukee is outside the FP population • Our SSC are targeting the infections, even in high-prevalence areas • The trend (increased GC) may be reversing