ADHS AND COUNTY STD CONTROL AND PREVENTION PROCESSES AND ACTIVITIES Kerry Kenney ADHS/STDP

1. ADHS AND COUNTY STD CONTROL AND PREVENTION PROCESSES AND ACTIVITIES Kerry Kenney ADHS/STDP STATEWIDE STD MEETING April 25, 2008

2. Reporting Chlamydia, Gonorrhea, Chancroid, LGV and Syphilis Case Follow-up Inter-jurisdictional Case Transfers Outbreak Detection and Follow-up STD Training Opportunities Performance Measures Topics

3. Updated Administrative Rules for Provider Reporting (R9-6-202) http://www.azdhs.gov/phs/oids/code.htm New Communicable Disease Reports http://www.azdhs.gov/phs/hvstdhpc/CDRReportFinal_fill3.pdf Reporting

7. Updated Administrative Rules for Provider Reporting (R9-6-202) New Communicable Disease Reports http://www.azdhs.gov/phs/hvstdhpc/CDRReportFinal_fill3.pdf So Who Reports to Whom? Administrative Code requires Health Care Providers to report STDs to the Local Health Agency. "Local health agency" means a county health department, a public health services district, a tribal health unit, or a U.S. Public Health Service Indian Health Service Unit. Administrative Code requires Local Health Agencies to report to the State STD Program. Reporting

8. What Do We Want? Providers report directly to their county health department Other local health agencies receiving reports forward or copy and forward the report to the county health department County health departments report to the STD Program and also to other local health agencies (i.e., tribal health units, IHS health units) Reporting

9. Updated Administrative Rules for STD Control Measures and STD Related Testing and Notification Control Measures for Communicable Diseases and Infestations (R9-6-313, 314, 332, 375) STD Related Testing and Notification (R9-6-1102-1104) STD Case Follow-up

10. Review CDRs received from providers for completeness and accuracy Offer or arrange for treatment for each chlamydia or gonorrhea case that seeks treatment from the local health agency Inform case that they must notify all sexual contacts within 60 days of symptoms or diagnosis up to the date of treatment of the need for testing/treatment STD Case Follow-upChlamydia and Gonorrhea

11. Provide each case seeking treatment with health information including confidentiality of results, a description of the disease, treatment options, and risk reduction measures Offer or arrange treatment for each contact of a case who seeks treatment from the local agency (consider EPT) Provide contact with same health information as provided to a case STD Case Follow-upChlamydia and Gonorrhea(cont’d)

12. State STD Program requires chancroid, LGV, and syphilis case management activities be conducted only by individuals who have completed CDC Employment Development Guide module training and attended CDC Introduction to STD Intervention or Fundamentals of STD Intervention course State STD Program has assigned Program staff to assist counties with syphilis, LGV and chancroid investigations STD Case Follow-upSyphilis, LGV andChancroid Investigations

13. Notify State STD Program immediately and follow instruction for collection and shipment of swab and serum specimens to State/CDC Conduct an epidemiologic investigation of each reported or suspect LGV case and submit a detailed written report Enhanced Interview Record CDC Lymphogranuloma Venereum (LGV) Suspected Case-Patient Information (ver.12.0, revised 5/4/2005) – Must be submitted to State/CDC along with specimens collected STD Case Follow-upLymphogranuloma Venereum (LGV)

14. Offer or arrange for treatment for each LGV case that seeks treatment from the local health agency Inform LGV case that they must notify all sexual contacts within 60 days preceding treatment Provide each LGV case seeking treatment with health information including confidentiality of results, a description of the disease, treatment options, and risk reduction measures STD Case Follow-upLGV(cont’d)

15. Notify each contact to a LGV case of exposure to the disease and of the need for testing/ treatment Offer or arrange treatment for each contact of a LGV case who seeks treatment from the local agency Provide contact with same health information as provided to a case STD Case Follow-upLGV(cont’d)

16. Conduct an epidemiologic investigation of each reported or suspect syphilis case and submit a detailed written report (R9-6-206(D)) Enhanced Interview Record Congenital Syphilis Case Investigation and Report (CDC 73.126) Offer or arrange for treatment for each syphilis case that seeks treatment from the local health agency Inform syphilis case that they must notify all sexual contacts within the appropriate time frame preceding treatment based on the stage of disease as follows: STD Case Follow-upSyphilis

17. Syphilis Interview Periods for Contacts Primary Syphilis 4 months and 1 week prior to date of treatment Secondary Syphilis 8 months prior to date of treatment Early Latent Syphilis 1 year preceding date of treatment Latent Syphilis of Unknown Duration 1 year prior to date of treatment Late Latent Syphilis 1 year prior to date of treatment STD Case Follow-upSyphilis(cont’d)

18. Syphilis Disease Stages Primary Chancre or other appropriate symptom(s) of primary syphilis present at time of first examination Secondary Rash or other symptom(s) appropriate for secondary syphilis present at time of first examination AND a titer ≥ 1:4 Early Latent History of primary or secondary syphilis symptoms in the preceding 12 months OR negative syphilis serology in the preceding 12 months OR 4-fold increase in titer in the preceding 12 months OR epidemiologic link to an independently confirmed early syphilis case STD Case Follow-upSyphilis(cont’d)

19. Syphilis Disease Stages(cont’d) Latent Syphilis of Unknown Duration Case does not meet early latent criteria AND patient is 35 or younger AND titer is 1:32 or higher Late Latent Syphilis Latent syphilis in a patient with no evidence of having acquired the disease within the preceding 12 months AND whose age and titer do not meet criteria for latent syphilis of unknown duration Note:All diagnoses of syphilis must be associated with a reactive treponemal test (FTA or TP-PA) OR positive darkfield exam. STD Case Follow-upSyphilis(cont’d)

20. Provide each syphilis case seeking treatment with health information including confidentiality of results, a description of the disease, treatment options, and risk reduction measures Notify each contact to a syphilis case of exposure to the disease and of the need for testing/ treatment Offer or arrange treatment for each contact of a syphilis case who seeks treatment from the local agency Provide contact with same health information as provided to a case STD Case Follow-upSyphilis(cont’d)

21. Conduct an epidemiologic investigation of each reported or suspect chancroid case and submit a detailed written report (R9-6-206(D) Enhanced Interview Record Offer or arrange for treatment for chancroid case that seeks treatment from the local health agency Inform case that they must notify all sexual contacts within 10 days of symptom onset of the need for testing/treatment STD Case Follow-upChancroid

22. Provide each case seeking treatment with health information including confidentiality of results, a description of the disease, treatment options, and risk reduction measures Notify each contact to a chancroid case of exposure to the disease and of the need for testing/ treatment Offer or arrange treatment for each contact of a case who seeks treatment from the local agency Provide contact with same health information as provided to a case STD Case Follow-upChancroid(cont’d)

23. STD Case Follow-upSTD Case Management Forms • New 6-page CDC Enhanced Interview Record • Effective January 1, 2008, required report form for syphilis and chancroid cases • Forms, instructions, and PowerPoint training program available from theSTD Program

24. STD Case Follow-upSTD Case Management Forms (cont’d) • CDC Field Record (CDC 73.2936 • Used to conduct positive laboratory report and contact investigations • required form for syphilis, chancroid and outbreak investigations • Forms and instructions available from theSTD Program

25. STD Case Follow-upSTD Case Management Forms (cont’d) • CDC Visual Case Analysis (VCA) form • Required form for syphilis, chancroid and outbreak investigations • At-a-glance tool for determining exposure gaps and performing source spread analysis

26. STD Case Follow-upSTD Case Management Forms (cont’d) • CDC Congenital Syphilis Case Investigation and Report form (CDC 73.126) • Used to evaluate congenital syphilis status • Required Report form for State STD Program and CDC • Forms and instructions available from theSTD Program

27. STD Case Follow-upSTD Case Management Forms (cont’d) • CDC LGV Case-Patient Information form (5 page) • Required form for reporting confirmed or suspected LGV to State/CDC • Form must be submitted to State/CDC along with specimens

28. All STD case investigations with actionable locating information belonging to another jurisdiction, whether in-state or out-of-state, should be sent to State STD Program’s ICCR (Inter/Intra-state Communication Control Record) Desk for forwarding Positive laboratory reports STD contact investigations State ICCR Desk Contact Information: Phone: (602) 364-4654 FAX: (602) 364-2119 Inter-jurisdictional Case Transfers

29. Local health agencies are responsible to report any syphilis outbreak to the STD Program, conduct an epidemiologic investigation of the outbreak, and submit an outbreak investigation report to the STD Program [AAC R9-6-206 (F), R9-6-375 (C)] The STD Program has developed an STD Outbreak Response Plan that can be used/adapted by local health agencies Includes recommended outbreak threshold criteria Includes recommended response organization and activities The STD Program will provide outbreak assistance to local health agencies Outbreak Detection and Follow-up

30. California STD/HIV Prevention Training Center (CA PTC) On or off-site and online training available Clinical Behavioral Partner Services Several courses hosted by the State STD Program Contact Information: http://www.stdhivtraining.org STD Training Opportunities

31. Examples of Courses Offered Through CA PTC Introduction to STD Intervention (9 days) Fundamentals of STD Intervention (4 days) Training Operating for Safety around Field Encounters (2 days) Using Surveillance and Data for STD/HIV Programs (2 days) HIV Disclosure & Partner Services Training for PCRS (2 days) Bridging Theory and Practice: Applying Behavioral Theory to STD/HIV Prevention (2 days) Fundamentals of STDs in Clinical Practice (3 days) 28th Annual Reproductive Health Symposium (2 days) Comprehensive Risk Counseling and Services (3 days) STD Training Opportunities

32. CDC Resources CDC STD Program Tools http://www.cdc.gov/std/program Public Health Training Network http://www2.cdc.gov/phtn HIV/AIDS Training and Resources http://www.cdc.gov/hiv/conferences.htm Other Resources National Coalition of STD Directors http://www.ncsddc.org STD Prevention Online http://www.stdpreventiononline.org STD Training Opportunities

33. CDC Required Performance Measures beginning with 2005 grant cycle Medical and Lab Services (1 measure) Partner Services (6 measures) Surveillance and Data Management (3 Measures) Clinical Services (4 Measures) Syphilis Elimination - Enhanced Surveillance (1Measure) STD Program staff may call on County STD staff to request information necessary to respond to the CDC performance measures Performance Measures

34. Kerry M. Kenney Sr. Public Health Advisor Arizona STD Control Program 50 North 18th Avenue, Suite 140 Phoenix, Arizona 85007 Phone: (602) 364-2124 Fax: (602) 364-2119 E-Mail: kenneyk@azdhs.gov Contact Information