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Infertility Prevention Project Region I June 1, 2009 Wells Beach, Maine

This presentation discusses the budget, strategic goals, and priority activities of the National Infertility Prevention Project, with a focus on gonorrhea prevention. It also highlights the CDC's efforts in infrastructure, performance measures, and funding allocations.

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Infertility Prevention Project Region I June 1, 2009 Wells Beach, Maine

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  1. Infertility Prevention ProjectRegion I June 1, 2009Wells Beach, Maine Steven J. Shapiro Infertility Prevention Project Coordinator CDC/NCHHSTP/DSTDP/PTB Disclaimer: The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.

  2. Topics National Infertility Prevention Project: • Budget and Funding • Division Strategic Goals • Priority Activities • Gonorrhea • Performance Measures • CSPS • Infrastructure • NCQA and HEDIS • GYT 09

  3. National IPP Funding Allocations 1998-2008 35 29 30 28.1 28.1 27.6 27.5 27.4 27.3 25 23.1 20 17.9 Millions 16.6 15 13.7 10 5 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year

  4. Strategic Goals • Division of STD Prevention Strategic Plan October 2008 • Prevent STD-related infertility • Screening and Treatment; Partner Services • Prevent adverse outcomes of pregnancy • Prevent STD-related cancers • Prevent STD-related HIV transmission and acquisition • Strengthen STD prevention capacity and infrastructure • Reduce STD health disparities • Address effects of social and economic determinants and costs of STDs and associated sequelae among specific populations

  5. Coordinate Regional Meetings Assure Equal Partnership Regional IPP Plan Conduct Site Visits Support National CT Prevention Activities Evaluate and Disseminate Data Data Quality Assurance Collaboration Special Projects Infrastructure Performance Measures Data Management Collection Quality Assurance Analysis Dissemination Attend Regional Coordinators Meetings Infrastructure Funding and ActivitiesCDC-OPA IAA

  6. Ensure CT and GC Screening and Treatment Support Lab Testing Ensure Collection and Reporting of all core CDC data elements Provide Program Management Ensure Provider Training Grant Development Use Data to plan programs Prevalence Monitoring Surveillance Performance Measures 50% Rule Male Screening Up to 15% of IPP funds Targeted GC Screening Up to 10% of IPP funds GC Burden Calculation Project Area Funding and ActivitiesCSPS IPP 09-902

  7. CSPS-IPP 2009 • Gonorrhea Burden Calculation • Portion of Total IPP funds to be used to target GC screening • Total GC women <26/Total CT GC women <26 • Up to 10% of funds available • Identify venues/providers • High morbidity with limited screening coverage • In geographic catchment areas with high morbidity • Shift resources to those areas

  8. GC Burden Calculation Example • Project Area X • Total IPP funds = $500,000 • Among women 25 and younger • 500 Gonorrhea and 10,000 Chlamydia • GC Burden = [500/(10000+500)]X100= 4.76% • IPP Funds to be used • $500,000 X 4.76% = $23,800 • @ $10/test = 2380 tests available for targeting

  9. WHY GONORRHEA?

  10. Gonorrhea rates, U.S., 1941-2007* *Preliminary 2007 data

  11. Gonorrhea — Rates by county, 2007 Note: The Healthy People 2010 target for gonorrhea is 19.0 cases per 100,000 population.

  12. Gonorrhea rates by age and sex, 2007 48% 15-24 years 69% 15-24 years

  13. Gonorrhea rates by race/ethnicity, 1981-2007* *Preliminary 2007 data

  14. STD Surveillance Network (SSuN) • Purpose: to improve national capacity to detect, monitor, and respond to emerging trends in STDs and related behaviors • Population-based enhanced gonorrhea surveillance • Sample of patients reported with gonorrhea in selected counties • Excludes patients who attend the primary STD clinic(s) • Analysis of data from Feb 2006 – June 2008

  15. STD Surveillance Network (SSuN) project areas (n=5) & participating counties and independent cities (n=11), 2006-2008 Washington King Co. Pierce Co. Snohomish Co. Minnesota Hennepin Co. New York City Virginia Chesterfield Co. Henrico Co. Richmond City San FranciscoSan Francisco Co. Colorado Adams Co. Arapaho Co. Denver Co. SSuN project areas Participating counties and independent cities

  16. SSuN Cycle 2: Participating project areas (n=12) and labs (n=6), 2009 – 2013 Washington . Connecticut* Chicago* Philadelphia* New York City Baltimore* San Francisco Colorado Virginia Los Angeles/CA* Alabama* Louisiana* SSuN Laboratory Sites ~ 100 counties ~ 40 STD clinics * New Sites

  17. Gonorrhea rates per 100,000 population in African American and white counties, U.S., 2005

  18. Percent of Neisseria gonorrhoeae isolates with resistance or intermediate resistance to ciprofloxacin, 1990–2005 Note: Resistant isolates have ciprofloxacin MICs ≥ 1 µg/ml. Isolates with intermediate resistance have ciprofloxacin MICs of 0.125 - 0.5 µg/ml. Susceptibility to ciprofloxacin was first measured in GISP in 1990.

  19. Resistance to Cephalosporins • Oral Cephalosporins (Cefixime et al) • 2% Treatment Failure • Increasing MICs since 2003 • Increasing number of GC strains with decreased susceptibility • Injectable Cephalosporins (Ceftriaxone) • No documented treatment failures to date • Increasing MICs since 2003 • Recommended treatment doses increasing

  20. Past and Future • Penicillins (larger and larger doses) • Tetracyclines • Spectinomycins • Fluoroquinolones • Oral Cephalosporins • Injectable Cephalosporins • Penems • New Drugs?

  21. Performance Measures • CSPS Project started 1999 • Pilot project 2001 • Set of 12 measures 2005 • Timeliness of Treatment CT and GC in FP clinics • STD Clinics added 2008 • GC Interviews modified 2009 • Infrastructure Performance Measures • Among clients attending family planning clinics, the number of women screened for chlamydia, stratified by age. • Screening coverage estimate among sexually active 15-19 year old women in FP clinics

  22. Performance Measure DataTimeliness of Treatment for CT (14 Days)Prevalence Monitoring Family Planning Sites

  23. Performance Measure DataTimeliness of Treatment for GC (14 Days)Prevalence Monitoring Family Planning Sites

  24. Performance Measure DataTimeliness of Treatment CT and GC (14 Days)STD Sites- 2007 and 2008

  25. Old Measure: Proportion of “priority” gonorrhea cases interviewed within 7, 14, and 30 days from date of specimen collection (2005-2008). Programs receiving SE funds were not required to submit data for this measure. New Measure: Proportion of all gonorrhea cases interviewed within 7, 14, and 30 days from date of specimen collection. HMA programs receiving SE funds are not required to submit data for this measure; non-HMAs receiving SE funds ARE required to submit data. Performance MeasuresGonorrhea Interviews

  26. Infrastructure Performance MeasuresEstimated Screening Coverage (%)Females 15-19 years old

  27. Figure. Percentage of sexually active female enrollees aged 16−25 years who were screened for chlamydia, by health plan type and year ─ Healthcare Effectiveness Data and Information Set (HEDIS), 2000−2007

  28. Infrastructure Performance MeasuresProportion of Tests Females 15-24 years of age (%)

  29. GYT ‘09 • 275,000 unique visitors to website • 4X visitors compared to previous campaigns • Planned Parenthood Affiliates • 24 out of 98 reported so far • STI testing increased 10%-103% over April 08 • Planned Parenthood Health Systems 103% • Planned Parenthood Rocky Mountains • 1418 CT GC tests in two days • Normally 78 tests per day • Final Reports due May 30 • Posted Summary Report by mid-July

  30. Questions?

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