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Dine' Be Keyah. NAIHS 2008 Population Reservation Area: 237,030 Reservation plus Navajos living in major border towns: 298,197. . Southwest U.S. Four Corners Area 27,000 sq. mi./17.5 mil. acres. SCOPE OF SERVICES Social Hygiene Branch. To reduce STD transmission and prevent complicationsMonitor STD/HIV burdens and trendsIdentify the population with high risksMonitor and evaluate surveillance dataIncrease STD/HIV education and awarenessMISSION:The STD Program will facilita34244
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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
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)
6. Adult Syphilis Cases By Service Area Cumulative Total: 502 Jan. 2001-Aug, 2009
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 Syphilis Morbidity
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. Benefits of Collaboration {Working Method} 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”.
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