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Epidemiology of Syphilis on Gila River Indian Community

Epidemiology of Syphilis on Gila River Indian Community. Cheryl (McDermott) Shuy RN, BSN Public Health Nurse Epidemiology Gila River Health Resource Department. Gila River STD Statistics. *Information gathered by Cheryl McDermott, PHN Epidemiology.

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Epidemiology of Syphilis on Gila River Indian Community

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  1. Epidemiology of Syphilis on Gila River Indian Community Cheryl (McDermott) Shuy RN, BSN Public Health Nurse Epidemiology Gila River Health Resource Department

  2. Gila River STD Statistics *Information gathered by Cheryl McDermott, PHN Epidemiology

  3. *Information gathered by Cheryl McDermott, PHN Epidemiology

  4. Gila River STD Statistics * (denotes complete stats unavailable) *Information gathered by Cheryl McDermott, PHN Epidemiology

  5. *Information gathered by Cheryl McDermott, PHN Epidemiology

  6. Case Counts on GRIC • Increases in sexual behavior 15-29 year olds • Increase in drug and alcohol among 15-29 year olds • Limited resources for testing and treatment • Social stigmas for getting tested • Patients are afraid of what will be reported in their charts • Many patients have reported that they fear going to the Mobile Unit • Fear of someone “finding out” (CONFIDENTIALITY) • Better testing technology

  7. Further Epidemiology of Cases • ~75% with reported drug use • 4 Congenital Syphilis cases, 2 congenital syphilis cases have occurred during the outbreak period. • Prenatal testing has resulted in the diagnosis of 26% of female cases. • Exists in every district, majority of cases from D5, D6 • Tribal member cases have been linked to non-tribal member cases living on GRIC and in other areas of the state

  8. Concerns • No evidence that the 2007 outbreak is over • Decrease in cases doesn’t indicate the outbreak is ‘slowing down’, most likely reflect the limited screening opportunities available • Many undiagnosed cases of syphilis in the community • ‘Tip of the Iceberg’ • Congenital syphilis • Symptomatic cases not being correctly diagnosed • Limited provider awareness activities • Limited community awareness activities • Confidentiality/stigmatization barriers • Insufficient personnel to contact all the cases, clusters, and at risk individuals for screening and/or treatment to gain control of the outbreak.

  9. Recommendations for Screening • Increased comprehensive STD screening among ages 12-55 • Comprehensive STD as part of regular exams, including HIV • Triple testing of prenatal patients (1st prenatal, 26-30 weeks, at delivery) • Continuous community based screening events • Continuous screening at jails and detention centers • Increased provider education at all GRHCC facilities. -correctly diagnosing symptomatic cases -treatment given at time of presentation of symptoms -standing orders for treatment of confirmed cases and their contacts -treat contacts and clusters prophylactically • Increased door to door screening

  10. Additional Recommendations • Additional position to perform door to door screenings and conduct case investigations • PHN and HIV staff cross trainings in STD case investigations • Continuous confidentiality training to all personnel surrounding case investigations • Increased education in the community

  11. QUESTIONS???

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