Implementing a Gonorrhea
and Chlamydia Screening
Program in Philadelphia Public
High Schools
Melinda Salmon
Philadelphia Department of Public Health
Why?
How?
Reported Cases of Chlamydia: Philadelphia, 1991-2003*
(*2003 data are provisional) 2000 – present:
New surveillance programs
1999 data
analysis:
shows high Citywide HS
Number of cases Adult screening &
re-infection prisons 5 HRC HS
20,000 rates in Nov 2001:
1997 & 1998: women Youth 2 HRC
Increasingly Study high
sensitive Center schools
(HS)
laboratory
1994:
technologies
16,000 Infertility
Prevention
Project (IPP)
12,000
8,000
*Chlamydia
reportable as of
October 1991
4,000
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Year
Chlamydia - Case Rates by Age
and Sex, 2003
Figure 6. Rate of Chlamydia per 100,000 Population by Age and Gender: Philadelphia, 2002.
Age Group
10.0 0-4 18.7
0.0 5-9 0.0
103.1 10-14 830.6 8251.8
2246.9 15-19
2307.2 20-24 5319.5
1103.1 25-29 2168.0
594.0 30-34 899.4
331.5 35-39 446.1
223.5 40-44 203.2
107.0 45-54 72.1
34.3 55-64 12.9
7.5 65+ 6.0
634.7 Total 1324.3
6,000 4,000 2,000 0 0 2,000 4,000 6,000
Men Women
Rate per 100,000 Population
CY 2000
• Report Card 2000 issued – Phila. Coalition For
Kids
– STD’s given a failing grade
• School District Legal Opinion (8/21):
– No Screening in schools
• Safe and Sound Initiative addresses all Report
Card issues
– Various Organizations on Committee
– STD Program states key to control is school-
based screening
• School District Legal Opinion (12/19):
– Screening in school-based HRC’s OK
CY 2001
• Meetings with PDPH/FPC/School
District
• November: Screening initiated in 1st
Health Resource Center
• December: Screening initiated in 2nd
Health Resource Center
Health Resource Center STD Screening
(2 schools)
2001-2002
Male Tests Female Tests Total
Total # of tests 536 683 1219
Total positives (%) 28/536 110/683 138/1219
(5.2%) (16.1%) (11.3%)
Positive for CT only 26/536 87/663 (12.7%) 113/1219 (9.3%)
(4.9%)
Positive for GC only 0/536 (0.0%) 10/683 (1.5%) 10/1219 (0.8%)
Dual Infection Rate 2/536 (0.4%) 13/683 (1.9%) 15/1219 (1.2%)
CY 2002
• January: Commissioner’s Forum on
STD’s Held
• Adolescent STD’s described as
“EPIDEMIC”
• February: New Health Commissioner
Appointed:
• Mr. John Domzalski
• February-June: HRC data presented
to Commissioner and others
CY 2002 Cont’d.
• October: New CEO @ School District (Mr. Paul Vallas) &
PDPH Commissioner Meet
– Commissioner proposes screening in 10 schools;
Mr. Vallas counters with 44; Mr. Domzalski
accepts. (54,000 Students)
• November : Television and Newspaper Press Coverage
– Generally positive; issue of “no parental
consent” raised
• December: Meeting with All Principals
– Letter Given to Principals
– STD Program Presentation to Principals
– Parent Letter Developed w. Joint Signatures
CY 2003
• January 7th: Testing Begins
• Meetings with:
– Home & School Council Presidents
– Individual School Councils
• Scheduling of Individual High
Schools for Screening Days and
Treatment Clinics Ongoing
Philadelphia Department of Public Health
STD Control Program
2002-2003 High School Screening Program Summary Data
# Male Tests # Female Totals
Tests
# of students tested 10,198 9,515 19,713
Total positives (%) 256 (2.5%) 796 (8.4%) 1,052
(5.3%)
CT only positives (%) 240 (2.4%) 718 (7.5%) 958 (4.9%)
GC only positives (%) 9 (0.1%) 30 (0.3%) 39 (0.2%)
Dual infections (%) 7 (0.1%) 48 (0.5%) 55 (0.3%)
Number (%) treated 255/256 = 795/796 = 1050/1052 =
99.6% 99.9% 99.8%
How it all works…
Pre-meeting with the
School
• Usually involves the assistant principal,
nurse, roster chair
• Informational folder distributed
• Explanation by health department staff of
what occurs
Pre-meeting with the
School (cont’d)
• Communicate our needs to make screening
work:
– Commitment to see at least 300 students per day
in classes of approximately 60
– A presentation room in proximity to rest rooms
– Space to process specimens Tentative dates for
screening set, as well as dates for the delivery of
supplies, brochures, etc.
• Explanation of our need return to treat and
see additional students and identification of a
process and tentative date(s)
Screening Begins
• Presentation
• Bags
• Explanation of the process
– All students receive a bag
– All students complete the paperwork
– All students go the bathroom
– All bags must be returned
• Based upon the information in the
presentation, each student makes a
decision, on their own, whether or not
to be screened
During Screening
• Specimens processed in separate
room
– Sort out empty specimen cups from
those with urine
– If time permits, aliquot specimens and
create lab slips
– Deal with other issues as they arise
At the close of the day
• Return to the Health Department
with specimens
– Any remaining specimens are aliquoted
and/or lab slips created
– Specimens are submitted to the lab
– Information form with a copy of lab slip
attached are submitted for data entry
In the days following
• Data entry of information slips with
“pending” results indicated
• As lab results are received, pending
results changed to positive or negative
• Test results given to students by
telephone
Treatment
• List of students to be seen submitted
to nurse 1 day prior to the arrival of
medical staff
• Students issued call slips or called
from class
• Oral medications administered
• Counseling, instructions for follow-up
exams and partner referral cards given
Treatment
• For students not treated at school,
we continue to work through school
nurse to refer for treatment
• Use the “best way to contact”
information
In summary….
• Process takes a solid commitment
from many, including:
– School personnel
– Health Department screening staff
– All other staff for data entry
– Staff giving results
– Clinical staff to give treatment
– Laboratory staff to process tests
– Administrative staff
• But, most importantly…it takes
the political will of those who
have the power to make it
happen