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Implementing Gonorrhea and Chlamydia Screening Program in

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									Chlamydia and Gonorrhea
  Screening Program in
Philadelphia’s Public High
        Schools
   Philadelphia Department of Public
                 Health
    Background
   Chlamydia remains an epidemic
    among adolescents
   40-85% of infections are
    asymptomatic
   Complications of chlamydia include:
       Pelvic Inflammatory Disease (PID)
       Increased risk of ectopic pregnancy
       Chronic pelvic pain
       Infertility (males and females)
       Preterm delivery
       Conjunctivitis/a febrile pneumonia
        in newborns
    Background Cont’d.

   Gonorrhea continues to
    disproportionately affect
    adolescents

   Complications are similar to those
    for chlamydia.
How it all works…
Pre-meeting with the School

   Contact with principal (or designee):
    overview of program, logistics
   Communicate our needs to make
    screening work:
       300 students per day in classes of
        approximately 60
       A presentation room near the restrooms
       Space to process specimens
       Dates for screening set, as well as dates
        for the delivery of supplies, brochures, etc.
Pre-meeting with the School
   Need to return to treat positives
    and counsel additional students
     Confidentiality process developed
     Space needed to treat, educate,
      counsel and refer to HIV testing
      and local provider specializing in
      adolescent care
     Education includes partner
      notification, counseling and testing,
      and treatment
     Literature and condoms dispensed
            Process Overview
   STD / HIV presentation and student education,
    includes showing of new DOH DVD
   Presentation also includes information from
    school’s Health Resource Center (HRC):
    hours of operation, services, referrals
   Explanation of the process
      All students receive a bag
      All students complete the paperwork
      All students go to the restroom
      All bags must be returned
   Based upon the information in the
    presentation, each student makes a decision,
    on their own, whether or not to submit a
    specimen
   Lab testing is performed off-site to detect
    infection with chlamydia and gonorrhea
Results
        Number of Students Reached by Philadelphia’s
       High School STD Screening Program 2002-2007
 # of students      Year 1        Year 2       Year 3       Year 4       Year 5       Year 6
                  (2002-03)     (2003-04)    (2004-05)    (2005-06)    (2006-07)    (2007-08)
Attending                       ~30,000      ~30,000      ~30,000      ~30,000      ~30,000
Presentation      ~30,000
Screened           19,713        17,019       16,378       15,919       15,821       15,090

Total Positive   1,052 (5.3)    813 (4.8)    680 (4.2)    764 (4.8)    777 (4.9)    807 (5.3)
(%)
+ Chlamydia       958 (4.9)     727 (4.3)    605 (3.7)    682 (4.3)    729 (4.6)    721 (4.8)


+ GC               39 (0.2)      45 (0.3)     38 (0.2)     39 (0.2)     34 (0.2)     36 (0.2)


+Both              55 (0.3)      41 (0.2)     37 (0.2)     43 (0.3)     14 (0.1)     50 (0.3)


Treated (%)      1,051 (99.9)   807 (99.3)   676 (99.4)   755 (99.0)   758 (97.4)   772 (96.2)
    Impact Summary 2002-2008
   Educated >30,000 students each school year
   Performed 99,940 tests for GC/CT
       Identified 4,893 students with infection
       Treated 98.5% (4,819)

   Identified and treated 792 contacts to these
    students including:
       312 infected brought to treatment
       111 previously treated
       369 preventively treated

   Prevented an estimated 1,273 cases of Pelvic
    Inflammatory Disease (3,537x0.36).
       Averted costs estimated to be up to $4,064,330

   Chlamydia case rate among adolescent females
    has decreased 10% from 10,256 to 9,363 per
    100,000.
HIV Counseling & Testing
   Those infected with an STI or
    partner of infected are referred
    to HIV C/T and other STI
    screening
     Health Clinics
     Other Community based testing
      sites
     Private Physicians
     Partner notification and treatment
      also available
    STI Re-screening

   CDC recommends retesting
    positives 3 months after initial
    infection

   Of those tested again:
    13% re-infection rate
                         Rescreening Activities

# of Students              2003-04     2004-05     2005-06     2006-07     2007-08

# Students Eligible          411         417         457         534         459

# (%) Rescreened             199         189         198       66 (12.4)    149
                            (48.4)      (45.3)      (43.3)                 (32.5)
# (%) Reinfected           30 (15.1)   21 (11.1)   26 (13.1)   10 (15.1)   14 (9.4)

  Males Reinfected (%)       9/55        5/46        5/48        1/25       1/31
                            (16.3)      (10.9)      (10.4)       (4.0)      (3.2)
  Females Reinfected (%)    21/144      16/143      21/150       9/41      13/ 118
                            (14.6)      (11.2)      (14.0)      (22.0)      (11.0)
# Treated (%)                 30          19          23          9          14
                            (100.0)     (90.4)      (88.5)      (90.9)     (100.0)
Long Term Goal
Goal:

   Reduce number of HIV/ STI
    infections, unintended
    pregnancies, and other risky
    health behaviors that lead to
    disease and injury among
    school age youth
    Program Enhancements

   Partner assistance
   Active rescreening participation
    incentives introduced
   Condoms available at treatment
   Charter schools added
   Screening also conducted in
     several Health Resource Centers,
    including pregnancy testing
                   Reported Cases of Chlamydia: Philadelphia 1992-2007

                  20,000
                                                                                                                      17,747
                  18,000                                                                                                                         17,199 17,029
                                                                                                                               16,723

                  16,000                                                                                     15,234                     15,577


                  14,000                                                                     13,593 13,586
                                                                                    12,660
Number of Cases




                                                                           11,763
                  12,000
                                                                  10,480
                                   10,053 9,956
                  10,000
                           8,716
                                                  8,079   8,118
                   8,000

                   6,000

                   4,000

                   2,000

                      0
                           1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

                                                                                      Year
                   Reported Cases of Gonorrhea: Philadelphia, 1990-2007

                  21,000
                           19,554


                  18,000

                                    15,429
                  15,000
Number of Cases




                                             11,914
                  12,000
                                                      10,580


                   9,000                                       8,026                                       8,170 8,061
                                                                                                   7,776
                                                                                           7,271                         7,277
                                                                       6,565 6,415 6,504
                                                                                                                                 5,731
                   6,000                                                                                                                 5,206 5,053 5,218 5,246



                   3,000


                      0
                           1990              1992              1994         1996           1998            2000          2002            2004       2006

                                                                                            Year
    Program Recognition
   Recognized by CDC in their annual
    “State of CDC” report, 2004.
   Achievement Award presented by the
    City’s Managing Director for service to
    Philadelphia’s youth, 2004.
   Recognized by National Association of
    City and County Health Officers as a
    Model Program, 2005.
   Received grant from National
    Association of County & City Health
    Officials (NACCHO) to enhance program
    to promote additional STD screenings
    and behavioral interventions, 2008.
    Program Recognition
   HD staff spoke about the program at
    the Healthy States Program for State
    Legislators in Boston, 2006.
   Emulated by the New York City Health
    Department and School System (30
    schools in 2006-2007).
   Contacted by New Jersey DOE who
    are developing screening program
   3 Articles published in the STD
    Journal.

								
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