Download Philadelphia High School STD Screening Program

Philadelphia High School STD
Screening Program
Declining Disease Prevalence
After 4 Years of Screening
Lenore Asbel, Melinda Salmon,
C. Victor Spain, Christa Seidman,
Mindy J Perilla, Martin Goldberg
Background
• Adolescents disproportionately affected
• 2003 – Philadelphia 15-19 year olds
– 43% of CT infections and 31% of GC
infections
– Chlamydia rate: 6,705 /100,000
• Rate among females 10,256 /100,000
– Gonorrhea rate: 1,597 /100,000
• Increased screening throughout the city had
begun
Reported Cases of Chlamydia:
Philadelphia, 1991-2003
2000 – present:
New surveillance programs
Number of cases
20,000
1994:
Infertility
Prevention
Project (IPP)
16,000
1999 data
analysis:
shows high
re-infection
rates in
1997 & 1998: women
Increasingly
sensitive
laboratory
technologies
DHCC’s
July ‘01
Nov 2001:
2 HRC
Youth
high
Study
Center schools
(HS)
Citywide HS
Adult screening &
prisons 5 HRC HS
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
High School Screening Pilot Project
during the 2001-2002 school year.
Health Resource Center STD Screening
(2 schools)
Male Tests
Female Tests
Total
Total # of tests
536
683
1219
Total positives
(%)
28 (5.2%)
110 (16.1%)
138 (11.3%)
Positive for CT
only (%)
26 (4.9%)
87 (12.7%)
113 (9.3%)
Positive for GC
only (%)
0 (0.0%)
10 (1.5%)
10 (0.8%)
Dual Infection (%)
2 (0.4%)
13 (1.9%)
15 (1.2%)
How it all works
•
•
•
•
•
Parents notified by school district
Meet with schools to set up screening
Educational presentation
The process
Each student makes a decision, on their
own, whether or not to submit a
specimen
Numbers of Students Reached by Philadelphia’s
STD High School Screening Program
# of Persons
Year 1
(2002-03)
Year 2
(2003-04)
Year 3
(2004-05)
Attending
Presentation
~30,000
~30,000
~30,000
Screened
19,713
17,019
16,378
Positive persons
1,052 (5.3)
813 (4.8)
680 (4.2)
{55 co-infected}
{41 co-infected}
{37 co-infected}
1013 (5.1)
94 (0.5)
768(4.5)
96 (0.6)
642 (3.9)
75 (0.4)
1,051 (99.9)
807 (99.3)
676 (99.4)
Chlamydia +
GC +
Treated (%)
Percent Positive for GC/CT combined
by Sex and Year
Percent Testing Positive
10%
8%
6%
Year 1
Year 2
Year 3
4%
2%
0%
MALES
FEMALES
TOTAL
Percent Positive for GC/CT combined by
School Type and Year
12%
10%
8%
Year 1
6%
Year 2
4%
Year 3
2%
Othe
r
h
Vo-T
ec
Ne ig
hbo r
hoo d
Mag
net
Alter
nativ
e
0%
Percent Positive for GC/CT combined
within age-group by year
7%
6%
5%
Year 1
Year 2
Year 3
4%
3%
2%
1%
0%
12-14 years
15-17 years
18-20 years
Over the first three years…
 CT positivity rate among participating high
school students
 declined from 5.1% in 2002-2003 to 3.9% in 20042005
 GC positivity rate remained fairly stable
 0.5% to 0.4%
 Overall GC/CT infection
 24% decline in positivity rate
 35% decline in the number of positive cases
Preliminary Year 4 Data
• GC/CT infection rates seem to have
increased slightly from Year 3 – though
remain less than Year 1
• Total positivity in Year 4: 4.7%
– Female positivity: 7.2%
– Male positivity: 2.4%
• Overall testing rates have decreased
Reported Cases of Chlamydia: Philadelphia, 1992 - 2005
20,000
17,747
18,000
16,723
Number of Cases
16,000
14,000
13,593
13,586
2000
2001
12,660
11,763
12,000
10,000
15,577
15,234
10,053
10,480
9,956
8,716
8,079
8,118
1995
1996
8,000
6,000
4,000
2,000
0
1992
1993
1994
1997
1998
Year
1999
2002
2003
2004
2005
Rates of Chlamydia per 100,000 Population, by Age:
Philadelphia, 1995 – 2005
7,000
0 - 4 yrs
Rate per 100,000 population
6,000
5 - 9 yrs
10-14 yrs
5,000
15-19 yrs
20-24 yrs
4,000
25-29 yrs
30-34 yrs
3,000
35-39 yrs
40-44 yrs
2,000
45-54 yrs
55-64 yrs
1,000
65+ yrs
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Rates for 1995 to 1999 calculated with 1990 Census denominator. Rates for 2000 to present calculated with 2000 Census denominator.
Conclusions
• High school STD screening program
implemented successfully with few issues
• The broad-based screening program
implemented in Philadelphia public high
schools was successful in finding and
treating cases of CT and GC
Conclusions, continued…
• Continuing the program yearly has
contributed to the declining rates of infection
among students.
– Preliminary decreases in testing rates and
increases in positivity in Year 4 require further
evaluation.
• High School screening may also have
contributed to a citywide decline in chlamydia
infection rates.
– Broad-based screening in a variety of venues
important
Many Thanks!!!!!!!
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Screening Staff
High School Staff and Administrators
Support Staff
Martin Goldberg, Melinda Salmon,
Caroline Johnson
• Vic Spain, Mindy Perilla, Christa Seidman