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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!!!!!!! • • • • Screening Staff High School Staff and Administrators Support Staff Martin Goldberg, Melinda Salmon, Caroline Johnson • Vic Spain, Mindy Perilla, Christa Seidman