STDs in STDs in Houston/Harris Houston/Harris County County - - PowerPoint PPT Presentation

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STDs in STDs in Houston/Harris Houston/Harris County County

Trends Trends Interventions Interventions Emerging Issues Emerging Issues

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Reportable STDs Reportable STDs

Chlamydia Chancroid Gonorrhea HIV/AIDS Syphilis Chlamydia Chlamydia Chancroid Chancroid Gonorrhea Gonorrhea HIV/AIDS HIV/AIDS Syphilis Syphilis

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Why are STDs Important? Why are STDs Important?

Facilitate Transmission of HIV Infection Facilitate Transmission of HIV Infection Cause Infertility Cause Infertility Cause PID Cause PID Adverse Outcomes on Pregnancy Adverse Outcomes on Pregnancy 17 Billion Dollar Cost Annually in USA 17 Billion Dollar Cost Annually in USA

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Emerging Issues Emerging Issues

Syphilis Outbreaks Syphilis Outbreaks HIV Co HIV Co-

• Infection

Infection Resurgence in Risky Behavior Resurgence in Risky Behavior Partner Services Innovation Partner Services Innovation Internet and STDs Internet and STDs Hepatitis Hepatitis

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How Are We Doing in How Are We Doing in

Houston? Houston?

In 2002, Houston Ranked: In 2002, Houston Ranked: 48th 48th-

• Chlamydia (346.1/100,000)

Chlamydia (346.1/100,000) 45th 45th-

• Gonorrhea (153.9/100,000)

Gonorrhea (153.9/100,000) 31st 31st-

• P&S Syphilis (3.3/100,000)

P&S Syphilis (3.3/100,000)

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Chlamydia Chlamydia

EPIDEMIOLOGY EPIDEMIOLOGY

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Chlamydia: Crude Rate

8018 9092 10635 11499 10443 12144 11304 11793

2000 4000 6000 8000 10000 12000 14000 1995 1996 1997 1998 1999 2000 2001 2002

Cases

50 100 150 200 250 300 350 400

Rate Per 100,000 No. Rate

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Chlamydia: U.S. to Houston

50 100 150 200 250 300 350 400 1995 1996 1997 1998 1999 2000 2001

Rate per 100,000 US Houston

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Chlamydia: Gender-Specific Rates

2000 4000 6000 8000 10000 12000 1995 1996 1997 1998 1999 2000 2001 2002

Number of Cases

0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0

Rate per 100,000 Female No. Male No. Male Rate Female Rate

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Chlamydia: Average (1995-2001) Rates by Age

500 1000 1500 2000 2500 3000 3500 15-19 20-24 25-29 30-34 35-39 40-44 >44

Rate per 100,000

Male Female

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Chlamydia: Percent of Cases Identified

200 400 600 800 1000 1200 1400 1600 1800

City STD City Family Planning/Maternity Teen Clinics District Clinics County Clinics/County Family Planning Jail

Cases

2001 2002

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Gonorrhea Gonorrhea

EPIDEMIOLOGY EPIDEMIOLOGY

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Gonorrhea: Crude Rate

7191 6046 6633 7164 5905 6033 5501 5243 1000 2000 3000 4000 5000 6000 7000 8000 1995 1996 1997 1998 1999 2000 2001 2002 Cases 0.0 50.0 100.0 150.0 200.0 250.0 Rate per 100,000

No. Rate

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Gonorrhea: U.S. to Houston

100 200 300 1995 1996 1997 1998 1999 2000 2001 Rate per 100,000

U.S Houston

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500 1000 1500 2000 2500 3000 3500 4000 4500 1995 1996 1997 1998 1999 2000 2001 2002

Number of Cases

0.0 50.0 100.0 150.0 200.0 250.0 300.0

Rate per 100,000 Male No. Female No. Male Rate Female Rate

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Gonorrhea: Average (1995-2001) Rates by Age Group

200 400 600 800 1000 1200 15-19 20-24 25-29 Rate per 100,000

Male Female

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Gonorrhea: Percent of Total Cases from Providers

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% City STD Clinics Private Clinics & HMOs All other Sites

2001 2002

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Syphilis Syphilis

EPIDEMIOLOGY EPIDEMIOLOGY

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Syphilis Syphilis Houston/Harris County Houston/Harris County

Syphilis: Crude Rate

500 1000 1500 2000 2500 3000 1995 1996 1997 1998 1999 2000 2001 2002

Cases

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 Rate per 100,000 No. Rate

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Syphilis Syphilis Houston/Harris County Houston/Harris County vs vs U.S. U.S.

Syphilis: U.S. to Houston

10 20 30 40 50 60 70 80 90 1995 1996 1997 1998 1999 2000 2001 Rate per 100,000 U.S Houston

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Syphilis: Primary and Secondary Syphilis: Primary and Secondary Houston/Harris County Houston/Harris County

Syphilis: Primary and Secondary Houston/Harris County 1995-2002

50 100 150 200 250 300 350 400 450 1995 1996 1997 1998 1999 2000 2001 2002

Number of Cases

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HDHHS HDHHS STD Interventions STD Interventions

Screening Screening Treatment Treatment Education Education Counseling Counseling Partner Services Partner Services

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Screening Screening

Syphilis, gonorrhea, Syphilis, gonorrhea, chlamydia chlamydia, , hep hep C,HIV testing in 3 STD clinics C,HIV testing in 3 STD clinics Family Planning (no Family Planning (no hep hep C) C) Prenatal (no Prenatal (no hep hep C) C) Outreach Contractors (no gc) Outreach Contractors (no gc)

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Screening Screening

Mobile Unit Outreach testing Mobile Unit Outreach testing Collaboration with Collaboration with CBOs CBOs in outreach in outreach Bookstores, Bath houses, streets, bars Bookstores, Bath houses, streets, bars Mobile clinic planned for 2003 Mobile clinic planned for 2003 Jail tanks Jail tanks Key HIV providers encouraged to test Key HIV providers encouraged to test Contracts with 7 Contracts with 7 CBOs CBOs to do screening to do screening

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Treatment Treatment

3 STD Clinics 3 STD Clinics Some treatment in Family Planning and Some treatment in Family Planning and Maternity Clinics except for syphilis Maternity Clinics except for syphilis Facilitate treatment with private Facilitate treatment with private providers providers -

• provide some meds

provide some meds Facilitate treatment with Harris Co. Jail Facilitate treatment with Harris Co. Jail

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Treatment Treatment

DOT for DOT for chlamydia chlamydia Recommend Recommend epi epi profile based preventive profile based preventive treatment around syphilis outbreak treatment around syphilis outbreak Encouraging stat RPR testing around Encouraging stat RPR testing around

• utbreak
• utbreak

Hope to provide on site treatment on Hope to provide on site treatment on mobile clinic in 2003 mobile clinic in 2003

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Vaccine Vaccine

Hepatitis B vaccine in STD clinics Hepatitis B vaccine in STD clinics Plans for Plans for Hep Hep A vaccine in STD clinics A vaccine in STD clinics

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Education Education

9 Health Educators trained in STDs 9 Health Educators trained in STDs CDBG health ed in K CDBG health ed in K-

• 12; and in K

12; and in K-

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12 HIV/STD HIV/STD Infoline Infoline Contracts with 23 Contracts with 23 CBOs CBOs for education for education Work with CPG to emphasize STDs Work with CPG to emphasize STDs Provider alerts, media alerts, provider training Provider alerts, media alerts, provider training Expanding education to web sites, chat rooms Expanding education to web sites, chat rooms

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Counseling Counseling

Clinicians Clinicians DIS DIS Contractors Contractors

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Partner Services Partner Services

DIS provide partner referrals and DIS provide partner referrals and notification for syphilis and HIV notification for syphilis and HIV Some Some chlamydia chlamydia and gonorrhea and gonorrhea Clustering and social network outreach Clustering and social network outreach Counseling and testing contractors Counseling and testing contractors

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Partner Services Partner Services

Pursuing web based self Pursuing web based self-

• interview

interview Self Self-

• referral through internet/email

referral through internet/email DIS Liaison with Key Providers DIS Liaison with Key Providers Working with Working with CBOs CBOs on training DIS and

• n training DIS and

DIS on training DIS on training CBOs CBOs to improve and to improve and promote partner notification promote partner notification