Implementing a Gonorrhea Implementing a Gonorrhea and Chlamydia Screening and Chlamydia Screening Program in Philadelphia Program in Philadelphia Public High SchoolsPublic High Schools

Implementing a Gonorrhea Implementing a Gonorrhea and Chlamydia Screening and Chlamydia Screening Program in Philadelphia Program in Philadelphia Public High SchoolsPublic High Schools

Melinda SalmonMelinda Salmon

Philadelphia Department of Public Philadelphia Department of Public HealthHealth

Why?

How?

Reported Cases of Chlamydia: Philadelphia, 1991-2003*(*2003 data are provisional)

0

4,000

8,000

12,000

16,000

20,000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Year

Number of cases

*Chlamydia reportable as of October 1991

1994: Infertility

Prevention Project (IPP)

1999 data analysis:

shows high re-infection

rates in women1997 & 1998:

Increasingly sensitive laboratory

technologies

Youth Study Center

Adult prisons

Citywide HS screening &

5 HRC HS

2000 – present: New surveillance programs

Nov 2001: 2 HRC high

schools (HS)

Chlamydia - Case Rates by Age and Sex, 2003

Age Group

Figure 6. Rate of Chlamydia per 100,000 Population by Age and Gender: Philadelphia, 2002.

34.3

107.0

223.5

331.5

594.0

1103.1

2307.2

2246.9

10.0

7.5

103.1

0.0

634.7

02,0004,0006,000

Rate per 100,000 Population

1324.3

72.1

203.2

446.1

899.4

2168.0

5319.5

830.6

18.7

0.0

12.9

6.0

8251.8

0 2,000 4,000 6,000

Total

65+

55-64

45-54

40-44

35-39

30-34

25-29

20-24

15-19

10-14

5-9

0-4

Men Women

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 (5.2%)

110/683 (16.1%)

138/1219 (11.3%)

Positive for CT only

26/536 (4.9%)

87/663 (12.7%)

113/1219 (9.3%)

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 HealthSTD Control Program

2002-2003 High School Screening Program Summary Data

# Male Tests # Female Tests

Totals

# 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 = 99.6%

795/796 = 99.9%

1050/1052 = 99.8%

How it all works…How it all works…How it all works…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