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