Infertility Prevention ProjectRegion V

June 9-10, 2010Indianapolis, Indiana

Steven J. ShapiroInfertility Prevention Project Coordinator

CDC/NCHHSTP/DSTDP/PTB

Disclaimer: The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Topics

National Infertility Prevention Project:

Budget and FundingDivision UpdatesPSCIHealth Care ReformNational Chlamydia CoalitionGonorrhea Performance Measures

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16.617.9

23.1

27.4 27.5 27.329

28.1 28.1 27.6 27.6

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5

10

15

20

25

30

35

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Year

Mill

ion

s (D

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rs)

National IPP Funding Allocations 1998-2009

Funding Applications

CSPS 2011» Guidance under development» IPP

Progress on 3% CT Positivity Targeted GC Burden Calculation and plans Progress on general objectives Progress on GC meeting action items

IPP-OPA IAA 2010-2011» IPP Regional Infrastructure Objectives

Pregnancy-test Only AI/AN Health Care Delivery Systems

DSTDP Update

Leadership Changes» Office of the Director (Douglas)

Policy Office (Pulver)» Epidemiology and Surveillance (Berman)

Summer Consultations» Sexual Health (4/28-4/29)» Tuskegee CoAg Blue Ribbon Panel» EPT (5/13)» STD Prevention Training» STD Prevention and Health Care Reform» STD Prevention Core Priorities

DSTDP Update (2)

STD Treatment Guidelines» Recommended treatment for uncomplicated GC will be

increased to 250 mg Ceftriaxone.» Cefixime 400 mg will remain as a recommended therapy» Combination therapy for GC NAAT + and CT NAAT -

STD Laboratory Guidelines» CT GC and syphilis» Re-testing/Supplemental Testing

GYT» 190K Unique visitors; average time 3 minutes» Just under 40K Toolkit Downloads

PCSI

Funding Opportunity Announcement» Grants.gov CDC-PS10-10175» “To plan, scale-up, and support the implementation of a

syndemic approach to the prevention of HIV/AIDS, viral hepatitis, STD and TB through PCSI activities as described……”Enhancing the Prevention and Control of HIV/AIDS, viral hepatitis, STD and TB in the United States”

Eligibility (2007 Surveillance Data)» 630 AIDS Cases» 225 TB Cases» 900 Syphilis (all stages) Cases» 6760 Gonorrhea Cases» 82 HBV Cases

Webinar May 10th

Health Care Reform

What does this mean for CDC, in general, and STD Prevention specifically?

Patient Protection and Affordable Care Act

Mandatory Programs– Prevention and Public Health Fund

» Up to 2 Billion dollars annually by 2015» Can be spent on any prevention, wellness or public health

activities authorized in the Public Health Services Act. Section 318 of the PHSA authorizes STD prevention (CSPS); section 318A authorizes IPP.

– National Prevention, Health Promotion, and Public Health Council» Advisory in Nature- must create a National Prevention and

Health Promotion Strategy

PPACA : New Prevention Programs

CDC – Community Transformation– Epidemiology and

Laboratory Capacity – Healthy Aging Living Well – Prevention Research– Improvement of vaccine

delivery systems– Office of Women’s Health

HHS– State access to purchase

vaccine at federally negotiated prices

– Menu labeling (FDA)– Individual Wellness Plan

evaluation at FQHCs– Grants to support School-

based Health Centers– Evidence based teen

pregnancy prevention– Evidence based Abstinence-

only programs

PPACA: Other Provisions Insurance (private)

» Required to provide recommended clinical preventive benefits, including vaccinations without cost-sharing

Medicaid and Medicare» Medicare preventative services and USPSTF recommended services

(“A” level, maybe “B”) become no cost-sharing; coverage and cost sharing for vaccines unchanged

» Tobacco cessation pharmaceuticals and expanded cessation services for pregnant woman are covered

» Hospitals required to report rates of healthcare-associated infections (MRSA, VRE, etc)

Public Health Workforce» Loan repayment program, expand fellowship programs (EIS)

Monitoring Key National Health Indicators» Standardizes data collection related to health disparities

National Chlamydia Coalition

Annual Meeting» December 3-4, 2009 DC» Social Marketing» Sub-Committee Meetings

Research Subcommittee What can you do?

– Chlamydia Screening Priority in Health Care Delivery Systems» Outreach to State Adolescent Health Coordinator» Child Health Indicators for Medicaid and CHIP» EMR Incentives for Medicaid and Medicare

National Chlamydia CoalitionMini Grants: To fund innovative strategies to increase CT screening and

follow-up care including partner treatment

College Health Program» Old Dominion (VA)

Sports Health Screenings» Uplift School (IL)

Academic Detailing» Private Providers (IL)

CT screening» Medicaid Managed Care

(MI) Awareness and Screening

» PP Greater Washington and North Idaho

CT Model Protocol» AI/AN (Regions VIII & X)

JDC Screenings» Baltimore JDC (MD)

Targeted use of GIS» Adagio Health (PA)

Provider Outreach» NYS providers (Region II)

Plan Development » Coalition Building (MN)

DRIP, DRIP, DRIP

Gonorrhea

“Incurable gonorrhea may be next superbug”» MSNBC 4-8-2010

“Emergence of Antibiotic-resistant gonorrhea”» Time (blog) 3-31-2010

“Gonorrhea mutating into superbug especially in SEAsia”

» Pattaya Daily News 4-1-2010

“Sex Infection gonorrhea becoming drug-resistant”» BBC News 3-29-2010

Gonorrhea

AR GC Laboratory Activities» GISP» Enhanced surveillance in the Far East with WHO

Documented Clinical Cases of resistance to oral cephalosporins WHO-WPRO Consultations (Manila in April; Bali in May)

» Basic research to develop a molecular test that could indicate resistance in NAAT-positive specimens

AR GC Outbreak response plan development» Consultation Atlanta September 14-15» State-level Outbreak Response Plan Development and Pilots

California, Hawaii, Illinois, New York State and Washington state

Regional Meetings» Monitoring Action Plan progress» Meetings Report Development

Performance Measures

CSPS Project started 1999 Pilot project 2001 Set of 12 measures 2005

» Timeliness of Treatment CT and GC in FP clinics» STD Clinics added 2007» GC Interviews modified 2009

NCSD Survey Optional Measures– Feasibility. Usefulness and Intent to Use– All CT male and females 15-24– All Gonorrhea

Performance Measure DataTimeliness of Treatment for CT (14 Days)

Prevalence Monitoring Family Planning Sites

2005 2006 2007 2008 2009

Chicago N/A N/A N/A N/A 0.30

Illinois 0.70 0.71 0.66 0.71 0.98

Indiana 0.51 0.64 0.68 0.73 0.77

Michigan 0.56 0.74 0.71 0.60 0.57

Minnesota 0.91 0.90 0.88 0.82 0.84

Ohio 0.40 0.28 0.69 0.16 0.30

Wisconsin 0.76 0.72 0.76 0.70 0.74

Region V 0.63 0.63 0.70 0.58 0.64

National 0.62 0.66 0.64 0.64 0.67

Performance Measure DataTimeliness of Treatment for GC (14 Days)

Prevalence Monitoring Family Planning Sites

2005 2006 2007 2008 2009

Chicago N/A N/A N/A N/A 0.15

Illinois 0.68 0.71 0.72 0.67 0.89

Indiana 0.61 0.79 0.87 0.78 0.79

Michigan 0.77 0.76 0.61 0.63 0.65

Minnesota 0.93 0.92 0.71 0.87 0.65

Ohio 0.41 0.27 0.67 0.14 0.32

Wisconsin 0.67 0.56 0.67 0.56 0.60

Region V 0.61 0.63 0.67 0.55 0.59

National 0.62 0.66 0.64 0.64 0.67

Performance Measure DataTimeliness of Treatment CT and GC (14 Days)

STD Sites: 2007-2009

CT2007

CT2008

CT2009

GC2007

GC2008

GC2009

Chicago N/A N/A 0.17 N/A N/A 0.18

Illinois 0.57 0.74 0.79 0.50 0.75 0.80

Indiana 0.70 0.87 0.89 0.79 0.89 0.90

Michigan 0.67 0.73 0.81 0.68 0.84 0.86

Minnesota 0.79 0.77 0.78 0.77 0.80 0.86

Ohio 0.89 0.17 0.28 0.90 0.22 0.21

Wisconsin 0.67 0.66 0.69 0.65 0.52 0.54

Region V 0.67 0.59 0.66 0.66 0.61 0.54

National 0.69 0.72 0.69 0.70 0.73 0.67

Performance Measure and Morbidity DataChlamydia- All Females

STD Sites: 2008

Total CT CasesNETSS

CT STD CasesNETSS

% Cases

CT STD CasesPM Data

Chicago 18130 1578 8.7 N/A

Illinois 24982 1783 7.1 1752

Indiana 16513 1234 7.5 1119

Michigan 33719 2070 6.1 879

Minnesota 10266 431 4.2 380

Ohio 35021 1374 3.9 1850

Wisconsin 15229 18 0.1 548

National 893004 89943 10.00 67074

Performance Measure and Morbidity DataGonorrhea- All Females

STD Sites: 2008

Total GC CasesNETSS

GC STD CasesNETSS

% Cases

GC STD CasesPM Data

Chicago 5388 816 15.00 N/A

Illinois 5954 738 12.4 732

Indiana 5056 679 13.4 445

Michigan 10047 758 7.5 313

Minnesota 1657 147 8.9 140

Ohio 9784 604 6.2 782

Wisconsin 3744 11 0.3 188

National 182577 27825 15.00 2600

Questions?