Region II IPP Data & Region II IPP Data & Infrastructure Performance Infrastructure Performance

MeasuresMeasures

Kelly Opdyke, MPHKelly Opdyke, MPHRegion II IPP Advisory Committee MtgRegion II IPP Advisory Committee Mtg

May 16-17, 2007May 16-17, 2007Cicatelli Associates Inc.Cicatelli Associates Inc.

Region II IPP Workplan, 2006-2007Region II IPP Workplan, 2006-2007

PRIORITY 2: Incorporate Analysis of PRIORITY 2: Incorporate Analysis of Regional Prevalence Monitoring Data for Regional Prevalence Monitoring Data for Regional and Local Data-Directed Regional and Local Data-Directed Planning and Quality AssurancePlanning and Quality Assurance GOAL: IPP data will direct the most cost GOAL: IPP data will direct the most cost

effective implementation of screening and effective implementation of screening and treatment funds.treatment funds.• OBJECTIVE 2B: OBJECTIVE 2B: Identify what percentage of Identify what percentage of

eligible women are being screened on an annual eligible women are being screened on an annual basis among select sites participating in the basis among select sites participating in the Region II IPP.Region II IPP.

Region II IPPRegion II IPP2005 Screening “Audit”2005 Screening “Audit”

Purpose:Purpose: Estimate chlamydia screening coverage Estimate chlamydia screening coverage

among eligible female patients according among eligible female patients according to Region II IPP minimum screening to Region II IPP minimum screening criteriacriteria

Pilot regional methodology for assessing Pilot regional methodology for assessing screening coverage and adherence to screening coverage and adherence to screening criteria in anticipation of CDC screening criteria in anticipation of CDC proposed measures of effectivenessproposed measures of effectiveness

Region II IPPRegion II IPPMinimum Screening CriteriaMinimum Screening Criteria

Title X Family Planning ClinicsTitle X Family Planning Clinics All women ≤ 24 years of age attending the All women ≤ 24 years of age attending the

clinic for an initial or annual visit will be clinic for an initial or annual visit will be screened for chlamydia.screened for chlamydia.

STD ClinicsSTD Clinics All women ≤ 29 years of age attending the All women ≤ 29 years of age attending the

STD clinic will be screened for chlamydia.STD clinic will be screened for chlamydia.

FP Screening CoverageFP Screening Coverage(Expected 85%)(Expected 85%)

Project Project AreaArea

# Sites# Sites Sample Sample SizeSize

% Screened (95% CI)% Screened (95% CI)

NJ 4343 864864 87.0%87.0% (84.8%-89.3%) (84.8%-89.3%)

NYC 99 170170 98.8%98.8% (97.2%-100%) (97.2%-100%)

NYS 7474 1,5351,535 87.9%87.9% (86.3%-89.5%) (86.3%-89.5%)

PR 3838 154154 47.4%47.4% (39.5%-55.3%) (39.5%-55.3%)

TOTAL 164164 2,7232,723 86.0%86.0% (84.7%-87.3%) (84.7%-87.3%)

Implications/DiscussionImplications/Discussion

Region II IPP Region II IPP minimum screening criteriaminimum screening criteria for FP include only those women who for FP include only those women who have an initial or annual (i.e. pelvic) examhave an initial or annual (i.e. pelvic) exam

In the pastIn the past, chlamydia testing required the , chlamydia testing required the collection of a cervical specimen.collection of a cervical specimen.

Highly-sensitive urine-based NAATs Highly-sensitive urine-based NAATs (nucleic acid amplification tests) provide (nucleic acid amplification tests) provide an opportunity for expanded screening to an opportunity for expanded screening to additional high-risk clients.additional high-risk clients.

Percent of Ct Tests Reported as NAATPercent of Ct Tests Reported as NAATRegion II IPP, 2004-2006Region II IPP, 2004-2006

0%10%20%30%40%50%60%70%80%90%

100%

NJ (All)

NYC MHRA

NYC DO

HMH

NYS FP

NYS STD

PR DOH

UPR TXFPP

USVI

Region II

CY 2004

CY 2005

CY 2006

Current Use of Urine Specimen forCurrent Use of Urine Specimen forCt Testing Among FemalesCt Testing Among Females

Region II IPP, CY2005Region II IPP, CY2005

Project Area

FP STD All Other

# Tests % Urine # Tests % Urine # Tests % Urine

NJ 4754247542 3.0%3.0% 63676367 3.0%3.0% 87168716 11.3%11.3%

NYC 2087120871 0.0%0.0% 2079020790 4.0%4.0% 52375237 93.4%93.4%

NYS 9595795957 0.1%0.1% 1031910319 2.5%2.5% 43994399 14.8%14.8%

PR 70547054 0.0%0.0% 34203420 2.9%2.9% 1246412464 1.3%1.3%

USVI 966966 0.0%0.0% 245245 13.5%13.5% 15291529 0.0%0.0%

Reg II Total 172390172390 0.8%0.8% 4114141141 3.4%3.4% 3234532345 20.7%20.7%

Current Use of Urine Specimen forCurrent Use of Urine Specimen forCt Testing Among FemalesCt Testing Among Females

Region II IPP, CY2006Region II IPP, CY2006

Project Area

FP STD All Other

# Tests % Urine # Tests % Urine # Tests % Urine

NJ 4838748387 4.1%4.1% 65866586 5.9%5.9% 92049204 11.4%11.4%

NYC 1438814388 0.0%0.0% 2611026110 26.6%26.6% 1119711197 57.8%57.8%

NYS 101880101880 0.7%0.7% 1048110481 2.8%2.8% 37813781 28.6%28.6%

PR 67106710 32.1%32.1% 49884988 62.1%62.1% 1318613186 16.1%16.1%

USVI 800800 0.0%0.0% 259259 0.0%0.0% 11341134 0.0%0.0%

Reg II Total 172165172165 2.8%2.8% 4842448424 22.1%22.1% 3850238502 27.9%27.9%

Region II IPPRegion II IPPStrategic Plan 2005-2009Strategic Plan 2005-2009

PRIORITY 1: Target/Expand Chlamydia PRIORITY 1: Target/Expand Chlamydia Screening to Young Sexually Active Screening to Young Sexually Active Women and Men at Risk for Infection in Women and Men at Risk for Infection in Public and Private Settings.Public and Private Settings. GOAL: All at risk men and women under the GOAL: All at risk men and women under the

age of 25 will be screened at least annually.age of 25 will be screened at least annually.• OBJECTIVE 1C: By December 2007, decrease OBJECTIVE 1C: By December 2007, decrease

routine CT and GC screening by 50% in women routine CT and GC screening by 50% in women >30 years of age in FP clinics where the >30 years of age in FP clinics where the prevalence of CT is less than 2%.prevalence of CT is less than 2%.

Screening Trends inScreening Trends inFP Clinics, Region II IPPFP Clinics, Region II IPP

Proportion of Females* Tested for ChlamydiaWho Were Age 30+ Yrs, CY2003-CY2006

(*Includes records with +/- CT results and age >= 10 yrs)

0.0%

10.0%

20.0%

30.0%

40.0%

NJ NYC NYS PR USVI Reg I I

% o

f All

Tes

ts

2003200420052006

N (2003) = 46,077 22,691 41,609 4,684 2,030 117,091N (2004) = 36,825 21,995 26,050 6,503 2,019 93,392 N (2005) = 47,542 20,871 95,957 7,054 966 172,390N (2006) = 48387 14,388 101,880 6,710 800 172,165

Chlamydia Positivity Among Chlamydia Positivity Among Females Age 30+ Yrs in FP ClinicsFemales Age 30+ Yrs in FP Clinics

Project Area

CY2005

# Tests % Pos

NJ 7,9677,967 2.3%2.3%

NYC 6,4566,456 1.0%1.0%

NYS 16,33716,337 1.0%1.0%

PR 1,4791,479 2.2%2.2%

USVI 242242 6.2%6.2%

Reg II Total

32,48132,481 1.4%1.4%

Project Area

CY2006

# Tests % Pos

NJ 8,0388,038 2.4%2.4%

NYC 4,1514,151 1.1%1.1%

NYS 17,55517,555 1.2%1.2%

PR 1,2001,200 1.4%1.4%

USVI 7474 10.8%10.8%

Reg II Total

31,01831,018 1.5%1.5%

2007 Regional IPP Infrastructure 2007 Regional IPP Infrastructure Performance MeasuresPerformance Measures

Measure 1: Screening Coverage in FPMeasure 1: Screening Coverage in FPProportion of female Family Planning users Proportion of female Family Planning users

screened for chlamydia, by age groupscreened for chlamydia, by age group• Data Source: FPAR Tables 1 & 11Data Source: FPAR Tables 1 & 11

Measure 2: Test Utilization Measure 2: Test Utilization Proportion of chlamydia tests conducted on Proportion of chlamydia tests conducted on

females, stratified by age groupfemales, stratified by age group• Data Source: IPP Prevalence Monitoring DataData Source: IPP Prevalence Monitoring Data

IPP Infrastructure PM 1:IPP Infrastructure PM 1:Estimated Ct Screening CoverageEstimated Ct Screening Coverage

YEARYEAR Age Group Age Group

(Years)(Years)

# Females # Females ScreenedScreened

# Females # Females EligibleEligible

Estimated Estimated Screening Screening

Coverage (%)Coverage (%)

CY 2005CY 2005 15-1915-19 51,028 51,028 112,134 112,134 45.5%45.5%

20-2420-24 67,541 67,541 140,010 140,010 48.2%48.2%

>24>24 75,895 75,895 190,106 190,106 39.9%39.9%

TOTALTOTAL 194,464 194,464 442,250 442,250 44.0%44.0%

CY 2006CY 2006 15-1915-19 50,614 50,614 110,734 110,734 45.7%45.7%

20-2420-24 69,288 69,288 140,198 140,198 49.4%49.4%

>24>24 79,355 79,355 191,509 191,509 41.4%41.4%

TOTALTOTAL 199,257 199,257 442,441 442,441 45.0%45.0%

IPP Infrastructure PM 1:IPP Infrastructure PM 1:Estimated Ct Screening CoverageEstimated Ct Screening Coverage

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

15-19 yrs

20-24 yrs

>24 yrs

TOTAL

Proportion of Female Family Planning Users Screened for Chlamydia, by Age Group, 2006 FPAR

IPP Infrastructure PM 2:IPP Infrastructure PM 2:Chlamydia Test UtilizationChlamydia Test Utilization

Age Group Age Group (Years)(Years)

CY 2005CY 2005 CY 2006CY 2006

# Females # Females TestedTested

% of % of Females Females

Tested by Tested by AgeAge

# Females # Females TestedTested

% of % of Females Females

Tested by Tested by AgeAge

15-1915-19 58,660 58,660 23.7%23.7% 64,071 64,071 24.9%24.9%

20-2420-24 88,131 88,131 35.7%35.7% 91,209 91,209 35.4%35.4%

25-2925-29 45,986 45,986 18.6%18.6% 47,087 47,087 18.3%18.3%

>29>29 54,362 54,362 22.0%22.0% 55,096 55,096 21.4%21.4%

TOTALTOTAL 247,139 247,139 100.0%100.0% 257,463 257,463 100.0%100.0%