ADHS AND COUNTY STD CONTROL AND PREVENTION PROCESSES AND ACTIVITIES

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• ADHS AND COUNTY STD CONTROL AND PREVENTION
  PROCESSES AND ACTIVITIES
• Kerry Kenney
• ADHS/STDP
• STATEWIDE STD MEETING
• April 25, 2008

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Topics

• Reporting
• Chlamydia, Gonorrhea, Chancroid, LGV and Syphilis
  Case Follow-up
• Inter-jurisdictional Case Transfers
• Outbreak Detection and Follow-up
• STD Training Opportunities
• Performance Measures

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Reporting

• Updated Administrative Rules for Provider
  Reporting (R9-6-202)
• http//www.azdhs.gov/phs/oids/code.htm
• New Communicable Disease Reports
• http//www.azdhs.gov/phs/hvstdhpc/CDRReportFinal_f
  ill3.pdf

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Reporting

• Updated Administrative Rules for Provider
  Reporting (R9-6-202)
• New Communicable Disease Reports
• http//www.azdhs.gov/phs/hvstdhpc/CDRReportFinal_f
  ill3.pdf
• So Who Reports to Whom?
• Administrative Code requires Health Care
  Providers to report STDs to the Local Health
  Agency.
• "Local health agency" means a county health
  department, a public health services district, a
  tribal health unit, or a U.S. Public Health
  Service Indian Health Service Unit.
• Administrative Code requires Local Health
  Agencies to report to the State STD Program.

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Reporting

• What Do We Want?
• Providers report directly to their county health
  department
• Other local health agencies receiving reports
  forward or copy and forward the report to the
  county health department
• County health departments report to the STD
  Program and also to other local health agencies
  (i.e., tribal health units, IHS health units)

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STD Case Follow-up

• Updated Administrative Rules for STD Control
  Measures and STD Related Testing and Notification
  
• Control Measures for Communicable Diseases and
  Infestations (R9-6-313, 314, 332, 375)
• STD Related Testing and Notification
  (R9-6-1102-1104)

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STD Case Follow-up Chlamydia and Gonorrhea

• Review CDRs received from providers for
  completeness and accuracy
• Offer or arrange for treatment for each chlamydia
  or gonorrhea case that seeks treatment from the
  local health agency
• Inform case that they must notify all sexual
  contacts within 60 days of symptoms or diagnosis
  up to the date of treatment of the need for
  testing/treatment

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STD Case Follow-up Chlamydia and Gonorrhea
(contd)

• Provide each case seeking treatment with health
  information including confidentiality of results,
  a description of the disease, treatment options,
  and risk reduction measures
• Offer or arrange treatment for each contact of a
  case who seeks treatment from the local agency
  (consider EPT)
• Provide contact with same health information as
  provided to a case

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STD Case Follow-upSyphilis, LGV and Chancroid
Investigations

• State STD Program requires chancroid, LGV, and
  syphilis case management activities be conducted
  only by individuals who have completed CDC
  Employment Development Guide module training and
  attended CDC Introduction to STD Intervention or
  Fundamentals of STD Intervention course
• State STD Program has assigned Program staff to
  assist counties with syphilis, LGV and chancroid
  investigations

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STD Case Follow-up Lymphogranuloma Venereum (LGV)

• Notify State STD Program immediately and follow
  instruction for collection and shipment of swab
  and serum specimens to State/CDC
• Conduct an epidemiologic investigation of each
  reported or suspect LGV case and submit a
  detailed written report
• Enhanced Interview Record
• CDC Lymphogranuloma Venereum (LGV) Suspected
  Case-Patient Information (ver.12.0, revised
  5/4/2005) Must be submitted to State/CDC along
  with specimens collected

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STD Case Follow-upLGV (contd)

• Offer or arrange for treatment for each LGV case
  that seeks treatment from the local health agency
• Inform LGV case that they must notify all sexual
  contacts within 60 days preceding treatment
• Provide each LGV case seeking treatment with
  health information including confidentiality of
  results, a description of the disease, treatment
  options, and risk reduction measures

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STD Case Follow-upLGV (contd)

• Notify each contact to a LGV case of exposure to
  the disease and of the need for testing/
  treatment
• Offer or arrange treatment for each contact of a
  LGV case who seeks treatment from the local
  agency
• Provide contact with same health information as
  provided to a case

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STD Case Follow-up Syphilis

• Conduct an epidemiologic investigation of each
  reported or suspect syphilis case and submit a
  detailed written report (R9-6-206(D))
• Enhanced Interview Record
• Congenital Syphilis Case Investigation and Report
  (CDC 73.126)
• Offer or arrange for treatment for each syphilis
  case that seeks treatment from the local health
  agency
• Inform syphilis case that they must notify all
  sexual contacts within the appropriate time frame
  preceding treatment based on the stage of disease
  as follows

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STD Case Follow-upSyphilis (contd)

• Syphilis Interview Periods for Contacts
• Primary Syphilis
• 4 months and 1 week prior to date of treatment
• Secondary Syphilis
• 8 months prior to date of treatment
• Early Latent Syphilis
• 1 year preceding date of treatment
• Latent Syphilis of Unknown Duration
• 1 year prior to date of treatment
• Late Latent Syphilis
• 1 year prior to date of treatment

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STD Case Follow-upSyphilis (contd)

• Syphilis Disease Stages
• Primary
• Chancre or other appropriate symptom(s) of
  primary syphilis present at time of first
  examination
• Secondary
• Rash or other symptom(s) appropriate for
  secondary syphilis present at time of first
  examination AND a titer 14
• Early Latent
• History of primary or secondary syphilis symptoms
  in the preceding 12 months OR negative syphilis
  serology in the preceding 12 months OR 4-fold
  increase in titer in the preceding 12 months OR
  epidemiologic link to an independently confirmed
  early syphilis case

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STD Case Follow-upSyphilis (contd)

• Syphilis Disease Stages (contd)
• Latent Syphilis of Unknown Duration
• Case does not meet early latent criteria AND
  patient is 35 or younger AND titer is 132 or
  higher
• Late Latent Syphilis
• Latent syphilis in a patient with no evidence of
  having acquired the disease within the preceding
  12 months AND whose age and titer do not meet
  criteria for latent syphilis of unknown duration
  
• Note All diagnoses of syphilis must be
  associated with a reactive treponemal test
  (FTA or TP-PA) OR positive darkfield exam.

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STD Case Follow-upSyphilis (contd)

• Provide each syphilis case seeking treatment with
  health information including confidentiality of
  results, a description of the disease, treatment
  options, and risk reduction measures
• Notify each contact to a syphilis case of
  exposure to the disease and of the need for
  testing/ treatment
• Offer or arrange treatment for each contact of a
  syphilis case who seeks treatment from the local
  agency
• Provide contact with same health information as
  provided to a case

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STD Case Follow-upChancroid

• Conduct an epidemiologic investigation of each
  reported or suspect chancroid case and submit a
  detailed written report (R9-6-206(D)
• Enhanced Interview Record
• Offer or arrange for treatment for chancroid case
  that seeks treatment from the local health agency
• Inform case that they must notify all sexual
  contacts within 10 days of symptom onset of the
  need for testing/treatment

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STD Case Follow-upChancroid (contd)

• Provide each case seeking treatment with health
  information including confidentiality of results,
  a description of the disease, treatment options,
  and risk reduction measures
• Notify each contact to a chancroid case of
  exposure to the disease and of the need for
  testing/ treatment
• Offer or arrange treatment for each contact of a
  case who seeks treatment from the local agency
• Provide contact with same health information as
  provided to a case

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STD Case Follow-upSTD Case Management Forms

• New 6-page CDC Enhanced Interview Record
• Effective January 1, 2008, required report form
  for syphilis and chancroid cases
• Forms, instructions, and PowerPoint training
  program available from the STD Program

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STD Case Follow-upSTD Case Management Forms
(contd)

• CDC Field Record (CDC 73.2936
• Used to conduct positive laboratory report and
  contact investigations
• required form for syphilis, chancroid and
  outbreak investigations
• Forms and instructions available from the STD
  Program

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STD Case Follow-upSTD Case Management Forms
(contd)

• CDC Visual Case Analysis (VCA) form
• Required form for syphilis, chancroid and
  outbreak investigations
• At-a-glance tool for determining exposure gaps
  and performing source spread analysis

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STD Case Follow-upSTD Case Management Forms
(contd)

• CDC Congenital Syphilis Case Investigation and
  Report form (CDC 73.126)
• Used to evaluate congenital syphilis status
• Required Report form for State STD Program and
  CDC
• Forms and instructions available from the STD
  Program

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STD Case Follow-upSTD Case Management Forms
(contd)

• CDC LGV Case-Patient Information form (5 page)
• Required form for reporting confirmed or
  suspected LGV to State/CDC
• Form must be submitted to State/CDC along with
  specimens

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Inter-jurisdictional Case Transfers

• All STD case investigations with actionable
  locating information belonging to another
  jurisdiction, whether in-state or out-of-state,
  should be sent to State STD Programs ICCR
  (Inter/Intra-state Communication Control Record)
  Desk for forwarding
• Positive laboratory reports
• STD contact investigations
• State ICCR Desk Contact Information
• Phone [phone] FAX [phone]

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Outbreak Detection and Follow-up

• Local health agencies are responsible to report
  any syphilis outbreak to the STD Program, conduct
  an epidemiologic investigation of the outbreak,
  and submit an outbreak investigation report to
  the STD Program AAC R9-6-206 (F), R9-6-375 (C)
• The STD Program has developed an STD Outbreak
  Response Plan that can be used/adapted by local
  health agencies
• Includes recommended outbreak threshold criteria
• Includes recommended response organization and
  activities
• The STD Program will provide outbreak assistance
  to local health agencies

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STD Training Opportunities

• California STD/HIV Prevention Training Center
• (CA PTC)
• On or off-site and online training available
• Clinical
• Behavioral
• Partner Services
• Several courses hosted by the State STD Program
• Contact Information
• http//www.stdhivtraining.org

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STD Training Opportunities

• Examples of Courses Offered Through CA PTC
• Introduction to STD Intervention (9 days)
• Fundamentals of STD Intervention (4 days)
• Training Operating for Safety around Field
  Encounters (2 days)
• Using Surveillance and Data for STD/HIV Programs
  (2 days)
• HIV Disclosure Partner Services Training for
  PCRS (2 days)
• Bridging Theory and Practice Applying Behavioral
  Theory to STD/HIV Prevention (2 days)
• Fundamentals of STDs in Clinical Practice (3
  days)
• 28th Annual Reproductive Health Symposium (2
  days)
• Comprehensive Risk Counseling and Services (3
  days)

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STD Training Opportunities

• CDC Resources
• CDC STD Program Tools
• http//www.cdc.gov/std/program
• Public Health Training Network
• http//www2.cdc.gov/phtn
• HIV/AIDS Training and Resources
• http//www.cdc.gov/hiv/conferences.htm
• Other Resources
• National Coalition of STD Directors
• http//www.ncsddc.org
• STD Prevention Online
• http//www.stdpreventiononline.org

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Performance Measures

• CDC Required Performance Measures beginning with
  2005 grant cycle
• Medical and Lab Services (1 measure)
• Partner Services (6 measures)
• Surveillance and Data Management (3 Measures)
• Clinical Services (4 Measures)
• Syphilis Elimination - Enhanced Surveillance
  (1Measure)
• STD Program staff may call on County STD staff to
  request information necessary to respond to the
  CDC performance measures

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Contact Information

• Kerry M. Kenney
• Sr. Public Health Advisor
• Arizona STD Control Program
• 50 North 18th Avenue, Suite 140
• Phoenix, Arizona 85007
• Phone [phone]
• Fax [phone]
• E-Mail kenneyk_at_azdhs.gov