Controlling a Syphilis Outbreak on a Native American Reservation

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Controlling a Syphilis Outbreak on a Native
American Reservation

• CDR Kara M Levri, MD, MPH
• Angela Fallon, RN, BSN
• Sells Service Unit, Tucson Area IHS
• USPHS Scientific Symposium
• June 12, 2008

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MEXICO
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The Tohono Oodham Nation

• Tribal Government
• 11 Districts
• 3M Acres
• 76 Mile Border
• Members 28K
• Reservation - 13K
• Off Reservation 13,500
• OIM 1,500

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Sells Service Unit
San Xavier Health Center
Sells Hospital
Santa Rosa Health Center
San Simon Health Center
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Sells Hospital

• Inpatient Ward
• Outpatient Clinic
• Emergency Room
• X-ray Dept.
• Laboratory
• Pharmacy
• Physical Therapy
• Dialysis Unit
• Opto/Ophtho
• Dental
• Public Health
• Social Services
• Dietary

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Ambulatory Clinics

• Continuity
• Urgent Care
• Prenatal
• Womens Health
• Colposcopy
• Well Child
• Developmental
• Teen
• Hospital F/U
• Podiatry
• TB

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Specialty Services

• Perinatology
• Surgery
• ENT
• Rheumatology
• Cardiology
• Orthopedics
• Renal

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Tohono Oodham Culture

• "People of the Desert."

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T.O. Transportation
Without Automobile Transportation 30
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• Homes w/out Electricity 10

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• Homes w/out Plumbing 15

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T.O.
U.S.
American Indians, Alaska Natives 2000 Census of
Population using 1999 Poverty Line
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Syphilis

• Sexually Transmitted Infection (STI)
• Stages
• Primary
• Secondary
• Latent
• Early
• Late
• Unknown Duration
• Congenital
• Tertiary (Late)
• Treatment
• Follow-up

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Syphilis Reported Cases by Stage United States
19412006
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Primary and Secondary Syphilis Cases and Rates
per 100,000 Population, Arizona 2000-2007
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PS Syphilis Rates per 100,000 Population by
Race/Ethnicity, Arizona 2002-2007
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Syphilis Cases by Diagnosis MonthTohono Oodham
Nation (n74)
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Syphilis Cases by Gender(n81)
Congenital cases not included
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Syphilis Cases by Age Group2006-2008(n72)
10-14
Congenital cases not included
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Syphilis Cases by Stage(n71)
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Syphilis Outbreak Risk Factors
MSM Men who have sex w/ men
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Outbreak Response Interventions and Strategies
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Partnerships

• Indian Health Service
• Tohono Oodham Nation
• Arizona Department of Health Services
• Pima County
• Centers for Disease Control
• Inter-Tribal Council of Arizona

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Community Mobilization

• Weekly STD core group meetings
• Consultation from elder youth groups
• Intensive STD training
• Phlebotomy training
• Re-designing PHN Department
• TO Nation DHHS to establish STD Program
• Monthly updates
• Tohono Oodham Legislative Council
• TON Health Human Service Oversight
• School Boards

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Health Promotion Marketing

• Mass marketing campaign
• Informational material
• Local newspapers articles
• Tribal radio station

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Clinic- Based Strategies

• Universal Screening ages 12-55
• STD Standing orders implemented
• Prophylactic treatment of contacts clusters
• Fast track services through PHN department
• Triple screen pre-natal patients
• Rapid partner follow-up

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School- Based Strategies

• Local school STD screening
• Provided STD education
• Enhanced IHS School Health Program

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Community Based Strategies

• Community recreation centers
• Band concerts
• Door to door screening
• Worksite STD testing and screening
• Local grocery and convenience stores

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Challenges/Barriers

• Recognition of TODHHS as a local health authority
  
• Underreporting of STD cases
• Lack of communication between all jurisdictions
• No protocol for data sharing
• Lack of communicable disease program in TODHHS
• Limited resources among all jurisdictions
• Vast geographical size of the TON

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Conclusion

• Develop Partnerships
• Foster Collaboration
• Engage the Community
• Be Innovative

The whole is greater than the sum of its parts-
Aristotle
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