Family Planning Title X Chlamydia Screening Quality Improvement Project

Transcription

1 Family Planning Title X Chlamydia Screening Quality Improvement Project Illinois Department of Public Health STD Section Staff March 22, 2017

2 Objectives Discuss current STD trends and epidemiology of chlamydia infection Discuss importance of chlamydia screening Review chlamydia screening and treatment data of Title X clinics Review reporting of positive Ct & Gc cases in I-NEDSS Discussion of successes and barriers of increasing chlamydia screening in the Title X clinics

3 STD/Title X Program Partnership Since 2014: Chlamydia Screening Project/Initiative Chlamydia screening presentations/reports IDPH STD program provides STD treatment medications free of charge to Title X clinics IDPH STD program provides I-NEDSS TA and required Title X reports

4 Background Approximately 20 million new STI infections* reported annually - almost half are among youth aged Chlamydia: Most commonly reported infectious disease in the US (approximately 3 million cases annually) In fall 2015, CDC announced for the first time since 2006, the rates for all three reportable STIs (chlamydia, gonorrhea, and syphilis) all increased. *STI: chlamydia, gonorrhea, syphilis, HIV, HPV, herpes, trichomoniasis 4

5 Reported STDs in Illinois 2014 & 2015 Illinois Excluding Chicago Chicago Gonorrhea 15,971 17,130 7,665 8,344 8,306 8,768 Chlamydia 66,593 69,610 39,273 40,592 27,320 29,018 Early Syphilis 1,682 1, ,189 1,352 Congenital Syphilis

6 Illinois STD Statistics: Chlamydia 2015 CDC National Chlamydia Data Total Illinois: Ranked 11 th in chlamydia infections by rate per 100,000 population Ranked 5 th by overall by case count Cook County: Ranked 2 nd among all U.S. counties for total cases of chlamydia 2014 & 2015 Illinois Chlamydia Data 2014 Chlamydia: 66,593 total cases 4% increase from 2013 Chicago reported 41% of cases 2015 Chlamydia: 69,610 total cases 4.5% increase from 2014 Chicago reported 42% of cases

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8 Illinois 2015 STD Statistics: Chlamydia By Race/Ethnicity Unk White NH By Age 15 to 19 Hispanic Black NH By Sex 70% 30%

9 Chlamydia: Why Should We Care? Most commonly reported infectious disease in the US (approximately 3 million cases annually) Health impact severe and costly (especially in women) Pelvic Inflammatory Disease (PID), infertility, ectopic pregnancy Inflammation facilitates HIV transmission High Prevalence and Incidence in Adolescents and Young Adults Diagnosis can be difficult many infected are asymptomatic More women asymptomatic or with atypical, nonspecific symptoms; delayed care Rate in women 3 times higher than men Transmission efficiency greater male to female than the reverse Chlamydial infection is one of most common causes of eye infections and Pneumonia in infants

10 HEDIS Chlamydia Screening Measure Screening for Chlamydia trachomatis, the most common bacterial sexually transmitted in the U.S., has been included as a HEDIS measure since 2000 Proportion of sexually active females ages of 16 and 24 who were screened for chlamydia annually. Chlamydia screening is a HEDIS measure because it is: a grade A U.S. Preventive Services Task Force service for women <25 years of age; it is cost effective; it can prevent PID that leads to infertility, and; it is an indicator of adolescent and maternal health.

11 Title X Family Planning Chlamydia Screening AHLERS Data Percent Unduplicated Females Aged Screened for CT Year Illinois Title X Family Planning Percent Screened Clients Seen Clients Screened Total Screening Rate ,632 20, % ,574 19, % ,911 15, % ,130 10, %

12 AHLERS Form

13 Recommendations Annual CT/GC screening for all female clients 25 years of age: Unless they have an identifiable risk factor which warrants more frequent testing Opt-out chlamydia/gonorrhea testing on all health clinic visits Re-test clients treated for chlamydia 3-4 months post treatment (Do not test sooner than 21 days, may get false positive test) Clients at very high risk, multiple sex partners-offer more frequent screening Pregnancy test urines could/should be screened for CT/GC Birth control refill visits Male screening initiate sex sooner and have more partners than females

14 Complication of Reinfections: Retesting as a priority Reinfection is associated with an increased risk of reproductive complications: Ascension of CT/GC into the upper genital tract Ectopic Pregnancy Pelvic Inflammatory Disease Relative to 1 st infection. 2 nd infection 4x risk of PID 2x risk of ectopic pregnancy 3+ infections 6x risk of PID 5x risk of ectopic pregnancy

15 Illinois Title X Family Planning Female Client Chlamydia Treatment Rates Percent Clients Adequately Treated for Chlamydia Seen at Illinois Title X Sites Percent of Total Cases Treated* Percent of Total Cases Treated Within 14 Days* Percent of Total Cases Treated Within 30 Days* % 79% 95% % 86% 96% 2016 Goal 90% 86% 97% *Clients tested and treated at the same site Source: IDPH STD Section *Clients tested and treated at the same site

16 Treatment Timeliness Reports Call the IDPH STD Program and request a report Give a week for the program to generate the report Or Each clinic with I-NEDSS access can run a treatment timeliness report in I-NEDSS Business Objects 100%

17 I-NEDSS Provider Reporting Clinic staff can report positive cases of Gonorrhea or Chlamydia directly into I-NEDSS

18 Expedited Partner Therapy (EPT) EPT prescribe, dispense, furnish or otherwise provide prescription drugs to the partner or partners of persons diagnosed with chlamydia or gonorrhea (last 60 days) without physical examination of the partners Goals: To treat partners who are unable or unlikely to seek care Decrease new CT/GC infections in community Reduce CT/GC re-infection rates Decrease complications from untreated CT and GC Legal in Illinois as of January 1,

19 Reporting EPT Usage Very important to report any & all EPT prescriptions dispensed on the Morbidity Report Form and/or in INEDSS

20 Reporting EPT in INEDSS

21 Discussion? How have you been successful in increasing (or maintaining) screening rates in your clinic?? What are some barriers you are facing with increasing chlamydia screening rates in your clinics?? Ideas on how to increase screening?

22 Questions Dawn Nims IDPH STD Section