Region X IPP Vaginal Swabs Update

Transcription

1 Region X IPP Vaginal Swabs Update Sarah Goldenkranz Data Manager, IPP Region X Center for Health Training Regional Advisory Committee February 9, 2011

2 Agenda Review specimen source options for CT/GC testing How does Region X compare to the nation? Discuss variation by state Examine uptake of vaginal swabs Explore variations in specimen source and positivity by client demographics

3 Review of Specimen Sources Endocervical Urethral Urine (patient-collected) Vaginal swab (patient- or clinician-collected) Other sites conjunctival, rectal, pharyngeal

4 Urine-Based Testing: A Major Breakthrough, But Specimen handling can be a challenge: spills Less easily mailed Slightly less sensitive than endocervical and male urethral specimens Urine processing protocols require meticulous attention to detail and, therefore, are error prone Patients sometimes associate it with drug testing Source: Vaginal Swabs Performance, Patient Preference and Applications (Webinar, Jan 2010) Jeanne Marrazzo, MD, MPH Medical Director, Seattle STD/HIV Prevention Training Center, University of Washington

5 Self-Obtained Vaginal Swabs: Advantages Amenable to NAAT technology: highly sensitive, specific Highly acceptable to women Avoid pelvic examination Especially useful for asymptomatic screening Improves outreach to underserved population groups May allow for more representative screening group (not just people who come to clinic) Source: Vaginal Swabs Performance, Patient Preference and Applications (Webinar, Jan 2010) Jeanne Marrazzo, MD, MPH Medical Director, Seattle STD/HIV Prevention Training Center, University of Washington

6 100 Distribution of CT Tests by Sex and Specimen Source, NATIONAL* Percentage (Median) Females Males Vaginal Urine Urethral Cervical *Preliminary 2009 data supplied by CDC, not yet published

7 *Preliminary 2009 data supplied by CDC, not yet published Distribution of CT Tests by Region and Specimen Source, Females* 100 Percentage (median) I II III IV V VI VII VIII IX X Median % Vaginal Median % Urine Median % Cervical

8 *Preliminary 2009 data supplied by CDC, not yet published Distribution of CT Tests by Region and Specimen Source, Males* 100 Percentage (median) I II III IV V VI VII VIII IX X Median % Urine Median % Urethral

9 100% 0.0% CT test distribution Region X, Jan-Jun % 8.6% 75% 50% 25% 98.3% 34.5% 50.0% vaginal clinician collected vaginal patient collected other urine urethral cervical 0% 0.0% males (n=11,597) females (n=56,463)

10 CT test distribution, females 2010, by State 100% 0.0% 0.2% 2.7% 0.6% 4.5% 14.3% 75% 75.3% 36.0% 18.3% 16.8% vaginal clinician collected 50% 25% 62.9% 74.5% 43.3% vaginal patient collected urine 24.6% 25.5% 0% AK* (N=4353) ID (N=6000) OR (N=23,779) WA (N=56,458) cervical *AK does not collect vaginal swab options on lab slip

11 Number of vaginal swabs per state, Jan-Jun 2010 State # Patient-Collected # Clinician-Collected AK N/A N/A ID OR WA Your reactions?

12 A deeper look into WA State

13 Use of vaginal swabs over time 35% 30% % of all female tests 25% 20% 15% 10% 5% 0%

14 Use of Patient-Collected Vaginal Swabs Year # patientcollected vaginal swabs # of CT/GC tests (females) Percentage , % , % , % 2010 (Jun) , % 20% 15% 10% 5% 0% Percent patient-collected vaginal swabs 14.6% 0.3% 4.3% %

15 Specimen source distribution has changed 100% % of female visits 75% 50% 25% Cervical Urine Vaginal patientcollected 0% 2006 (n=37,405) 2007 (n=25,039) 2008 (n=22,254) 2009 (n=16,525) 2010 (n=5691) Vaginal cliniciancollected

16 Overall increase in patient-collected specimen types (urine + vaginal) 60% 50% 53.7% % of all tests 40% 30% 20% 41.4% 10% 0%

17 Patient-Collected swabs replacing clinician-collected* and urine Table 1: Specimen Source Distribution by Year (CT/GC test data) % change, N % N % N % N % Clinican-collected* 25, % 23, % 22, % 8, % -12.2% Urine 23, % 26, % 25, % 9, % -4.4% Patient-Collected Vaginal Swab % 1, % 5, % 3, % 16.6% Total 48, % 51, % 54, % 22, % 0.0% *Clinician-Collected methods include endocervical and clinician-collected vaginal swabs Intervention initiated in 2008 chi-sq <.001

18 Percentage of visits without an exam, females 100% 75% % of female visits 50% 29.9% 53.6% 25% 0%

19 Specimen Source at visits with no 100% exam (female clients), WA 75% % of visits 50% 25% Cervical Urine Vaginal-patient Vaginal-clinician 0% No exam/signs

20 Specimen Source at visits with an exam* (female clients), WA 100% 75% % of visits 50% 25% Cervical Urine Vaginal-patient Vaginal-clinician 0% Exam/signs *includes missing values during , prior to lab slip revision

21 Percentage of clinics using patientcollected vaginal swabs % 76.8% % % 2007 (n=107) 2008 (n=116) 2009 (n=122) 2010 (n=112) *Only clinics with average >25 female tests/year are included

22 Clinics using patient-collected swabs are using more of them % Mean % PCVS % 4.2% 1.7%

23 Percentage of female Family Planning tests from patient-collected specimens by age ( ) 100% 75% 50% % vaginal % urine 25% 0% Age Group

24 Percentage of patient-collected specimens that were vaginal swabs, by race/ethnicity ( ) 30% 25% 24.5% 20% 18.6% 19.2% 21.3% 16.8% 21.3% 15% 10% 5% 0% White Black American Indian Asian/Pacific Islander Hispanic Other

25 Patient-collected specimens more likely to be Chlamydia-positive Specimen Source % CT Positive Cervical 5.40% Vaginal-clinician 4.20% Urine 6.50% Vaginal-patient 6.70%

26 Chlamydia positivity by exam, all WA female test, Exam % CT+ Yes 4.7% No 6.1% (11% missing values)

27 Multivariate Results Factors independently associated with PCVSs: Age<20 (AOR=1.55 ) Clinic type (FP: ref., STD: AOR=0.27, School-Based: AOR=5.44, Women s Health: AOR=0.07). Race, ethnicity, and CT/GC positivity were not associated with utilization of PCVSs.

28 Changes in Chlamydia Prevalence? 10 8 Female tests %CT AK ID OR WA 0 *Jan-June

29 Changes in Chlamydia Prevalence? 20 Male tests %CT AK ID OR WA

30 Summary Region X is leading the way in vaginal swab uptake! Significant differences by state Thank you for collecting this data! Increasing use of clinician- and patient-collected vaginal swabs More clinics using vaginal swabs each year Clinics are increasing vaginal swab test volume Patient-collected vaginal swabs replacing urine and cervical specimens

31 Summary Increasing proportion of patient-collected specimens (urine and patient-collected vaginal) Patient-collected specimens now comprise over 50% of all tests in WA Reflects increasing proportion of visits with no exam Predominant method for young female clients

32 Summary Higher Chlamydia positivity for patient-collected specimens Due to differences in clientele Younger clients no exam patient-collected specimen Variation in use of vaginal swabs by: Age Clinic type

33 Contact Information Sarah Goldenkranz Center for Health Training (Seattle) (206)