Working to Stem the Tide: Rapid Syphilis Testing Outreach

Transcription

1 Working to Stem the Tide: Rapid Syphilis Testing Outreach Linda S Lewis, DVM, MPVM Health Scientist Note: All Butte County data presented should be considered preliminary in nature Community Health & Sciences Division Protecting the public through promoting individual, community, and environmental health

2 Working to Stem the Tide: Rapid Syphilis Testing Outreach Treating a syphilis patient, Vienna, 1498

3 Syphilis: Background

4 Syphilis: Background

5 Syphilis: Background Syphilis Trends, US, mass production of penicillin

6 Syphilis: Background Congenital Syphilis, California Incidence Rates, * Case Definition change Rev. 6/2017 * The Modified Kaufman Criteria were used through The CDC Case Definition (MMWR 1989; 48: 828) was used effective January 1, 1990.

7 Congenital Syphilis, California versus United States Incidence Rates, California In 2016, CA had approx.: 12% of the US population 33% of all US CS cases Rev. 7/2018 United States 2020 Objective (9.6) CA= =15.7 (2017 n/a)

8 Syphilis and Congenital Syphilis, Butte County, 2017 Congenital Syphilis, 2017 In 2017, among CA counties, Butte ranked: 11 th - total early syphilis rate Butte County 2017 pop est. 226,403 (DOF) 7 th - 1 o and 2 0 syphilis rate 7 th - congenital syphilis rate Congenital syphilis rate, 2017 Butte: /100,000 livebirths CA: 58.2 /100,000 livebirths

9 Early Syphilis, All Genders Butte County Number of Cases Rate per 100,000 population % of cases in Butte Co are females vs 13% statewide 22% of cases are MSM only in Butte vs 78% statewide Since 2015, ES has risen 2 to 4 fold each year in Butte County Cases Rate per 100, projected 2018 Congenital Syphilis Cases by County, Counties and the California, State, , with Benchmark. Sacramento, California, May 2018 Population data source: State of California, Department of Finance, E-4 Population Estimates for Cities,

10 CMSP Grant: Outreach and Rapid Syphilis Testing (RST) Provide outreach-based free RST and specimen collection for confirmatory syphilis testing; homeless persons and persons in substance abuse treatment/recovery

11 CMSP Grant: Rapid Syphilis Testing

12 CMSP Grant: Rapid Syphilis Testing Outreach: CMSP education & information Rapid syphilis test (unless no risk factors) Blood draws for confirmatory testing Interview w/ contact info collected Refer for treatment Safer sex kits distributed Piggy backed Rapid HCV testing Rapid HIV testing

13 Persons Served CMSP Grant: Events, Staffing and Persons Served Events 0 to 4 events per month Staffing 3 PHNs 2 testers, 1 Lab 3 PHES Intake, results 0-2 interns Participation 2-37 persons served per events Mean = 16 persons per event 0

14 Percent of Persons Tested CMSP Grant: Participation Rates 100.0% 80.0% 96.7% 95.8% 84.6% 94.3% 60.0% 40.0% 20.0% 0.0% CMSP info Rapid Syphilis Test Rapid HCV Test Rapid HIV Test

15 Number Persons Positive CMSP Grant: Persons with Positive Rapid Tests Number of Persons Testing Positive by Test Type and Site Type, Butte County, Homeless SA Treatment RST HIV HCV Rapid Test Type 72% (13) of RST (+) persons had blood draw onsite 5 (28%) RST (+) persons completed treatment

16 CMSP Grant: Age Distribution by Site Type Homeless Service Centers Substance Abuse Treatment Centers > < % 30.0% 20.0% 10.0% 0.0% 0.0% 10.0% 20.0% 30.0% 40.0% Community Health & Sciences Division Protecting the public through promoting individual, community, and environmental health Note: Butte County data presented should be considered preliminary in nature

17 CMSP Grant: Gender Distribution by Site Type Female Male SA Tx Homeless Number of persons served Homeless venues: 29% 55 and older 58% male Community Health & Sciences Division Protecting the public through promoting individual, community, and environmental health Note: Butte County data presented should be considered preliminary in nature

18 Working to Stem the Tide: Summary - MMU services at homeless service and substance abuse treatment venues are well received and attended (incentives help) - Multiple tests are well accepted and efficient - Patient reluctance to have blood drawn for confirmatory testing during outreach - CalREDIE - checking patients history - Follow-up is difficult for those electing to have confirmatory blood collection elsewhere

19 Working to Stem the Tide: Lessons Learned Lessons learned - Need better venues to reach at risk women of childbearing age not yet in substance abuse treatment. - Challenge: political will for outreach in public spaces - Testing at the jail works - Jan Sept tested, 10 (15%) RST (+) positive - Closer partnership to test persons prior to intake medical evaluation to identify more cases

20 Working to Stem the Tide: Adjustments Underway Increasing focus on women of childbearing age - Identify and pilot alternative outreach venues to reach at risk (homeless or drug using) women of childbearing age - Increase partner agency, esp. agencies serving women of childbearing age, and public awareness of importance of syphilis test and treatment - Increase provider awareness to help ensure test & treat - Institute multi-agency case reviews for all CS cases to identify system gaps and opportunities for improvement

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