Development of a STI Clinic-based Surveillance System in British Columbia Presenter: Jason Wong Co-authors: Daphne Ling, Naveed Janjua, Stanley Wong, Mel Krajden, Linda Hoang, Muhammad Morshed, Melanie Achen, Michelle Murti, Richard Lester, Gina Ogilvie, Mark Gilbert May 1 26, 2015
Surveillance of STIs in BC Case report forms (Chlamydia, gonorrhea, syphilis) 2
Current gaps in STI surveillance Difficulties monitoring trends in key subgroups 65% completion rate of gender of sexual partners 61% completion rate of ethnicity Unable to examine trends for non-reportable STIs e.g. genital warts, genital herpes Inability to answer key questions of public health and clinical relevance Identify core groups that are contributing most to STI transmission Impact of changes in testing frequency and testing patterns 3
STI clinic sentinel surveillance for BC Information from STI clinics (sentinel sites) may address these gaps Less costly and more efficient compared to cohort studies for estimating long-term disease rates and trends Used in other jurisdictions (e.g., surveillance GUM clinics in the UK) In BC, many public health STI clinics and outreach programs use a common EMR system (STI-IS) 4
Objectives 1. Evaluate feasibility of a sentinel site surveillance system 2. Describe STI trends in BC using data from a sentinel site surveillance system 5
1. Feasibility Assessment 6
Clinic Selection Over 25 clinics and outreach programs identified 15 STI clinics and outreach program had >75 visits/year and were selected for inclusion 7
Clinic Locations Notes: Kamloops, Kelowna, and Penticton in STI- IS up to 2011; Health Initiative for Men (HIM) joined STI- IS in 2010 8
Characteristics of STI clinic data, 2000-2013 Total visits 170,407 Unique clients 94, 542 No. visits per client, mean (range) 4 (1-75) Age, median (IQR) 31 (25-40) Health Region Fraser 9,595 (6%) Interior 12,525 (7%) Northern 10,176 (6%) Vancouver/BCCDC 134,896 (79%) Vancouver Island 3,215 (2%) 9
Characteristics of STI clinic data, 2000-2013 Gender Male 118,400 (69%) Female 51,311 (30%) Transgender 678 (<1%) Gender of Sexual Partners Heterosexual male 63,732 (37%) Gay, bisexual, or other men who have sex with men 47,170 (28%) Heterosexual female 45,471 (27%) Women who have sex with women 889 (1%) Unknown 13,145 (8%) 10
Data Quality, 2000-2009 11
Summary Data quality was good Key fields are well-completed Received approval from clinics/regional health authorities to include in a sentinel site surveillance system 12
2. Application of system 13
Demonstration Using Diagnosis Rate Describe reportable and common non-reportable STIs Stratified by gender of sexual partners from 2000-2013 WSW excluded due to small numbers DDDDDDDDDDDDDDDDDD rrrrrrrr = # oooo uuuuuuuuuuuu cccccccccccccc wwwwwwww + vvvv tttttttt iiii tttttttt yyyyyyyy TTTTTTTTTT # oooo tttttttttt (oooo vvvvvvvvvvvv) iiii tttttttt yyyyyyyy 14
Diagnosis Rate for Syphilis, 2000-2013 40 35 Diagnosis Rate (per 1000) 30 25 20 15 10 5 0 Heterosexual males MSM Heterosexual females 15
Diagnosis Rate of HIV, 2004-2013 35 30 Diagnosis Rate (per 1000) 25 20 15 10 5 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Heterosexual males MSM Heterosexual females 16
Diagnosis Rate of Chlamydia, 2000-2013 120 100 Diagnosis Rate (per 1000) 80 60 40 20 0 Heterosexual males MSM Heterosexual females 17
Diagnosis Rate of Gonorrhea, 2000-2013 120 100 Diagnosis Rate (per 1000) 80 60 40 20 0 Heterosexual males MSM Heterosexual females 18
Diagnosis Rate of HCV, 2000-2013 Diagnosis Rate (per 1000) 90 80 70 60 50 40 30 20 10 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Heterosexual males MSM Heterosexual females 19
Diagnosis Rate for Genital Warts, 2000-2013 70 Diagnosis Rate (per 1,000) 60 50 40 30 20 10 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Heterosexual males MSM Heterosexual females 20
Diagnosis Rate for Genital Herpes, 2000-2013 60 Diagnosis Rate (per 1000) 50 40 30 20 10 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Heterosexual males MSM Heterosexual females 21
Summary Trends for some STI/BBI differ by sexual exposure category Rates may be influenced by changes in testing patterns Screening for HCV among MSM starting 2011 Screening for extra-genital Chlamyida/gonnorhea STOP HIV program 22
Conclusion Improves understanding of trends in key groups Longitudinal chart allows other calculations (e.g. incidence, prevalence) Permits evaluation of other questions e.g. trends in genital warts in HPV-vaccinated cohorts; e.g. HIV incidence among MSM, stratified by risk behaviour Intention to develop ongoing reporting for trends 23
Acknowledgements Regional Health Authorities FH: Christine Halpert, Victoria Lee, Amrit Rai, Heather Winnichuk IHA: Jeanie Fraser, Lorena Hiscoe, Lori McClenaghan, Sue Pollock Island Health: Brett Hodson, Dee Hoyano, Audrey Shaw, Jan Tatlock NHA: William Osei, Mary Margaret Proudfoot Community Organizations HIM: Wayne Robert BCCDC CPS Epidemiology and Surveillance: Lola Falasinnu CPS STI Clinics: Natalie Holgerson 24