Washington State’s SSuN Project:
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Washington State’s SSuN Project: Overview and Population Sampling Schema Principal Collaborators Meeting Atlanta, GA December 2009. WA SSuN Overview. Clinic Surveillance Patients seen at Harborview STD Clinic in Seattle Trich Susceptibility Testing King County Public Health Laboratory

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Wa ssun overview

Washington State’s SSuN Project:Overview and Population Sampling SchemaPrincipal Collaborators MeetingAtlanta, GA December 2009


Wa ssun overview

WA SSuN Overview

  • Clinic Surveillance

    • Patients seen at Harborview STD Clinic in Seattle

  • Trich Susceptibility Testing

    • King County Public Health Laboratory

  • Population Surveillance

    • GC patients

    • 39 Counties

    • Random sample

  • Data Quality Assurance


Clinic trich surveillance summary

Clinic & Trich Surveillance Summary

Clinic Surveillance

  • Harborview STD Clinic (Seattle)

  • Data collected for 6,634 patient visits (1/2009 - 9/2009)

  • Core, Standard, Lab and Dx data transmitted

    Trich Resistance Surveillance

  • Women seen at Harborview STD Clinic (Seattle)

  • Started 5/2009

  • Submitted 48 specimens as of 11/15

  • 47 survived and were assayed

  • 6.4% demonstrated in vitro resistance (MLC 50+)


What s happening with gc in wa

What’s Happening with GC in WA?

Gonorrhea Incidence Rate by Census Tract, Washington State, 2008

Gonorrhea Cases and Crude Incidence Rate, Washington State

1992 - 2008


Sampling schema for population based surveillance activities

Sampling Schema for Population-based Surveillance Activities

  • There are two random samples

    • 1. Fixed sample

      • 0.22 sample fraction (22% of all cases) in 25 counties

      • 0.15 sample fraction in King County

    • 2. Variable Sample

      • 0 - 0.50 sample fraction for some jurisdictions

        • Can be changed to reflect staff capacity

  • All GC cases diagnosed are eligible for sampling

  • Sample assigned at the time the case is initially entered into the surveillance system


Sampling schema

Sampling Schema

Imports System.Web.Caching

Public Class Randomizer

Public Shared Function GetRandomObj As System.Random

Dim ha As HttpApplication = HttpContext.Current.ApplicationInstance

Dim cash As Cache = HttpContext.Current.Cache

If ( IsNothing( cash("RandomizerObj") ) ) Then

dim randomObj as New System.Random()

cash.Insert( "RandomizerObj", randomObj, nothing, Cache.NoAbsoluteExpiration, TimeSpan.FromMinutes(20) )

End If

return ctype(cash.Item("RandomizerObj"), System.Random)

End Function

End Class

  • Random number generator returns an integer between 0 and 100

  • The random sample ‘cascades’

    • If Fixed Sample = No

    • Then eligible for Variable Sample

  • Effective sample fraction is increased for jurisdictions with a Variable Sample set at > 0


Sample fractions

Sample Fractions


Phims std data management system screenshots

PHIMS-STDData Management System Screenshots


Assigning the ssun sample

Assigning the SSuN Sample


Overview

Overview


Brief progress report population based surveillance

Brief Progress ReportPopulation-based Surveillance

  • 1,912 eligible GC cases diagnosed through 9/09

    • 516 (27%) randomly selected

    • 350/516 (68%) completed interview

    • Completed interviews comprise 18.3% of all cases diagnosed

  • Test data transferred and reviewed

  • Quality assurance processes in place to assess missing data and provide interviewer feedback


Challenges

Challenges

  • Staff/Interviewer capacity at the local level

  • Diversion of staff resources to H1N1

  • Interviewer turnover & training

  • Finding and organizing metadata for analysis

  • Permanent $ resources to support data/surveillance system

  • Pressure to change existing data systems to conform with SSuN formats (e.g., exposure period of 2 vs. 3 months)

  • Changing standards of care, new protocols, etc.

  • Data collection methods (CASI in clinic, etc.)


Questions

Questions?

Acknowledgements & Contacts:

Mark Stenger, MA

IDRH Assessment Unit,

Washington State Department of Health

[email protected], 360-236-3446

Roxanne Pieper Kerani, PhD

Public Health – Seattle & King Co.

STD Program/Harborview Medical Center

[email protected] , 206-744-8769

Matthew Golden MD, MPH

Director, PHSKC STD Control Program

Associate Professor of Medicine, UW Center for AIDS & STD

Harborview Medical Center

[email protected] , 206-744-6829


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