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Revision of Region II IPP Screening Criteria. May 16, 2007 Region II IPP Advisory Committee Meeting Cicatelli Associates Inc. New York City. Region II IPP Strategic Plan 2005-2009.

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revision of region ii ipp screening criteria

Revision of Region II IPP Screening Criteria

May 16, 2007

Region II IPP Advisory Committee Meeting

Cicatelli Associates Inc.

New York City

region ii ipp strategic plan 2005 2009
Region II IPPStrategic Plan 2005-2009
  • PRIORITY 1: Target/Expand Chlamydia Screening to Young Sexually Active Women and Men at Risk for Infection in Public and Private Settings.
    • GOAL: All at risk men and women under the age of 25 will be screened at least annually.
      • OBJECTIVE 1A: Revise regional screening criteria for females so that screening is targeted to the most at-risk populations by October 2007.
screening workgroup
Screening Workgroup

Members

  • Eileen Crayne (NJ DHSS STD)
  • Debbie Polacek (NJFPL)
  • Jennifer Howard (PPGNNJ)
  • Steve Rubin, Preeti Pathela, and Julie Schillinger (NYC DOHMH STD)
  • Alison Muse (NYS DOH STD)
  • Gale Burstein (Erie County DOH)

Facilitator

  • Kelly Opdyke (CAI - Infrastructure)
region ii minimum selective screening criteria
Region II Minimum Selective Screening Criteria*

Title X Clinics

  • All women ≤ 24 years of age attending the clinic for an initial or annual visit will be screened for chlamydia

STD Clinics

  • All women ≤ 29 years of age attending the STD clinic will be screened for chlamydia

*Region II IPP, 2003 Protocols & Guidelines

current limitations of screening criteria proposed revisions
Current Limitations of Screening Criteria & Proposed Revisions

Areas of Consideration:

  • Client Age
  • Clinic Site Type
  • Pelvic Exam
  • Re-Screening
  • Males
  • Local Prevalence
  • Test Technology
  • Females ≥26 years
criteria client age
Current Limitation

Criteria do not address screening among females age 25 years

age bracket does not correspond with USPSTF or CDC criteria (<26 yrs); clients age 25 omitted

Proposed Revision

Criteria based on national standards

all sexually active females age ≤25 yrs (i.e. <26 yrs)

Includes expanding screening to females age 25 in Family Planning

Criteria: Client Age
criteria clinic site type
Current Limitation

Criteria do not address screening in sites other than STD or FP

Proposed Revision

Criteria no longer specific to site type, but should consider local prevalence data

Criteria: Clinic Site Type
criteria pelvic exam
Current Limitation

Screening contingent on pelvic exam

Proposed Revision

Expanded to include limited service clients (no pelvic exam) using urine-based NAAT

Criteria: Pelvic Exam
criteria re screening
Current Limitation

Criteria do not address re-screening of positives (as per national guidelines)

Proposed Revision

Expanded to include recommendation for re-screening positive females within 3-12 months as per CDC guidelines

Criteria: Re-Screening
criteria males
Current Limitation

Criteria do not address screening of males

Proposed Revision

Provision for screening sexually active young males in high-prevalence settings

Criteria: Males
criteria local prevalence
Current Limitation

Criteria do not address targeted screening based on local prevalence

Proposed Revision

Recommendation for sites to adjust age criteria based on local age-specific prevalence (≥2%)

Criteria: Local Prevalence
criteria test technology
Current Limitation

No mention of preferred diagnostic test methodology

Proposed Revision

Recommendation to use NAAT, as per CDC lab guidelines

Criteria: Test Technology
criteria females 26 yrs
Current Limitation

No guidance on testing in females outside of age criteria

Proposed Revision

Recommendation for clinical considerations for testing females age 26 and over

Criteria: Females ≥26 Yrs
region ii minimum selective screening criteria proposed
Region II Minimum Selective Screening Criteria - Proposed
  • The Region II Infertility Prevention Project Chlamydia Screening Workgroup has developed selective screening criteria for chlamydia based on national recommendations provided by the CDC in the 2006 STD Treatment Guidelines (http://www.cdc.gov/std/treatment/2006/urethritis-and-cervicitis.htm#uc4).
  • Providers should follow CDC guidelines for screening and treating pregnant women.
region ii minimum selective screening criteria proposed15
Region II Minimum Selective Screening Criteria - Proposed

FEMALES

Screening

  • Annually screen all sexually active females ≤ 25 years of age for chlamydia.

Re-Screening

  • All females, regardless of age, should be retested for chlamydia 3 months after being treated for a positive chlamydia test, or when they next present for care within the following 3-12 months.
region ii minimum selective screening criteria proposed16
Region II Minimum Selective Screening Criteria - Proposed

MALES

  • Screening of sexually active young males should be considered in clinical settings with a high prevalence of chlamydia (e.g., adolescent clinics, job corps, correctional facilities, and STD clinics).
recommendations for implementation use of limited resources
Recommendations for Implementation:Use of Limited Resources
  • Programs must consider implementation of these recommendations in relation to program resources, including fiscal, personnel, and technological.
  • The program’s aim should be to achieve the highest level of disease identification within this context.
recommendations for implementation test technology
Recommendations for Implementation: Test Technology
  • Use of highly sensitive and specific NAAT (nucleic acid amplification tests) is strongly recommended (http://www.cdc.gov/std/labguidelines).
  • Use of urine-based NAAT can facilitate non-invasive screening of females who do not require a pelvic exam, as well as males.
recommendations for implementation local age specific prevalence
Recommendations for Implementation: Local Age-Specific Prevalence
  • Sites with an age-specific chlamydia prevalence rate of less than 2% * should consider further targeting screening criteria based on local prevalence data.
  • Conversely, sites with an age-specific chlamydia prevalence rate of greater than 2% * may consider expanding criteria.
  • *Adjusted for laboratory test type.
recommendations for implementation clinical considerations
Risk History

Multiple sex partners in last 90 days

New sex partner in last 90 days

STD infection in past year

Contact to STD

Possible non-monogamous partner

Clinical Findings

Friable Cervix

Mucopurulent Cervicitis

Cervical motion/Tenderness

Pelvic Inflammatory Disease (PID)

Urethritis

New STD diagnosis

Bacterial Vaginosis

Recommendations for Implementation:Clinical Considerations

Testing of females ≥26 years of age with one or more of the following documented risk factors or clinical findings may be clinically indicated:

recommendations for implementation test of cure
Recommendations for Implementation:Test of Cure
  • Except in pregnancy, test-of-cure (repeat testing 3–4 weeks after completing therapy) is not recommended for persons treated with the recommended or alterative regimens, unless therapeutic compliance is in question, symptoms persist, or re-infection is suspected.
rationale
Rationale
  • CDC STD Tx and Lab Guidelines
  • USPSTF Ct screening recommendations
  • NCQA HEDIS measure for Ct screening
  • ACOG Pap guidelines for females <21 yrs
  • California Over 20 Study preliminary findings
  • Regional IPP data on high Ct prevalence among walk-in pregnancy test clients
  • CDC Males Screening Consultation outcomes
breakout groups
Breakout Groups

Pro’s – Con’s

  • Science
  • Promotes Targeted Use of Limited Resources
  • Ease of Implementation
next steps
Next Steps
  • Which of the proposed revisions should be adopted?
  • What are the pros and cons to consider?
  • What other information do we need to move forward?
  • Region II IPP Screening Workgroup.