EVALUATING AN IPS PROGRAM: ONE PROJECT AREA’S EXPERIENCE

1. EVALUATING AN IPS PROGRAM: ONE PROJECT AREA’S EXPERIENCE NASTAD TECHNICAL ASSISTANCE MEETING REACHING GAY MEN USING THE INTERNET MONDAY, MARCH 30,2009

2. Objective To explain how we evaluated the first 10 months of the Washington, DC, STD Control Program’s Internet-based Partner Notification (IPN) Program.

3. Background • 2005 - evaluated interview records to asses the role of the Internet in syphilis transmission • 2006 - modified STD*MIS to track syphilis patients who used the Internet for sex seeking • 2007 - March - completed our IPN protocol and began notifying partners of early syphilis cases via IPN

4. Risk Factor in STD*MIS 4.0e IPN Dispositions in STD*MIS:

6. Methods Analysis of Field Record STD Disposition Codes • Partners of early syphilis (710, 720, 730) cases with ≥1 Internet partner • March to December 2007

7. “Traditional” STD Disposition Codes A Preventive Treatment B Refused Preventive Treatment C Infected, Brought to Treatment D Infected, Not Treated E Previously Treated for This Infection F Not Infected G Insufficient Information to Begin Investigation H Unable to Locate J Located, Refused Examination K Out of Jurisdiction L Other

8. Methods (cont.) STD Disposition Codes • “Traditional” Codes: A, B, C, D, E, F, G, H, J, K, L • Internet-specific Codes*: • Informed of Syphilis Exposure • Informed of STD Exposure • Not informed/ Unable to Confirm Receipt of E-mail * We created a local field in STD*MIS to capture IPN Disposition Codes.

9. Local Field Modification

10. Local Field Internet Dispositions Indicates Internet used to initiate contact Shows how Internet Partner names are recorded IPN-specific dispositions

11. Methods (cont.) • STD*MIS 4.0e • Microsoft® Office Access 2003 • SAS® 9.1

12. Results 23 early syphilis cases with ≥ 1 Internet partner • 151 Field Records initiated by home visit or telephone • 323 IPN Field Records, as part of 23 syphilis cases • 47 provided physical locating information during investigative period • 276 did not

16. IPN Improved Case Management Indices for 23 Early Syphilis Cases, Wash., DC, 2007 The majority were elicited through Internet

17. Results (cont.) • The aforementioned improved case management indices reflect only 47 of the 323 partners with confirmed follow-up. • 85 of the remaining 276 partners e-mailed or called me to find out more information and likely sought medical attention.

19. Conclusions • Without IPN, over 300 sex partners (within the 10 month evaluation period) would not have been investigated • IPN augments traditional syphilis case management and aids in location, notification, testing, and treatment of partners

20. Questions Discussion

23. IPN Improved Case Management Indices for 11 Cases with ≥2 IPN-initiated Field Records, Washington, DC, 2007

27. Open vs Closed E-mail Systems • Open e-mail systems • E-mails can be sent within and outside of these websites. • E.g., earthlink, aol, yahoo, hotmail. • Assume these can be shared. • Closed e-mail systems • E-mails can be sent only within the website. • E.g., manhunt, adam4adam, men4now. • These are more likely NOT to be shared.

28. N=179 N=99 N=41