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Wisconsin State Report RVIPP Meeting June 24-25, 2009 Highlight Updates

Wisconsin State Report RVIPP Meeting June 24-25, 2009 Highlight Updates. Screening Projects Get Yourself Tested Update Prevalence Evaluation Clinical Services School Based Clinics EPT Update Medicaid Waiver Update Miscellaneous Juvenile Detention Text Messaging Project

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Wisconsin State Report RVIPP Meeting June 24-25, 2009 Highlight Updates

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  1. Wisconsin State ReportRVIPP Meeting June 24-25, 2009Highlight Updates • Screening Projects • Get Yourself Tested Update • Prevalence Evaluation • Clinical Services • School Based Clinics • EPT Update • Medicaid Waiver Update • Miscellaneous • Juvenile Detention Text Messaging Project • Quality Assurance Activities for Family Planning SSC • State Furlough

  2. Get Yourself Tested Update • GYT campaign • National Collaboration with Planned Parenthood, MTV, Kaiser Family Foundation and CDC • WI STD Control Section and SLH partnered with this effort to conduct a prevalence evaluation (6th effort to evaluate prevalence since 1986) • Included a supplemental form to indirectly assess risk through a Clinician Survey

  3. Get Yourself Tested Update • Patient Visits to all 26 PPW Clinics April 2009 • 7760: includes 3072 Exams & 4688 Fast Track visits • 3241 CT tests (42% of patients tested) • Compare to ~2500 tests done during a more typical month of testing at PPW clinics • 3217 GC tests (41% of patients tested) • 2960 Supplemental Risk forms submitted • 87 known PTO visits (11.5% positive; 10/87)

  4. Get Yourself Tested Update • Positivity Results • Overall Positivity: • 8.7% CT (281/3241) • 1.4% GC (44/3217) • Females: • 6.9% CT (188/2725) • .8% GC (21/2701) • Males: • 18% CT (93/516) • 4.5% GC (23/516)

  5. Get Yourself Tested Update Question to RVIPP Partners: 1. What was your GYTexperience in your state?

  6. Screening Projects • Prevalence Evaluation • Universal screening in all 26 WI PPW clinics for chlamydia and gonorrhea • All sexually active males and females • In conjunction with April National STD Awareness Month and the GYT campaign

  7. Prevalence Evaluation Clinician Survey Questions “Would you have tested outside SSC if patient did not meet current SSC and why”: • Concern about partners from high- prevalence areas • Risks exist outside the timeframe specified by SSC • Concern about reliability of history info provided _________________________________________ • Patient is a “Pregnancy Test Only” • Patient came into the clinic because of the STD Awareness Campaign

  8. Prevalence Evaluation Preliminary Analysis:John Pfister & Bobbie McDonald • Can April PPW data represent non-PPW clinics in WI for re-evaluation of SSC? • How do non-PPW population demographics compare to April PPW test data • PTO- implement universal PTO testing (if high% of PTO from April meet SSC) vs. active future assessment of PTO for SSC

  9. Prevalence Evaluation“Supplemental SSC” Questions 1. Does patient meet current WSLH Screening Criteria for:  1a. CT? Yes  No  1b. GC? Yes  No 2. If NO to 1a. or 1b. above, would you have tested the patient outside SSC for:  2a. CT? Yes  No  2b. GC? Yes  No 3. If Yes to 2a. or 2b. above, what are your reasons for testing? (Mark all that apply)  Yes  No Concern about partners from high-prevalence areas (What area? _________________________ )  Yes  No Risks exist outside the timeframe specified by SSC  Yes  No Concern about reliability of history info provided  Yes  No Other reasons: _______________________________ --------------------------------------------------------------------------------------------------------  Yes  No Patient is a “Pregnancy Test Only” Patient  Yes  No Patient came into the clinic because of the STD Awareness Campaign

  10. Prevalence EvaluationRoutine SSC Questions CHLAMYDIA Females • Sex Partner Risk • Contact • Symptomatic • History of STD (NOT “Test of Cure”) • Protocol (pre-IUD) Testing • Prenatal For AUTHORIZED clinics only: • Special Age Criteria Males • Contact • Symptomatic • Positive LET [circle: Trace 1+ 2+] • NO Chlamydia Criteria Met • GONORRHEA • “Level 1” Clinics: Females & Males -- Contact -- Symptomatic -- Currently Positive for Chlamydia -- History of STD (NOT “Test of Cure”) • “Level 2” Clinics: Females & Males -- Contact (to known/self-reported GC infection) -- Symptomatic (suggestive of GC) -- Currently Positive for Chlamydia • -- NO Gonorrhea Criteria Met

  11. Prevalence Evaluation Early Limitations • Short lead-up time, short training • A lot of misunderstanding of the additional SSC questions. • Many unanswered questions on forms • No way to track refusals

  12. Prevalence Evaluation Preliminary Data • 3241 specimens received in April (PPW) • Approximately 1200 ‘additional’ specimens as compared to ‘regular’ month • About 1200 extra CT, 2000 extra GC tests • 3008 specimens received with supplemental SSC form (2961 valid forms) • ~40 blank forms (name only) received • Lost a few others due to other issues

  13. Prevalence Evaluation Preliminary Results: Basic Positivity • As compared to March 09, approximately 60 additional CT positives detected (5%) • CT positivity March = 7.9%, April = 7.5% • Compared to March 09, no ‘additional’ GC positives detected (~2000 extra tests) • GC positivity March = 2.7%, April = 1.4%

  14. Prevalence Evaluation Results: Basic Positivity by Gender • 2728 Females • 1823 Cx swabs: 5.5% CT+; 0.7% GC + • 905 Urine: 9.7% CT+; 1.0% GC + • 516 Males • All urine, 18.0% CT+; 4.5% GC +

  15. Prevalence Evaluation Preliminary Results: SSC and Positivity • Females: • 67% met current CT SSC, 8.3% + CT (83% of all CT positives; 3.4%+ CT off SSC) • 20% met GC SSC, 2.0%+GC (56% of GC positives; 0.4%+ off SSC) • Males: • 46% met current CT SSC, 29.9%+ CT (79% of CT positives; 6.8%+ CT off SSC) • 25% met GC SSC, 15.7%+ GC (78% of GC positives;1.4% +GC off SSC)

  16. Prevalence Evaluation Preliminary Results: PTO = “Yes” • 87 Specimens received from 15 clinics • 38 from 2 SE WE sites (2 positive CT/ 0 GC) • 23 from 4 Milwaukee sites (5+CT/1+GC) • 26 remaining, 3+CT, 2 from Madison • 11 sites sent no PTO specimens • Low uptake in most clinics raises questions • Is there sufficient positivity in PTO to warrant screening independent of SSC? • Can SSC be applied to these specimens? • Can we improve uptake?

  17. Prevalence Evaluation • We have only just begun analyzing data! • Important Questions to address include: • Can adjustments to the SSC improve performance? • How well did providers do at selecting who they would test off SSC? • Can any risk factors be found for the few GC positives detected off SSC? • How useful are results to the rest of FP?

  18. Prevalence Evaluation Lessons Learned • More time spent on training would be worthwhile, even if lead time is short • Lab capacity was more limited by support issues (data entry, accessioning, etc.) than by testing (though there is a limit!) • Anything is possible. ;) QUESTIONS?

  19. Clinical Services • School Based Clinics (Aurora) • 15 clinics in Milwaukee schools • Students take Youth Student Risk Assessment • Offer testing for ct/gc/HIV/Herpes if come in for sports physicals, student request or if symptomatic • If positive, treated and partner f/u initiated through LHD • Working on enabling pick up of condoms at alternate site (not yet acceptable practice in high school) and referred for further reproductive health care f/u

  20. Clinical Services • Results • Testing since mid-Dec 2008 (~6 months) • 100 specimens (tested for CT and GC): • 80 females: CT 10% (8/77) GC 0% (0/76) • 16 males: CT & GC 0% • Next Steps • Develop a risk form/Broaden screening • Address delivery/referral of condoms/ birth control, treatment and partner f/u

  21. Clinical Services • EPT Update • Wisconsin Medical Examining Board (MEB) position paper adopted by the board • Supports EPT as standard of care for STD Rx whose partners are not available or agreeable to direct examination and supports the passage of legislative authority to authorize provision of EPT Rx by WI licensed physicians • STD Control Section to develop a ‘white issue paper’ for the fall legislative agenda • WFPRHA working with a legislator interested in EPT to promote this bill • Medicaid Waiver Update • Waiver for males is in budget and on track for approval

  22. Miscellaneous • JDC Project • Use of text messaging to increase post-release treatment for CT and GC • Wisconsin MAHP signed MOU and started pilot in June • QA issues for SSC in WI Family Planning • Monitor on/off criteria testing & positivity vs. sentinel universal screening as strategic approach to re-evaluate SSC • Evaluate low positivity clinics for ‘success’ in reducing morbidity and adjustment of SSC for lower prevalence population

  23. QA Issues 2008 Chlamydia Screening in WI FP Clinics • Non-PPW FP • 87.4% of females tested followed established SSC: 6.1% positivity (636 ÷ 10,489) • Test Cost per Positive: $800 ($508,717 ÷ 636) • Positivity range in FP clinics: 1.5%* to 13.9% Median: 6.8% • 12.6% of females tested did not follow established SSC: 2.3% positivity (34 ÷ 1,510) • Test Cost per Positive: $2,154 ($73,235 ÷ 34) • The ratio of male tests to female positive tests was 1.9 to 1, or 2 male tests for every 1

  24. QA Issues PPW Clinics • 90.5% of females tested followed established SSC: 8.6% positivity (1,728 ÷ 20,197) • Test Cost per Positive: $567 ($979,555 ÷ 1,728) • Positivity range in PPW clinics: 4.1% to 16.3% Median: 7.4% • 9.5% of females tested did not follow established SSC: 2.6% positivity (55 ÷ 2,129) • Test Cost per Positive: $1,877 ($102,257 ÷ 55) • The ratio of male tests to female positive tests was 2 to 1, or 2 males tests for every 1 female positive test. (3,555 male tests ÷ 1,783 female positive tests).

  25. QA Issues Feedback for QA/QI: • Clinic-specific reports are sent to family planning clinics • On-criteria testing has significantly improved.

  26. Miscellaneous • Treatment Performance Measure • Providers are still using Cipro for GC (no longer recommended): should this beconsidered inadequate treatment in PM? • State Furlough • All state employees 8 days per year for next two years

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