SSuN Cycle 2 Conference call #5 Population-based gonorrhea surveillance

1. SSuN Cycle 2Conference call #5Population-based gonorrhea surveillance Lori Newman & Kristen Mahle November 13, 2008

2. SSuN Conference Call #5 - Agenda • Misc admin topics • Population-based gonorrhea (GC) surveillance • Objectives • Sampling framework • Data elements • Data transmission • Analysis and use of data

3. Misc Admin Topics • SSuN Collaborator’s Meeting room reservations by Friday, November 14th • Draft meeting agenda sent out • Any feedback? • Scheduling 30 min calls with new sites

4. SSuN: Population-based gonorrhea (GC) surveillance

5. DSTD Goals & Objectives • Goal 1: Prevent STI-related infertility • Objective C: Reduce GC incidence • Goal 6: Reduce STD health disparities • Objective C: Reduce GC in African Americans

6. Rationale for Population-based GC Surveillance • GC rates still far from Healthy People 2010 objectives, but we don’t understand why • Case report data at national level limited to sex, age, race/ethnicity, and crude provider type • Need a better understanding of patients with GC, especially those outside of the STD clinic setting

7. Objectives of Population-based GC Surveillance in SSuN Cycle 1 • Establish network of health departments working collaboratively with standardized methodology • Collect demographic, behavioral, and clinical data on patients with gonorrhea • Monitor trends over time • Use data to guide local, state, and national STD programs and policies

8. SSuN Cycle 1 Methodology – Sampling • Data collected on sample of patients reported with GC in selected counties • Sample excludes patients who attend the primary STD clinic(s) • Phone or in-person interview of first reported patients each month until completed 10 male and 10 female • San Francisco: weekly sample adjusted for non-response for target of 100 men and 100 women per year

9. SSuN Cycle 1 Methodology – Data Transmission • Data transmitted with morbidity data for SSuN counties • Supplement to case reporting, NOT in lieu of • Assessment of representativeness, contact rate, etc. • Data collection initiated between Feb 2006 and Jan 2007 • Initially monthly, now quarterly • Cumulative data file with each transmission • Data stored and transmitted independently of SSuN STD clinic data

10. SSuN Cycle 1 Population Size, Sample Size, and Interview Success Rate

11. Demographics Sexual practices Substance use Partner characteristics HIV history STD history Clinical history Treatment Census tract Patient-provider distance Provider point data SSuN Cycle 1 Methodology - Collaborative Data Elements

12. SSuN Cycle 1: Comparison between STD clinic & population-based data elements • Population-based data elements mirror STD clinic data elements whenever possible • All population questions asked retrospectively (after GC diagnosis made) • Allows for additional questions about provider type, most recent sex partner, spatial data, etc. • No lab data (info obtained from patients)

13. SSuN Data dissemination • Quarterly reports • Data quality review • Data dissemination • Encouragement of joint analyses by local and CDC collaborators • National STD Conference presentations • Overview in OASIS special issue • Ongoing analyses • Single site analysis & dissemination

14. SSuN Data Uses (1) • MN, VA, CO: large numbers of GC patients not informed of GC diagnosis • SF, WA: value in improving provider type categorization • CO: need for additional STD clinic on eastern edge of city • MN: identification & follow-up of HIV-GC co-infection in “real time”

15. SSuN Data Uses (2) • CO & CDC: need to improve following of CDC recommendations in private, non-STD clinic settings • CDC: how to focus GC control strategies? • CDC: what data are useful for program guidance?

16. SSuN Cycle 1 - Limitations • Limited ability to generalize • Only 5 geographic sites and 11 counties • Excludes “primary” STD clinic patients • Possible response bias • Only able to contact ~ 1/3 patients with GC due to poor contact information • Slight variability in methodology between sites since integrated into routine activities • No trends over time available yet • Lengthy interview (~ 8-10 minutes)

17. Moving from SSuN Cycle 1 to Cycle 2……..

18. Do the SSuN Cycle 1 objectives still hold? • Establish network of health departments working collaboratively with standardized methodology • Collect demographic, behavioral, and clinical data on patients with gonorrhea • Monitor trends over time • Use data to guide local, state, and national STD programs and policies

19. Methodology changes? • Sampling population • Non-STD clinic vs. all morbidity? • Sample size • 10 men and 10 women per month? • Data elements • Should we design a shorter interview? • What to delete, add, or change?

20. SSuN Cycle 2: Participating project areas (n=12)How to handle different numbers of counties per project area? Washington . Connecticut Chicago Philadelphia New York City Baltimore San Francisco Colorado Virginia Los Angeles/CA Alabama Louisiana ~ 100 counties: Range: 1 to 61

21. Increasing use and dissemination of population-based data • Quarterly report modifications? • How to foster more multisite analyses? • How to make data more useful for program?

22. Questions & Comments?