STDs in STDs in Houston/Harris Houston/Harris County County - PowerPoint PPT Presentation

STDs in STDs in Houston/Harris Houston/Harris County County Trends Trends Interventions Interventions Emerging Issues Emerging Issues 1 1

Reportable STDs Reportable STDs Chlamydia Chlamydia Chlamydia Chancroid Chancroid Chancroid Gonorrhea Gonorrhea Gonorrhea HIV/AIDS HIV/AIDS HIV/AIDS Syphilis Syphilis Syphilis 2 2

Why are STDs Important? Why are STDs Important? Facilitate Transmission of HIV Infection Facilitate Transmission of HIV Infection Cause Infertility Cause Infertility Cause PID Cause PID Adverse Outcomes on Pregnancy Adverse Outcomes on Pregnancy 17 Billion Dollar Cost Annually in USA 17 Billion Dollar Cost Annually in USA 3 3

Emerging Issues Emerging Issues Syphilis Outbreaks Syphilis Outbreaks HIV Co- -Infection Infection HIV Co Resurgence in Risky Behavior Resurgence in Risky Behavior Partner Services Innovation Partner Services Innovation Internet and STDs Internet and STDs Hepatitis Hepatitis 4 4

How Are We Doing in How Are We Doing in Houston? Houston? In 2002, Houston Ranked: In 2002, Houston Ranked: 48th- - Chlamydia (346.1/100,000) Chlamydia (346.1/100,000) 48th 45th- - Gonorrhea (153.9/100,000) Gonorrhea (153.9/100,000) 45th 31st- - P&S Syphilis (3.3/100,000) P&S Syphilis (3.3/100,000) 31st 5 5

Chlamydia Chlamydia EPIDEMIOLOGY EPIDEMIOLOGY 6 6

Chlamydia: Crude Rate No. Rate 14000 400 350 12000 12144 11793 11499 11304 300 10635 10000 10443 Rate Per 100,000 250 9092 8000 Cases 8018 200 6000 150 4000 100 2000 50 0 0 1995 1996 1997 1998 1999 2000 2001 2002 7 7

Chlamydia: U.S. to Houston 400 US Houston 350 300 Rate per 100,000 250 200 150 100 50 0 1995 1996 1997 1998 1999 2000 2001 8 8

Chlamydia: Gender-Specific Rates 12000 700.0 Female No. Male No. Male Rate Female Rate 600.0 10000 500.0 8000 Rate per 100,000 Number of Cases 400.0 6000 300.0 4000 200.0 2000 100.0 0 0.0 1995 1996 1997 1998 1999 2000 2001 2002 9 9

Chlamydia: Average (1995-2001) Rates by Age 3500 3000 2500 Male Female Rate per 100,000 2000 1500 1000 500 0 15-19 20-24 25-29 30-34 35-39 40-44 >44 10 10

Chlamydia: Percent of Cases Identified 1800 1600 1400 2001 2002 1200 1000 Cases 800 600 400 200 0 City STD City Family Teen Clinics District Clinics County Jail Planning/Maternity Clinics/County Family Planning 11 11

Gonorrhea Gonorrhea EPIDEMIOLOGY EPIDEMIOLOGY 12 12

Gonorrhea: Crude Rate 8000 250.0 No. Rate 7000 7191 7164 200.0 6633 6000 6046 6033 5905 5501 5000 5243 Rate per 100,000 150.0 Cases 4000 100.0 3000 2000 50.0 1000 0 0.0 1995 1996 1997 1998 1999 2000 2001 2002 13 13

300 Gonorrhea: U.S. to Houston U.S Houston 200 Rate per 100,000 100 0 1995 1996 1997 1998 1999 2000 2001 14 14

Gonorrhea: Gender-Specific Rates 4500 300.0 Male No. Female No. Male Rate Female Rate 4000 250.0 3500 3000 200.0 Rate per 100,000 Number of Cases 2500 150.0 2000 1500 100.0 1000 50.0 500 0 0.0 1995 1996 1997 1998 1999 2000 2001 2002 15 15

Gonorrhea: Average (1995-2001) Rates by Age Group 1200 1000 Male Female 800 Rate per 100,000 600 400 200 0 15-19 20-24 25-29 16 16

Gonorrhea: Percent of Total Cases from Providers 2001 2002 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% City STD Clinics Private Clinics & HMOs All other Sites 17 17

Syphilis Syphilis EPIDEMIOLOGY EPIDEMIOLOGY 18 18

Syphilis Syphilis Houston/Harris County Houston/Harris County Syphilis: Crude Rate 3000 90.0 80.0 2500 70.0 No. Rate 2000 60.0 Rate per 100,000 50.0 Cases 1500 40.0 1000 30.0 20.0 500 10.0 0 0.0 1995 1996 1997 1998 1999 2000 2001 2002 19 19

Syphilis Syphilis Houston/Harris County vs vs U.S. U.S. Houston/Harris County Syphilis: U.S. to Houston 90 U.S Houston 80 70 Rate per 100,000 60 50 40 30 20 10 0 1995 1996 1997 1998 1999 2000 2001 20 20

Syphilis: Primary and Secondary Syphilis: Primary and Secondary Houston/Harris County Houston/Harris County Syphilis: Primary and Secondary Houston/Harris County 1995-2002 450 400 350 Number of Cases 300 250 200 150 100 50 0 1995 1996 1997 1998 1999 2000 2001 2002 21 21

HDHHS HDHHS STD Interventions STD Interventions Screening Screening Treatment Treatment Education Education Counseling Counseling Partner Services Partner Services 22 22

Screening Screening Syphilis, gonorrhea, chlamydia chlamydia, , hep hep Syphilis, gonorrhea, C,HIV testing in 3 STD clinics C,HIV testing in 3 STD clinics Family Planning (no hep hep C) C) Family Planning (no Prenatal (no hep hep C) C) Prenatal (no Outreach Contractors (no gc) Outreach Contractors (no gc) 23 23

Screening Screening Mobile Unit Outreach testing Mobile Unit Outreach testing Collaboration with CBOs CBOs in outreach in outreach Collaboration with Bookstores, Bath houses, streets, bars Bookstores, Bath houses, streets, bars Mobile clinic planned for 2003 Mobile clinic planned for 2003 Jail tanks Jail tanks Key HIV providers encouraged to test Key HIV providers encouraged to test Contracts with 7 CBOs CBOs to do screening to do screening Contracts with 7 24 24

Treatment Treatment 3 STD Clinics 3 STD Clinics Some treatment in Family Planning and Some treatment in Family Planning and Maternity Clinics except for syphilis Maternity Clinics except for syphilis Facilitate treatment with private Facilitate treatment with private providers - - provide some meds provide some meds providers Facilitate treatment with Harris Co. Jail Facilitate treatment with Harris Co. Jail 25 25

Treatment Treatment DOT for chlamydia chlamydia DOT for Recommend epi epi profile based preventive profile based preventive Recommend treatment around syphilis outbreak treatment around syphilis outbreak Encouraging stat RPR testing around Encouraging stat RPR testing around outbreak outbreak Hope to provide on site treatment on Hope to provide on site treatment on mobile clinic in 2003 mobile clinic in 2003 26 26

Vaccine Vaccine Hepatitis B vaccine in STD clinics Hepatitis B vaccine in STD clinics Plans for Hep Hep A vaccine in STD clinics A vaccine in STD clinics Plans for 27 27

Education Education 9 Health Educators trained in STDs 9 Health Educators trained in STDs CDBG health ed in K- -12; and in K 12; and in K- -12 12 CDBG health ed in K HIV/STD Infoline Infoline HIV/STD Contracts with 23 CBOs Contracts with 23 CBOs for education for education Work with CPG to emphasize STDs Work with CPG to emphasize STDs Provider alerts, media alerts, provider training Provider alerts, media alerts, provider training Expanding education to web sites, chat rooms Expanding education to web sites, chat rooms 28 28

Counseling Counseling Clinicians Clinicians DIS DIS Contractors Contractors 29 29

Partner Services Partner Services DIS provide partner referrals and DIS provide partner referrals and notification for syphilis and HIV notification for syphilis and HIV Some chlamydia chlamydia and gonorrhea and gonorrhea Some Clustering and social network outreach Clustering and social network outreach Counseling and testing contractors Counseling and testing contractors 30 30

Partner Services Partner Services Pursuing web based self- -interview interview Pursuing web based self Self- -referral through internet/email referral through internet/email Self DIS Liaison with Key Providers DIS Liaison with Key Providers Working with CBOs CBOs on training DIS and on training DIS and Working with DIS on training CBOs CBOs to improve and to improve and DIS on training promote partner notification promote partner notification 31 31