Innovative STD Screening Projects in Indian Country

1
Innovative STD Screening Projects in Indian
Country

• Lori de Ravello, MPH
• CDC Assignee
• National STD Program
• Indian Health Service
• May 9, 2006

2
Objective

• To describe AI/AN-focused STD screening projects
  developed by IHS and Tribal health programs

3
Screening Venues

• School-Based Screening
• Seasonal Firefighter Exams
• Community Outreach
• Jail-based

4
School-Based Screening

• Public High School (grades 9-12) on a small
  Northern Plains reservation
• STD 101 session followed by voluntary urine-based
  chlamydia and gonorrhea screening
• All students seen for 1-on-1 follow-up
  counseling, regardless of result
• Positives referred for usual partner services

5
Results of School-Based Screening

• 67 (388/577) attended STD 101
• 95 (367/388) accepted specimen cup
• 73 (269/370) provided specimen
• 5 overall chlamydia positivity
• 0 gonorrhea

6
Chlamydia Positivity, by sex
7
Chlamydia Positivity, by age
8
Evaluation Findings(80 response rate, 5-point
scale)
9
Seasonal Firefighter Exams

• Popular job option in rural areas
• Annual physical exam required
• Some health facilities voluntarily include
  chlamydia screen
• Data compare women screened or tested in clinic
  and male firefighters (FF) screened at physical

10
Sites

• Site 1
• Located in western U.S.
• IHS facility
• Began CT screening of FFs in 1998
• In 2002 ran 1800 CT tests
• Site 2
• Also located in western U.S.
• Tribal facility
• Began CT screening of FFs in 1999
• In 2002 ran 812 CT tests

11
Site 1 - Number of Chlamydia Tests, by sex and
year
12
Site 1 - Chlamydia Positivity, by sex, 1998-2002
13
Site 1 Chlamydia Positivity, by age and sex,
2002
14
Site 2 - Number of Chlamydia Tests, by sex and
year
15
Site 2 Chlamydia Positivity, by sex, 1998-2002
16
Site 2 Chlamydia Positivity, by age and sex,
2002
17
Community-Based Outreach

• Large southwestern tribe
• Ongoing syphilis outbreak since 2001
• Screening interventions in community
• Local bars
• Busy commercial areas
• Community fairs

18
2004 Syphilis Screening Data
19
Jail-Based Syphilis Screening Pilot Project

• Large southwestern reservation
• Syphilis outbreak since 2001
• Large tribal jail
• 2004 Epi Aid determined many cases passed
  through jail
• 6-month pilot project
• STD 101 followed by screening

20
Tribal Jail Screening Results
314
300
268
254
114
112
14
14
0
0
0
2
21
Conclusions

• A variety of promising screening interventions
  being done in Indian Country
• Yield of positive cases varies
• Effort required may not be offset by yield
• How to factor in other screening benefits (e.g.
  community awareness)
• Further efforts are needed to evaluate and
  improve screening activities in Indian Country

22
Acknowledgements

• CDC
• David Wong
• Lydia Blasini-Alcivar
• IHS
• James Cheek
• Pam McCloud
• Sandeep Patel

• Tribal Health
• Janet Runnion
• Larry Foster
• Mae Gilene Begay
• State Health Dept.
• Susie Zantos
• IPP
• Yvonne Hamby