Title: Syphilis and HIV screening initiatives in North Carolina jails
1Syphilis and HIV screening initiativesin North
Carolina jails
- Lynne A. Sampson PhD, MPH
- HIV/STD Update
- September 25, 2008
2BackgroundEpidemiology of Syphilis and HIV in
the United States
3Syphilis Reported cases by stage of infection
United States, 19412006
Data from CDC STD Report, 2006
4Primary and secondary syphilis Rates Total and
by sex United States, 19872006 and the Healthy
People 2010 target
Note The Healthy People 2010 target for PS
syphilis is 0.2 case per 100,000 population.
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7Syphilis and HIV Epidemiology
- Mode of transmission
- Synergy
- Subpopulations at risk
- Trade sex for drugs or money
- Use cocaine
- Use injection drugs
- History of incarceration
8Syphilis, HIV and Incarceration
- High prevalence in populations screened in US
jails and prisons - Syphilis
- Women 1 22
- Men lt1 6
- HIV
- Women 1 26
- Men 1 16
- Associated with behaviors that are associated
with incarceration - Trading sex for drugs or money
- Use of illegal drugs, especially cocaine
(syphilis) and injection drug use (HIV)
9Why Screen in Jail?
- Risk profile of current cases
- Population outside of health care system
- Revolving population (50 bond out in less than 2
days) - Available for education and treatment
10Characteristics of Jails Prisons
11North Carolina Screening Projects
12HIV and Early Syphilis (PSEL) rates in NC
13CDC National Plan to Eliminate Syphilis
- 1998 CDC identified 28 US Counties that
reported over 50 of ALL PS Syphilis Cases in US - 5 of these Counties are in NC (Forsyth, Guilford,
Mecklenburg, Robeson, Wake) - Durham added to SEP effort by State of NC
- All 6 Targeted for Elimination
- US PS cases lt1000 and 90 US Counties reporting
no new cases by 2005 - Not reached (in 2004 US PS cases n7,980)
14NC Reported Early Syphilis (PSEL) Cases
15PSEL Rates in SEP Counties
16NC Syphilis Elimination Jail Screening Program
- Screen for syphils (n7 jails) and HIV (n2
jails) - Screening staff access inmates in the jail and
offer education and screening - Risk questionnaire
- Blood sample(s) for testing
- Data linked to surveillance records to determine
case status and stage of syphilis infection
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18Syphilis Analysis
- Study population
- Male and female inmates screened for syphilis in
7 NC jails 2002-2005 (n24,010) - Outcome
- new syphilis case
- Descriptive Analyses
- Frequencies, distributions, missing values
- Demographic, risk factors, outcomes
- Unadjusted OR and 95 CI for each covariate and
outcome
19Syphilis Analysis
- Modeling
- Logistic regression for clustered data to account
for multiple observations for individuals - Separate models for males and females
- Reference Model
- Variables with bivariate associations p? 0.25
- Other variables from literature
- Reduced Model
- Backward elimination
- Examine area under ROC curves to assess change
- Goal is to achieve parsimonious, easy to use model
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22HIV Analysis
- Study population
- M/F inmates screened for syphilis in 2 NC jails
2002-2005 - Include only first observation for each
individual - Outcome
- HIV infection, new syphilis case, either
infection - Descriptive Analyses
- Frequencies, distributions, missing values
- Demographic, risk factors, outcomes
- Unadjusted OR and 95 CI for each covariate and
outcome
23HIV Analysis
- Modeling
- Multivariable logistic regression
- Single model that includes gender
- Reference Model
- Variables with bivariate associations p? 0.25
- Other variables from literature
- Reduced Model
- Backward elimination
- Examine area under ROC curves to assess change
- Goal is to achieve parsimonious, easy to use model
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27Summary of Analyses
- Syphilis
- Screened women much more likely to have new
syphilis cases - Difficult to predict risk among women
- Among men, STD history, race/ethnicity, and age
are associated with new syphilis cases - HIV
- Women and men who have sex with men much more
likely to be infected with HIV - HIV testing history, race/ethnicity, and age are
associated with HIV infection
28New Directions
- Funding sources for jail screening have changed
radically - Syphilis Elimination funds decreased
- Expanded HIV Testing funds now available
- Expansion of original SEE screening projects to
include new jails - Plan to use previous data to inform new screening
efforts