Innovative STD Screening Projects in

Indian Country

Lori de Ravello, MPHCDC Assignee

National STD ProgramIndian Health Service

May 9, 2006

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Objective

To describe AI/AN-focused STD screening projects

developed by IHS and Tribal health programs

Screening Venues

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

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

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

Chlamydia Positivity, by sex

0

1

2

3

4

5

6

7P

erce

nt

Total Female Male

Chlamydia Positivity, by age

0

1

2

3

4

5

6

7

8

9

Perc

en

t

Total 14 15 16 17 18

Evaluation Findings(80% response rate, 5-point scale)

Information was adequate and helpful 4.1

Testing at school a good idea 4.3

Screening procedure was private 4.2

Giving of results was private 4.3

Want to see repeated 83%yes

Received info on how to contact nurse 70% yes

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

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

Site 1 - Number of Chlamydia Tests, by sex and year

0

200

400

600

800

1000

1200

1400

1600

1800

1998 1999 2000 2001 2002

Nu

mb

er

Women Men (FF)

Site 1 - Chlamydia Positivity, by sex, 1998-2002

0

2

4

6

8

10

12

14

16

1998 1999 2000 2001 2002

Per

cent

Women FF (men)

Site 1 – Chlamydia Positivity, by age and sex, 2002

0

5

10

15

20

10 to 14 15 to 19 20 to 24 25 to 29 >29

Per

cen

t

Women FF (men)

Site 2 - Number of Chlamydia Tests, by sex and year

0

100

200

300

400

500

600

700

1998 1999 2000 2001 2002

Nu

mb

er

Women Men (FF)

Site 2 – Chlamydia Positivity, by sex, 1998-2002

02468

101214161820

1998 1999 2000 2001 2002

Per

cen

t

Women FF (men)

Site 2 – Chlamydia Positivity, by age and sex, 2002

0

5

10

15

20

25

10 to 14 15 to 19 20 to 24 25 to 29 >29

Perc

en

t

Women FF (men)

Community-Based Outreach

Large southwestern tribe Ongoing syphilis outbreak since

2001 Screening interventions in

community: Local bars Busy commercial areas Community fairs

2004 Syphilis Screening Data

Event Total RPRs Reactors New Cases

1 63 3 1

2 41 1 1

3 25 0 0

4 65 1 0

5 44 0 0

Total 238 5 2

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

Tribal Jail Screening Results

0

50

100

150

200

250

300

350# A

rreste

es

NewInmates

OfferredScreening

AcceptedScreening

PositiveResults

Total Male Female

314300

14

268254

14

114 112

2 0 0 0

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

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