MHRA/IPP clinic contribution to Chlamydia cases reported in NYC

Preeti Pathela

Bureau of STD Control

ppathela@health.nyc.gov

Objective

Develop neighborhood profiles that quantify the contribution that IPP sites (NYC BSTDC and MHRA) make to the overall burden of

disease estimates for chlamydia at the neighborhood level

Methods

• Review of data collected since the adoption of NAATs (early 2003 for most sites).

• Compared proportion of cases that came from BSTDC and MHRA sites compared to other sources (private sector physicians and hospitals).

Questions

• Are BSTDC and MHRA clinics serving the neighborhoods with the highest rates of disease?

• Are there neighborhoods in which private providers, CBOs, and other health facilities can take a more active role in providing Ct testing and treatment?

2005 data• 39,215 Ct cases citywide (12,242 male; 26,946 female)

-2000 -1000 0 1000 2000 3000 4000

Ag

e (

years

)

Case rate per 100,000 population

* Excludes persons with unknown sex or unknown age.

Chlamydia reported to the NYC DOHMH. Case rates (per 100,000 population) by age and sex* , full year 2005.

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

N=361

N=549

N=1038

N=1913

N=4322

N=9055

N=8901

N=270

N=157

N=86

N=37

N=50

N=58

N=2570

N=4118

N=2514

N=1373

N=725

N=426

N=183

N=76

N=31

N=11

N=52

1000 2000

Reporting Providers

Private71%

Correctional10%

STD Clinics13%

Juvenile detention1%Outreach/MIC

5%

2005 Ct case rate map (females)

2005 Ct case rate map (males)

NYC neighborhoods with highest Ct case rates

Patient residence No. of cases

Case rate/100,000 population

Crown Heights 3310 1043.2

Greenwich Village 817 976.0

East New York 1643 945.8

East Flatbush 2821 890.7

Central Harlem 1320 873.5

NYC neighborhoods with highest Ct case rates

Patient residence

No. of cases

Case rate/ 100,000

population

MHRA/IPP funded clinics?

% MHRA/IPP-contributed

cases

Crown Heights 3310 1043.2 √ 20.9%

Greenwich Village

817 976.0 18.0%

East New York 1643 945.8 17.1%

East Flatbush 2821 890.7 18.3%

Central Harlem 1320 873.5 √ 35.8%

Of all 42 NYC neighborhoods, Central Harlem had the largest proportion of cases reported by MHRA Title X / IPP Region II–funded sites

Conclusions

• The majority of cases contributing to the high rate in Greenwich Village come from a detention house located there.

• The majority of cases contributing to the high rates in the other top neighborhoods are reported by private providers.

Conclusions (cont.)

• Assumptions: – Since there are large numbers of cases in certain

neighborhoods of Brooklyn, there are many more infected, undiagnosed persons in the surrounding Brooklyn neighborhoods (e.g., Downtown Brooklyn) with lower rates of reported disease.

– Lower rates in these areas may not be due to less disease, but to less screening.

• As there is little to no presence of public health facilities in these areas, these are identified neighborhoods in which private providers, CBOs, and other health facilities can take a more active role in providing testing and treatment.

Next steps

The Bureau of STD Control will begin to work with DOHMH District Health Offices to develop plans to target and educate health care providers in these neighborhoods with high Ct morbidity that are not served by an

IPP clinic