Health & Community Services Department. The STD Problem in Kalamazoo County: Status Update, Education, and Future Directions
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1 Health & Community Services Department Promoting Health For All The STD Problem in Kalamazoo County: Status Update, Education, and Future Directions October 22, 2015
2 Today s Agenda 7:30 Registration 8:00 Welcome Dr. Douglas Homnick, MD, MPH, Medical Director KCHCS 8:10 Trends in Sexually Transmitted Diseases: Kalamazoo County, Michigan Yasaman Back, MS, Epidemiologist KCHCS 8:30 Increasing STI Screening Rates at the Family Health Center of Kalamazoo Dr. Dennis Means, MD, MMM, Chief Medical Officer Family Health Center 8:45 School-based Testing Initiative and Results Amy Peterson, STD Program Specialist MDHHS 9:00 KCHCS STD Toolkit Kristen Wehling, MPH, STD Health Coordinator KCHCS Cori Dupay, RN, BSN, Public Health Nurse KCHCS 9:30 Q&A/Group Discussion To obtain CME credits, please log on to: Activity Code: Health & Community Services Department Promoting Health For All
3 No one involved in the planning or presentation of this activity has any relevant financial relationship to disclose. Health & Community Services Department Promoting Health For All
4 Chlamydia Rates CDC 2013 Health & Community Services Department Promoting Health For All
5 Gonorrhea Rates CDC 2013 Health & Community Services Department Promoting Health For All
6 Trends in Sexually Transmitted Diseases Kalamazoo County, Michigan Yasaman Back, M.S. Health & Community Services Department Promoting Health For All
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8 HIV Prevalence by Residence at Diagnosis, 2014 # New HIV Diagnoses # Reported Cases # Estimated Cases Reported Prevalence Rate per 100,000 Michigan , , Kalamazoo Co Source: Michigan Department of Health and Human Services, Annual HIV Surveillance Analysis, July 2015
9 STD Incidence Rates per 100,000 (2015 YTD) Chlamydia Gonorrhea Syphilis Michigan Region Kalamazoo Co Source: Michigan Disease Surveillance System, 10/1/2015 Health & Community Services Department Promoting Health For All
10 Local Health Dept. (LHD) Chlamydia Rankings by LHD Rate * Rate * Rate * 2014 # Cases 2014 Ranking by 2014 Rate Michigan ,843 - City of Detroit HD 1, , , ,028 1 Kalamazoo County HCSD ,048 2 Muskegon County HD ,240 3 Genesee County HD ,925 4 Ingham County HD ,726 5 Kent County HD ,664 6 Washtenaw County HD ,436 7 Wayne County HD ,286 8 Oakland County HD ,589 9 Macomb County HD , All Other Local HDs ,487 - *Per 100,000 Source: Michigan Department of Health & Human Services
11 Rate per 100,000 Chlamydia Rates (per 100,000) Kalamazoo Co. Region 5 Michigan Source: Michigan Disease Surveillance System Health & Community Services Department Promoting Health For All
12 Local Health Dept. (LHD) Gonorrhea Rankings by LHD Rate * Rate * Rate * 2014 # Cases 2014 Ranking by 2014 Rate Michigan ,666 - City of Detroit HD ,181 1 Kalamazoo County HCSD Genesee County HD Saginaw County HD Muskegon County HD Ingham County HD Kent County HD Wayne County HD Macomb County HD Oakland County HD All other local HDs ,192 - *Per 100,000 Source: Michigan Department of Health & Human Services
13 Rate per 100,000 Gonorrhea Rates (per 100,000) Kalamazoo Co. Region 5 Michigan Source: Michigan Disease Surveillance System Health & Community Services Department Promoting Health For All
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22 Rate per 100,000 Chlamydia Rates (per 100,000) Kalamazoo Co. Region 5 Michigan Source: Michigan Disease Surveillance System Health & Community Services Department Promoting Health For All
23 # of Cases Total Diagnosed Cases of Chlamydia Kalamazoo County, MI Jan-Sep 2015 Source: Michigan Disease Surveillance System Health & Community Services Department Promoting Health For All
24 Chlamydia Diagnoses by Gender Kalamazoo County, % 33% Male Female Source: Michigan Disease Surveillance System Health & Community Services Department Promoting Health For All
25 Chlamydia Diagnoses by Race Kalamazoo County, % 6% 2% 44% Caucasian African American Other Unknown Source: Michigan Disease Surveillance System
26 Chlamydia Diagnoses by Gender & Age Kalamazoo County, % of cases between yrs of age 44% of cases between yrs of age Avg. female age: 23 Avg. male age: 25 Health & Community Services Department Promoting Health For All
27 Source: Michigan Disease Surveillance System Chlamydia Diagnoses by Female Gender & Age (Kalamazoo Co.) Jan-Sep % of Diagnosed Cases Chlamydia Diagnoses by Male Gender & Age (Kalamazoo Co.) Jan-Sep % of Diagnosed Cases
28 Chlamydia Diagnoses by City Kalamazoo County, 2014 Percent (%) 6% 3% 11% 80% Kalamazoo City Portage Other Missing Kalamazoo City Zip Codes Source: Michigan Disease Surveillance System
29 Rate per 100, Gonorrhea Rates (per 100,000) Kalamazoo Co. Region 5 Michigan Source: Michigan Disease Surveillance System Health & Community Services Department Promoting Health For All
30 # of Cases Total Diagnosed Cases of Gonorrhea Kalamazoo County, MI Jan-Sep 2015 Source: Michigan Disease Surveillance System Health & Community Services Department Promoting Health For All
31 Gonorrhea Diagnoses by Gender Kalamazoo County, % 42% Male Female Source: Michigan Disease Surveillance System Health & Community Services Department Promoting Health For All
32 Gonorrhea Diagnoses by Race Kalamazoo County, % 1% 23% 71% Caucasian African American Other Unknown Source: Michigan Disease Surveillance System
33 Gonorrhea Diagnoses by Gender & Age Kalamazoo County, % of cases between yrs of age 39% of cases between yrs of age Avg. female age: 23 Avg. male age: 26 Health & Community Services Department Promoting Health For All
34 Source: Michigan Disease Surveillance System Gonorrhea Diagnoses by Female Gender & Age (Kalamazoo Co., MI) Jan-Sep % of Diagnosed Cases Gonorrhea Diagnoses by Male Gender & Age (Kalamazoo Co., MI) Jan-Sep % of Diagnosed Cases
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37 Summary Kzoo Co. 2 nd highest LHD rate of Chlamydia & Gonorrhea (2014) Kzoo Co. Gonorrhea rates more than doubled between 2013 and 2014 African Americans and Females disproportionately affected Increased rate of STDs in younger age groups Increasingly wider geographical spread Health & Community Services Department Promoting Health For All
38 Presented by Dennis E. Means, MD, MMM Chief Medical Officer
39 Total Cases of Chlamydia & Gonorrhea in Kalamazoo County Listing Family Health Center as Referrer Chlamydia Gonorrhea Total
40 Increase Number of Eligible Patients Incentives Provided by Payors HEDIS Quality Measures Use of Lean Process Improvement Techniques Kaizen Event Medical Assistant Standard Work
41 School-based Testing Initiative and Results Amy S. Peterson, MPH Michigan Department of Health and Human Services STD Section
42 Epidemiology 101 Prevalence is steady Incidence = Cure New diagnoses Incidence Prevalence Cures
43 Epidemiology 101 Prevalence if Incidence > Cures New diagnoses Incidence Prevalence Cures
44 Epidemiology 101 New diagnoses Incidence Prevalence if Incidence < Cures Prevalence Cures
45 School-wide screening Initiated in 2011 in select SE Michigan high-schools Has proven to be an effective strategy to decrease prevalence in a population Conducted in KPS in early 2015
46 School A: CT Positivity by Year % CT+
47 Event Partners Kalamazoo Public Schools Superintendent Dr. Rice Assistant Superintendent of Student Services Cindy Green HS principals Kalamazoo Health and Community Services Department Michigan Department of Health and Human Services
48 Process Parent-Opt Letter Education schedule created with school All educated All go to restroom Private decision whether to test Lab set-up in school, processed and packaged on site Sent to laboratory Results faxed to medical provider
49 Process Continued Positive patients notified of infection Arrangement made for treatment Re-test appointment set Treatment of partners negotiated
50 KPS Screening Results Screened seniors at Central, Loy Norrix, and all students at Phoenix High 275 students tested Identified 18 positives (6.5%) Disproportionate burden among Females African American students
51 Lowering disease in Kalamazoo County Prevalence if Incidence < Cures New diagnoses Incidence Prevalence Cures
52 Everyone can make a difference No missed screening opportunities Priority populations Females Males Men who have sex with men Refer people to health department and clinics Retest all infected patients 3-months post treatment Ensure treatment of partners On-site Referral to health department Expedited Partner Therapy
53 Contact Me Amy Peterson STD Program Specialist
54 KCHCS STD Toolkit Kristen Wehling, MPH STD Health Coordinator Cori Dupay, RN Public Health Nurse Health & Community Services Department Promoting Health For All
55 Toolkit Design & Implementation Modeled after Spokane, WA Health Department Central location for clinical information on STDs Valuable use for providers and patients Health & Community Services Department Promoting Health For All
56 Why was an online STD Toolkit needed? Recognition of educational needs for medical providers Utilize most current CDC treatment guidelines Ask correct screening questions Test all exposed sites Concerns over potential for missing cases due to nongenital site infections Changing public health grant mandates requiring increased education, reduction in financial support for clinic services Concerns over potential for resistance emergence Health & Community Services Department Promoting Health For All
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72 How do we use the STD Toolkit? Medical Professional educational resource Lab testing collection Current CDC treatment guidelines Patient sexual history questions Resource for School health education professionals Promote available STD educational trainings Community STD statistics Health & Community Services Department Promoting Health For All
73 Plans & Future Use Accessible for patients and providers Parent resources Guidelines about how to discuss sex and STDs Links to CDC & Office of Adolescent Health Special tips Health & Community Services Department Promoting Health For All
74 Thank You! For content suggestion, please contact Kristen Wehling: Health & Community Services Department Promoting Health For All
75 STD Task Force First meeting: Thursday, November 19 From 12:00-1:00pm KCHCS Department (Nazareth Complex) 3299 Gull Road Georgian Room Presentation on barriers to sexual histories Guest Speaker: Dr. Lia Gaggino Defining our mission Seeking at least 1 representative from practices, community/faith organizations, schools Health & Community Services Department Promoting Health For All
76 Health & Community Services Department Promoting Health For All
77 Please complete the survey and submit at the front table on your way out. Health & Community Services Department Promoting Health For All
Kalamazoo County STD Task Force
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