Philadelphia High School STD Screening Program Declining Disease

Philadelphia High School STD Screening Program Declining Disease Prevalence After 4 Years of Screening Lenore Asbel, Melinda Salmon, C. Victor Spain, Christa Seidman, Mindy J Perilla, Martin Goldberg

Background • Adolescents disproportionately affected • 2003 – Philadelphia 15 -19 year olds – 43% of CT infections and 31% of GC infections – Chlamydia rate: 6, 705 /100, 000 • Rate among females 10, 256 /100, 000 – Gonorrhea rate: 1, 597 /100, 000 • Increased screening throughout the city had begun

Reported Cases of Chlamydia: Philadelphia, 1991 -2003 2000 – present: New surveillance programs Number of cases 1994: Infertility Prevention Project (IPP) 1999 data analysis: shows high re-infection rates in 1997 & 1998: women Increasingly sensitive laboratory technologies *Chlamydia reportable as of October 1991 Year DHCC’s July ‘ 01 Nov 2001: 2 HRC Youth high Study schools Center (HS) Citywide HS Adult screening & prisons 5 HRC HS

High School Screening Pilot Project during the 2001 -2002 school year. Health Resource Center STD Screening (2 schools) Male Tests Female Tests Total # of tests 536 683 1219 Total positives (%) 28 (5. 2%) 110 (16. 1%) 138 (11. 3%) Positive for CT only (%) 26 (4. 9%) 87 (12. 7%) 113 (9. 3%) Positive for GC only (%) 0 (0. 0%) 10 (1. 5%) 10 (0. 8%) Dual Infection (%) 2 (0. 4%) 13 (1. 9%) 15 (1. 2%)

How it all works • • • Parents notified by school district Meet with schools to set up screening Educational presentation The process Each student makes a decision, on their own, whether or not to submit a specimen

Numbers of Students Reached by Philadelphia’s STD High School Screening Program # of Persons Year 1 (2002 -03) Year 2 (2003 -04) Year 3 (2004 -05) Attending Presentation ~30, 000 Screened 19, 713 17, 019 16, 378 Positive persons 1, 052 (5. 3) 813 (4. 8) 680 (4. 2) {55 co-infected} {41 co-infected} {37 co-infected} 1013 (5. 1) 94 (0. 5) 768(4. 5) 96 (0. 6) 642 (3. 9) 75 (0. 4) 1, 051 (99. 9) 807 (99. 3) 676 (99. 4) Chlamydia + GC + Treated (%)

Percent Positive for GC/CT combined by Sex and Year

Percent Positive for GC/CT combined by School Type and Year

Percent Positive for GC/CT combined within age-group by year

Over the first three years… § CT positivity rate among participating high school students § declined from 5. 1% in 2002 -2003 to 3. 9% in 20042005 § GC positivity rate remained fairly stable § 0. 5% to 0. 4% § Overall GC/CT infection § 24% decline in positivity rate § 35% decline in the number of positive cases

Preliminary Year 4 Data • GC/CT infection rates seem to have increased slightly from Year 3 – though remain less than Year 1 • Total positivity in Year 4: 4. 7% – Female positivity: 7. 2% – Male positivity: 2. 4% • Overall testing rates have decreased

Number of Cases Reported Cases of Chlamydia: Philadelphia, 1992 - 2005 Year

Rate per 100, 000 population Rates of Chlamydia per 100, 000 Population, by Age: Philadelphia, 1995 – 2005 Year Rates for 1995 to 1999 calculated with 1990 Census denominator. Rates for 2000 to present calculated with 2000 Census denominator.

Conclusions • High school STD screening program implemented successfully with few issues • The broad-based screening program implemented in Philadelphia public high schools was successful in finding and treating cases of CT and GC

Conclusions, continued… • Continuing the program yearly has contributed to the declining rates of infection among students. – Preliminary decreases in testing rates and increases in positivity in Year 4 require further evaluation. • High School screening may also have contributed to a citywide decline in chlamydia infection rates. – Broad-based screening in a variety of venues important

Many Thanks!!!!!!! • • Screening Staff High School Staff and Administrators Support Staff Martin Goldberg, Melinda Salmon, Caroline Johnson • Vic Spain, Mindy Perilla, Christa Seidman