STD Prevention & Control Services: Working to … 17...STD Prevention & Control Services: Working to Maximize Sexual Health in San Francisco Susan Philip, MD MPH Director, STD Prevention
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STD Prevention & Control Services: Working to Maximize Sexual Health in
San Francisco
Susan Philip, MD MPH
Director, STD Prevention and Control Services San Francisco Department of Public Health
Assistant Clinical Professor of Medicine
Division of Infectious Diseases University of California, San Francisco
10 Essential Functions of Public Health: The STD Section Does all of These!
Monitor
Diagnose & Investigate
Inform, Educate, Empower
Mobilize Community Partnerships
Develop Policies
Research
Evaluate
Assure Competent Workforce
Link to or Provide Care
Enforce
STDs in San Francisco: 2010 and 2011* 2010 2011 Change
Chlamydia 4,603 4,739 +136 (3.0% ↑)
Rectal Chlamydia 923 964 +41 (4.3% ↑)
Gonorrhea 1,943 2,242 +299 (15.4% ↑) Rectal Gonorrhea 485 624 +139 (28.7% ↑)
Early Syphilis 660 681 +21 (3.2% ↑)
*preliminary
Chlamydia and Gonorrhea Rates by Age, San Francisco 2010
357
1,991
262
534
0
500
1000
1500
2000
2500
3000
Gonorrhea Chlamydia
Case
s pe
r 10
0,00
0 pe
r ye
ar
Adolescent Adult
Adolescent gonorrhea rate is 36% higher than adult rate
Adolescent chlamydia rate is 562% higher than adult rate
Chlamydia Rates by Age and Race/Ethnicity, San Francisco 2010
1,991
9,471
471
1,484
0
880 534
1,302
194 613 484 423
0
2000
4000
6000
8000
10000
All Races African-American
Asian/PI Hispanic Native American
White
Case
s pe
r 10
0,00
0 pe
r ye
ar
Adolescent Adult
African-American adolescent CT rate 11 times higher than white peers
Gonorrhea Rates by Age and Race/Ethnicity, San Francisco 2010
357
43
169
0
171
262
657
50
291
188
295
0
200
400
600
800
1000
All Races African-American
Asian/PI Hispanic Native American
White
Case
s pe
r 10
0,00
0 pe
r ye
ar
Adolescent Adult
African-American adolescent GC rate 13 times higher than white peers
2240
Enhanced Initiatives
Maintaining the core functions: expert clinical care, surveillance, case finding, health education
I will highlight some enhanced Section initiatives designed to impact sexual health disparities in SF: especially among Adolescents gay men, bisexual men and transpersons, those in jail.
E-STD Health System: Iknowsfbay.org
Research partnership with Dr. Freya Spielberg, RTI International
Women 18-30 can request chlamydia, gonorrhea and trichomonas tests kits online, obtain a vaginal swab specimen, mail the kits back and receive a secure notification of their results and either e-prescriptions or referrals to City Clinic if from SF.
We will be able to evaluate acceptability and outcomes for SF residents
Offers a novel option for sexual health promotion in young women
E-STD Health System: Iknowsfbay.org
YUTHE
Peer Educator Model of Sexual Health Promotion Workshops, street outreach, health fairs
Youth United Through Health Education
New street intercept sexual health survey planned for assessment May 2012
SFDPH HIV Partner Services, 2011
Number of index cases interviewed: 118 Total number of partners named: 114 Proportion of named partners not known to be HIV-
infected that were HIV tested: 37% (n=42) HIV positivity among those partners: 21% (n=9) Of the 31 also tested for syphilis, 23% (n=7) were
positive Of the 28 tested for gonorrhea or chlamydia, 21%
(n=6) were positive
Those who test HIV positive are offered voluntary counseling, referrals and linkage to care. STD staff offer assistance with disclosure to partners.
LINCS Linkages, Integration, Navigation, &
Comprehensive Services In conjunction with SFDPH HIV Prevention and HIV
Surveillance Sections Increase access to Partner Services
Embed DPH staff in two HIV testing sites with high positivity
A new Field Response LINCs team will increase access for medical settings and community providers.
Provide simultaneous support for STD screening and management
The Importance of STD Screening in SF Jails
Approximately 5% of men and women screened for chlamydia or gonorrhea in jail test positive – this is higher than at City Clinic.
Previous data have shown an association of screening and treating men in the jails with a decrease in female chlamydia positivity in the community (Barry STD 2008)
Despite this, screening coverage is only 35%, and can be improved
Expanding STD Screening in SF Jails
We have been working with Jail Health Services and the Forensic AIDS Project (FAP) to increase screening
STD is providing 1.5 FTEs and training for an integrated screening team at FAP which offers testing for chlamydia, gonorrhea, HIV and hepatitis
HIV Pre Exposure Prophylaxis (PrEP) Demonstration Project
Builds on results of iPrEX study – which showed that daily Truvada™ decreased HIV infections in Gay and Bisexual Men and Transgender women
Collaboration of HIV Prevention and STD, with funds from NIH awarded through HIV Research
First in nation, two sites: San Francisco and Miami SFDPH providing national project leadership – Dr.
Stephanie Cohen (STD) and Dr. Al Liu (HIV Research)
Expected to start enrolling mid 2012
Susan.Philip@sfdph.org www.sfcityclinic.org Thanks to: •Barbara Garcia, Tomas Aragon and SFDPH Leadership •STD Prevention & Control Staff •Community Partners Groups •SFDPH Public Health Lab •HIV Prevention Section •HIV Surveillance Section •Jail Health Services •Forensic AIDS Project
Thank You!
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