Results from the ACHA Pap Test and STI Survey for Calendar Year 2007 American College Health Association Sexual Health Education and Clinical Care Coalition.

Results from the ACHA Pap Test and STI Survey for

Calendar Year 2007

American College Health Association

Sexual Health Education and Clinical Care Coalition

August 2008

Participation

• CY 2007 survey (Web-based)– 128 Respondents

• CY 2006 survey (Web-based)– 128 Respondents

• CY 2005 survey (Web-based)– 147 Respondents

• CY 2004 survey (Web-based)– 135 Respondents

• CY 2003 survey (Paper-based)– 85 Respondents

Demographics

• Total Enrollment 2,215,299– Range 1650-52,270– Mean 17,307– Mean Percent Female 55

Demographics cont’d

• Total Medical Visits 2,410,526– Range 300-86,353– Mean 21,332

• Percent Female Visits– Mean 63%

• Women’s Health Visits 329,536– Range 25-18,383– Mean 3329

Campus Location

20 Urban >1,000,00040 Urban 100,000-1,000,00022 Urban < 100,00020 Suburban24 Rural2 Other

LOCALE

Urban >1,000,000 Urban 100,000-1,000,000 Urban < 100,000 Suburban Rural Other

42

40

38

36

34

32

30

28

26

24

22

20

18

16

14

12

10

8

6

4

2

0

15.6 %

31.3 %

17.2 %

15.6 %

18.8 %

1.6 %

Enrollment

51 0 thru 1199941 12000 thru 2399925 24000 thru 359998 36000 thru 479993 48000 thru 59999

ENROLLMENT SIZE

Mean = 17307.02Min = 1650.00, Max = 52270.00Median = 14623.50

50454035302520151050

0 thru 11999

12000 thru 23999

24000 thru 35999

36000 thru 47999

48000 thru 59999

39.8 %

32.0 %

19.5 %

6.3 %

2.3 %

Modalities Offered

31 Conventional slide cytology69 Liquid-based cytology without reflex HPV testing

104 Liquid-based cytology with reflex HPV testing44 Colposcopy31 Cryotherapy3 Laser

13 LEEP10 Other

Women's health modalities offered in-house

120100806040200

Conventional slide cytology

Liquid-based cytology without reflex HPV testing

Liquid-based cytology with reflex HPV testing

Colposcopy

Cryotherapy

Laser

LEEP

Other

24.2 %

53.9 %

81.3 %

34.4 %

24.2 %

2.3 %

10.2 %

7.8 %

Trend in Modalities Offered

0

10

20

30

40

50

60

70

80

90

2004 2005 2006 2007

Year

Per

cen

t U

se

Liquid with reflex

Liquid w/o reflex

Slide

Colpo

Cryo

LEEP

Document Age 1st Intercourse

92 Yes35 No

Document age first intercourse

Yes No

95

90

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

72.4 %

27.6 %

Recommend Pap Test

79 Three years after first intercourse or age 21, whichever comes first6 Age 183 Age 21

20 At onset of sexual activity20 Varies by provider, no standard practice

What is your usual recommendation for when to begin regular Pap testing?

100806040200

Three years after first intercourse or age 21, whichever comes first

Age 18

Age 21

At onset of sexual activity

Varies by provider, no standard practice

61.7 %

4.7 %

2.3 %

15.6 %

15.6 %

Trends in 1st Pap Recommendation

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Varies Coitarche Age 21 Age 18 1st IC + 3 yrs

Per

cen

t

2004

2005

2006

2007

Trends in 1st Pap Recommendation

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

2004 2005 2006 2007

Year

Per

cen

t

Varies

Coitarche

Age 21

Age 18

1st IC + 3 yrs

Providers of Service

Pap Test Results CY 2007

Long Term Result Trends

13.6

7.57.26.9

8.68.0

7.1

8.9

10.610.8

9.6

10.4

7.4 7.2

10.09.0

10.1

12.7 12.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Year

Per

cen

t A

bn

orm

al

Usual management 1st ASC-US Age <20

51 HPV DNA test (reflex or otherwise)20 Repeat Pap in 4-6 months38 Repeat Pap in 12 months1 Immediate colposcopy8 Varies by provider, no standard practice

Usual practice management ASC-US Pap

5550454035302520151050

HPV DNA test (reflex or otherwise)

Repeat Pap in 4-6 months

Repeat Pap in 12 months

Immediate colposcopy

Varies by provider, no standard practice

43.2 %

16.9 %

32.2 %

0.8 %

6.8 %

Usual management 1st ASC-US Age >20

80 HPV DNA test (reflex or otherwise)21 Repeat Pap in 4-6 months0 Repeat Pap in 12 months

10 Immediate colposcopy12 Varies by provider, no standard practice

Usual practice management ASC-US Pap

80706050403020100

HPV DNA test (reflex or otherwise)

Repeat Pap in 4-6 months

Repeat Pap in 12 months

Immediate colposcopy

Varies by provider, no standard practice

65.0 %

17.1 %

0.0 %

8.1 %

9.8 %

Management of ReportedASC-US Cases

ASC-US Outcomes

• 5257 Documented first ASC-US Cases– 3001 (57.1%) HPV DNA testing

• 55.4% (1662) positive for HR HPV

– 855 (16.3%) for repeat cytology• 28.0% (239) ≥ ASC-US

Results of Colpo by Indication

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Normal CIN 1 CIN 2 or 3 Unk/Inc

1st ASC-US

HR HPV

Pos Re-Pap

Results of Colpo by Indication

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Normal CIN 1 CIN 2 or 3

1st ASC-US

HR HPV

Pos Re-Pap

Preferred Method of Tracking

82 Logbook47 Tickler file42 Lab service provider generated prompts33 Electronic medical record28 Computerized tracking program8 No tracking system in place7 Other

How do you track Pap smear, Colposcopy, and biopsy results?

9080706050403020100

Logbook

Tickler file

Lab service provider generated prompts

Electronic medical record

Computerized tracking program

No tracking system in place

Other

64.1 %

36.7 %

32.8 %

25.8 %

21.9 %

6.3 %

5.5 %

Screening Tests Offered

124 Chlamydia122 Gonorrhea85 Hepatitis B92 Herpes

111 HIV109 Syphilis83 Trichomoniasis3 None of the above

11 Other

Tests you offer STI Screening asymptomatic students

1301201101009080706050403020100

Chlamydia

Gonorrhea

Hepatitis B

Herpes

HIV

Syphilis

Trichomoniasis

None of the above

Other

96.9 %

95.3 %

66.4 %

71.9 %

86.7 %

85.2 %

64.8 %

2.3 %

8.6 %

Coverage for STI Testing

3 Not applicable/STI testing is not provided by our health service18 STI testing is provided to students free of charge 56 Students are charged for lab tests but not the clinic visit16 Students are charged for both lab tests and the clinic visit23 Charges apply for some tests, but others (e.g. HIV) are provided for free10 Other

Which of the following statements best describes how the cost of STI testing is covered at your health service? (check one)

6040200

Not applicable/STI testing is not provided by our health service

STI testing is provided to students free of charge

Students are charged for lab tests but not the clinic visit

Students are charged for both lab tests and the clinic visit

Charges apply for some tests, but others (e.g. HIV) are provided for free

Other

2.4 %

14.3 %

44.4 %

12.7 %

18.3 %

7.9 %

HEDIS Guideline Compliance

102 Yes24 No

Routinely screen sexually active women < 26 chlamydia

Yes No

110

105

100

95

90

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

81.0 %

19.0 %

Usual Chlamydia Specimen Type for Female Patients

97 Cervical swab2 Vaginal swab7 Urine

18 Varies3 None

What type of specimen do you usually/ preferentially collect for chlamydia testing in women? (check one)

Cervical swab Vaginal swab Urine Varies None

105

100

95

90

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

76.4 %

1.6 %

5.5 %

14.2 %

2.4 %

Usual Chlamydia Specimen Type for Male Patients

16 Urethral swab92 Urine12 Varies3 None

What type of specimen do you usually/ preferentially collect for chlamydia testing in men? (check one)

Urethral swab Urine Varies None

95

90

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

13.0 %

74.8 %

9.8 %

2.4 %

Routine Screening Offered

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Women

Men CT

GC

Hep B

Herpes HIV

Syphilis

Trich

None

Other

Per

cen

t

CT Testing Results

Respondents Total % Positive

CT tests Undiff’d 111 124441

CT pos 4635 3.7

CT women 88 80517

CT women pos 2558 3.2

CT men 86 20244

CT men pos 1330 6.6

GC Testing Results

Respondents Total % Positive

GC tests Undiff’d 110 102156

GC pos 639 0.6

GC women 83 62998

GC women pos 276 0.4

GC men 83 20644

GC men pos 269 1.3

HIV Testing

• 111 (86.7%) schools offer HIV testing– 67.5% confidential tests only– 25.2% confidential & anonymous testing

HIV Test Modalities

103 Standard test, blood25 Rapid test, blood24 Rapid test, oral fluid18 Standard test, oral fluid3 Other3 None

What types of HIV antibody tests do you offer?

1101009080706050403020100

Standard test, blood

Rapid test, blood

Rapid test, oral fluid

Standard test, oral fluid

Other

None

80.5 %

19.5 %

18.8 %

14.1 %

2.3 %

2.3 %

HIV Test Results

• 106 schools reporting test data

• 44,507 tests done

• 37 positive tests (0.08%)

Syphilis Testing

• 109 (85.2%) schools offer Syphilis testing• 105 schools reporting test data• 29,755 tests done• 89 positive tests (0.30%)

Herpes Diagnosis

110 Viral culture32 PCR88 Type specific serology12 Antigen tests9 Tzank smears2 Other

What laboratory tests do you use to diagnose herpes infection

1101009080706050403020100

Viral culture

PCR

Type specific serology

Antigen tests

Tzank smears

Other

85.9 %

25.0 %

68.8 %

9.4 %

7.0 %

1.6 %

HSV Testing (Genital)

• 80 schools reported HSV test results• 36% of positives were not typed• Gender-specific data essentially identical with

regard to type breakdown

HSV-158%

HSV-242%

Trichomonas

• 83 (64.8%) schools offer testing.– 58 schools report positive findings

• 336 cases reported.

HPV Vaccine

• Respondents report– 40,839 doses HPV vaccine given– 22,361 students vaccinated