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

0

4,000

8,000

12,000

16,000

20,000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003Year

Number of cases

*Chlamydia reportable as of October 1991

1994: Infertility

Prevention Project (IPP)

1999 data analysis:

shows high re-infection

rates in women1997 & 1998:

Increasingly sensitive laboratory

technologies

Youth Study Center

Adult prisons

Citywide HS screening &

5 HRC HS

2000 – present: New surveillance programs

Nov 2001: 2 HRC high

schools (HS)

DHCC’s July ‘01

High School Screening Pilot Project during the 2001-2002 school year.

Health Resource Center STD Screening (2 schools)

Male Tests

Female Tests

Total

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 PersonsYear 1

(2002-03)Year 2

(2003-04)Year 3

(2004-05)

AttendingPresentation

~30,000 ~30,000 ~30,000

Screened 19,713 17,019 16,378

Positive persons

Chlamydia +

GC +

1,052 (5.3)

1013 (5.1)

94 (0.5)

813 (4.8)

768(4.5)

96 (0.6)

680 (4.2)

642 (3.9)

75 (0.4)

Treated (%) 1,051 (99.9) 807 (99.3) 676 (99.4)

{55 co-infected} {37 co-infected}{41 co-infected}

Percent Positive for GC/CT combined

by Sex and Year

0%

2%

4%

6%

8%

10%

MALES FEMALES TOTAL

Perc

ent

Test

ing P

osi

tive

Year 1

Year 2

Year 3

Percent Positive for GC/CT combined by School Type and

Year

0%

2%

4%

6%

8%

10%

12%

Alte

rnat

ive

Mag

net

Ne

ighb

orh

ood

Vo-

Tec

h

Oth

er

Year 1

Year 2

Year 3

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

year

0%

1%

2%

3%

4%

5%

6%

7%

12-14 years 15-17 years 18-20 years

Year 1

Year 2

Year 3

Over the first three years…

CT positivity rate among participating high school students declined from 5.1% in 2002-2003 to 3.9% in 2004-

2005

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

Reported Cases of Chlamydia: Philadelphia, 1992 - 2005

8,716

10,053 9,956

8,079 8,118

10,480

11,76312,660

13,593 13,586

15,234

17,747

16,723

15,577

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Nu

mb

er o

f C

ases

Rates of Chlamydia per 100,000 Population, by Age:

Philadelphia, 1995 – 2005

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

0 - 4 yrs

5 - 9 yrs

10-14 yrs

15-19 yrs

20-24 yrs

25-29 yrs

30-34 yrs

35-39 yrs

40-44 yrs

45-54 yrs

55-64 yrs

65+ yrs

Year

Rat

e p

er 1

00,0

00 p

opu

lati

on

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

• 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

Conclusions, continued…

Many Thanks!!!!!!!

• Screening Staff

• High School Staff and Administrators

• Support Staff

• Martin Goldberg, Melinda Salmon, Caroline Johnson

• Vic Spain, Mindy Perilla, Christa Seidman