Results from the ACHA Pap Test and STI Survey for

Calendar Year 2009

American College Health Association

Sexual Health Education and Clinical Care Coalition

September 2010

Participation

• CY 2009 survey (Web-based)– 172 Respondents

• CY 2008 survey (Web-based)– 176 Respondents

• 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 2,951,385– Range 439-67,990– Mean 17,159– Mean Percent Female enrolled 54

Demographics cont’d

• Total Medical Visits 3,692,328– Range 1,200-104,200– Mean 22,652

• Percent Female Visits– Mean 62%

• Women’s Health Visits 456,106– Range 0-45,871– Mean 3305

Geographic Distribution

16 Southwest College Association 22 Southern College Health Associatioon 15 North Central College Health Association 8 Central College Health Association5 Rocky Mountain College Health Association

16 Mid-America College Health Association 5 Ohio College Health Association

30 Mid-Atlantic College Health Association 18 New York State College Health Association 12 New England College Health Association 25 Pacific College Health Association

In which affiliate are you a member?

302520151050

Southwest College Association

Southern College Health Associatioon

North Central College Health Association

Central College Health Association

Rocky Mountain College Health Association

Mid-America College Health Association

Ohio College Health Association

Mid-Atlantic College Health Association

New York State College Health Association

New England College Health Association

Pacific College Health Association

9.3 %

12.8 %

8.7 %

4.7 %

2.9 %

9.3 %

2.9 %

17.4 %

10.5 %

7.0 %

14.5 %

Campus Location

19 Urban >1,000,00050 Urban 100,000-1,000,00034 Urban < 100,00034 Suburban35 Rural

LOCALE

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

545250484644

424038363432

302826242220

18161412108

6420

11.0 %

29.1 %

19.8 % 19.8 %20.3 %

Enrollment

71 0 thru 1199957 12000 thru 2399929 24000 thru 359999 36000 thru 479995 48000 thru 599991 60000 thru 71999

ENROLLMENT SIZE

Mean = 17159.22Min = 439.00, Max = 67990.00Median = 14632.00

757065605550454035302520151050

0 thru 11999

12000 thru 23999

24000 thru 35999

36000 thru 47999

48000 thru 59999

60000 thru 71999

41.3 %

33.1 %

16.9 %

5.2 %

2.9 %

0.6 %

Modalities Offered

147 Liquid-based cytology with reflex HPV testing98 Liquid-based cytology without reflex HPV testing57 Colposcopy40 Cryotherapy33 Conventional slide cytology14 LEEP7 None of these are offered5 Other

Women's health modalities offered in-house

160140120100806040200

Liquid-based cytology with reflex HPV testing

Liquid-based cytology without reflex HPV testing

Colposcopy

Cryotherapy

Conventional slide cytology

LEEP

None of these are offered

Other

85.5 %

57.0 %

33.1 %

23.3 %

19.2 %

8.1 %

4.1 %

2.9 %

Trends in Modalities Offered

Document Age 1st Intercourse

135 Yes36 No

Document age first intercourse

Yes No

140

130

120

110

100

90

80

70

60

50

40

30

20

10

0

78.9 %

21.1 %

Recommend First Pap Test

76 Three years after first intercourse or age 21, whichever comes first75 Age 2111 At onset of sexual activity7 Varies by provider, no standard practice3 Age 18

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

806040200

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

Age 21

At onset of sexual activity

Varies by provider, no standard practice

Age 18

44.2 %

43.6 %

6.4 %

4.1 %

1.7 %

Trends in 1st Pap Recommendation

Providers of Service

Nurse10%

APRN56%

PA8%

GYN7%

non-GYN MD16%

Non-provider visits2%

Other1%

Pap Test Results CY 2009

Long Term Result Trends

10.4

9.6

10.810.6

8.9

7.18.0

8.6

6.9 7.2 7.5 7.4 7.2

10.0

9.0

10.1

12.7 12.9

13.6

13.5

13.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Per

cen

t A

bn

orm

al

Year

Usual management 1st ASC-US Age <20

101 Repeat Pap in 12 months34 HPV DNA test (reflex or otherwise)18 Repeat Pap in 4-6 months9 Varies by provider, no standard practice

Usual practice management ASC-US Pap

1101009080706050403020100

Repeat Pap in 12 months

HPV DNA test (reflex or otherwise)

Repeat Pap in 4-6 months

Varies by provider, no standard practice

62.3 %

21.0 %

11.1 %

5.6 %

Usual management 1st ASC-US Age >20

125 HPV DNA test (reflex or otherwise)25 Repeat Pap in 4-6 months8 Varies by provider, no standard practice5 Immediate colposcopy3 Repeat Pap in 12 months

Usual practice management ASC-US Pap

120100806040200

HPV DNA test (reflex or otherwise)

Repeat Pap in 4-6 months

Varies by provider, no standard practice

Immediate colposcopy

Repeat Pap in 12 months

75.3 %

15.1 %

4.8 %

3.0 %

1.8 %

Management of ReportedASC-US Cases

HPV DNA56%

Repeat Cyto17%

Colpo16%

Unknown10%

Other1%

ASC-US Outcomes

• 3162 samples sent for HPV DNA testing• 58.8% positive for HR HPV

• 474 had repeat cytology• 32.1% ≥ 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

Colpo for ASC-US

Positive HR HPV

ASC-US or Greater

Preferred Method of Tracking

90 Logbook71 Lab service provider generated prompts68 Electronic health record52 Tickler file48 Computerized tracking program11 Other5 No tracking system in place

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

1009080706050403020100

Logbook

Lab service provider generated prompts

Electronic health record

Tickler file

Computerized tracking program

Other

No tracking system in place

52.3 %

41.3 %

39.5 %

30.2 %

27.9 %

6.4 %

2.9 %

Screening Tests Offered

165 Chlamydia162 Gonorrhea155 HIV154 Syphilis112 Hepatitis B111 Herpes108 Hepatitis C105 Trichomoniasis

5 Other4 None of the above

Tests you offer STI Screening asymptomatic students

160140120100806040200

Chlamydia

Gonorrhea

HIV

Syphilis

Hepatitis B

Herpes

Hepatitis C

Trichomoniasis

Other

None of the above

95.9 %

94.2 %

90.1 %

89.5 %

65.1 %

64.5 %

62.8 %

61.0 %

2.9 %

2.3 %

Coverage for STI Testing

81 All tests/visits are charged to the patient or their insurance 58 Some tests/visits are charged but others are free 11 All tests/visits are free to the student 5 None of the above or not applicable

13 Other

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

806040200

All tests/visits are charged to the patient or their insurance

Some tests/visits are charged but others are free

All tests/visits are free to the student

None of the above or not applicable

Other

48.2 %

34.5 %

6.5 %

3.0 %

7.7 %

HEDIS Guideline Compliance

151 Yes19 No

Routinely screen sexually active women < 26 chlamydia

Yes No

160

150

140

130

120

110

100

90

80

70

60

50

40

30

20

10

0

88.8 %

11.2 %

Usual Chlamydia Specimen Type for Female Patients

116 Cervical swab3 Vaginal swab

17 Urine29 Varies4 None

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

Cervical swab Vaginal swab Urine Varies None

125

120

115

110

105

100

95

90

85

80

75

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

68.6 %

1.8 %

10.1 %

17.2 %

2.4 %

Usual Chlamydia Specimen Type for Male Patients

16 Urethral swab136 Urine11 Varies5 None

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

Urethral swab Urine Varies None

140

130

120

110

100

90

80

70

60

50

40

30

20

10

0

9.5 %

81.0 %

6.5 %

3.0 %

CT Testing Results

Respondents Total % Positive

CT tests Undiff’d 146 160,640

CT pos 6931 4.3

CT women 107 83,547

CT women pos 2878 3.5

CT men 106 24,992

CT men pos 1765 7.1

excludes respondents with missing or unpaired test result data

GC Testing Results

Respondents Total % Positive

GC tests Undiff’d 143 139,736

GC pos 857 0.6

GC women 107 69,643

GC women pos 225 0.3

GC men 106 24,193

GC men pos 323 1.3

excludes respondents with missing or unpaired test result data

HIV Test Modalities

132 Standard test, blood34 Rapid test, blood32 Rapid test, oral fluid23 Standard test, oral fluid6 None

What types of HIV antibody tests do you offer?

1401301201101009080706050403020100

Standard test, blood

Rapid test, blood

Rapid test, oral fluid

Standard test, oral fluid

None

76.7 %

19.8 %

18.6 %

13.4 %

3.5 %

HIV Test Results

• 155 schools (90.1%) report offering HIV screening to their students

• 130 schools reporting reliable test data– 52,873 tests done

• 48 positive tests (0.1%)

excludes respondents with missing or unpaired test result data

Syphilis Testing

• 154 (89.5%) schools report offering syphilis testing

• 138 schools reporting reliable testing data• 34,861 tests done• 79 positive tests (0.2%)

excludes respondents with missing or unpaired test result data

Herpes Diagnosis

138 Viral culture35 PCR

120 Type specific serology (antibody testing)5 Antigen tests8 Tzank smears2 Other

What laboratory tests do you use to diagnose herpes infection

140120100806040200

Viral culture

PCR

Type specific serology (antibody testing)

Antigen tests

Tzank smears

Other

80.2 %

20.3 %

69.8 %

2.9 %

4.7 %

1.2 %

HSV Testing Results by HSV Type

Respondents Number% of

category

Undiff HSV tests 141 8232

HSV1 pos 1033 64%

HSV2 pos 582 36%

Female HSV tests 104 3356

HSV1 pos 1098 57%

HSV2 pos 830 43%

Male HSV tests 102 1522

HSV1 pos 529 59.4%

HSV2 pos 361 40.6%

note: many positive tests reported were of unknown type (n=609 all, 413 female, 307 male)

HPV Vaccine

• 148 respondents reported:– 28,719 total doses HPV vaccine given– 15,454 total students vaccinated

• Paired data was available from 108 respondents:– 23,556 doses given to 15,416 students– Average of 1.5 doses per student– Only 0.4% of vaccinated students (n=65) were

males, given by 18 respondents

On-Site Contraceptive Services

163 Education advice regarding general family planning or contraception 160 Prescription of oral contraceptives155 Administration of injectable contraception (e.g., Depo-Provera)153 Prescription or dispensing of other hormonal contraception 147 Dispensation, prescription, or sale of emergency contraception143 Dispensation of condoms for free135 Dispensation of oral contraceptives112 Prescription of other barrier methods 110 Education regarding recommended fertility awareness methods90 Sale of condoms54 Dispensation of other barrier methods 46 Insertion of intrauterine devices/systems (IUDs)32 Administration/insertion of intradermal contraception 5 None, no contraception services are provided on site1 Performance of vasectomies

Which of the following contraception services do you provide to students on-site in your health center? (check all that apply)

200150100500

Education advice regarding general family planning or contraception

Prescription of oral contraceptives

Administration of injectable contraception (e.g., Depo-Provera)

Prescription or dispensing of other hormonal contraception

Dispensation, prescription, or sale of emergency contraception

Dispensation of condoms for free

Dispensation of oral contraceptives

Prescription of other barrier methods

Education regarding recommended fertility awareness methods

Sale of condoms

Dispensation of other barrier methods

Insertion of intrauterine devices/systems (IUDs)

Administration/insertion of intradermal contraception

None, no contraception services are provided on site

Performance of vasectomies

94.8 %

93.0 %

90.1 %

89.0 %

85.5 %

83.1 %

78.5 %

65.1 %

64.0 %

52.3 %

31.4 %

26.7 %

18.6 %

2.9 %

0.6 %

On-Site Pregnancy Services

145 "All options" counseling and education133 Referral for prenatal care120 Referral for abortion services113 Referral for adoption services27 Limited counseling and education6 Prenatal care services provided on-site1 No services are provided

For students with a positive pregnancy test, what services are available from your health center? (check all that apply)

160140120100806040200

"All options" counseling and education

Referral for prenatal care

Referral for abortion services

Referral for adoption services

Limited counseling and education

Prenatal care services provided on-site

No services are provided

84.3 %

77.3 %

69.8 %

65.7 %

15.7 %

3.5 %

0.6 %

41 Yes128 No

Did your health center participate in the 2009 GYT “Get Yourself Tested” campaign?

Yes No

130

120

110

100

90

80

70

60

50

40

30

20

10

0

24.3 %

75.7 %

2009 GYT Participation

39 Yes69 No

If so, did your health center offer any free/ reduced cost STD/ HIV testing in April 2009?

Yes No

70

65

60

55

50

45

40

35

30

25

20

15

10

5

0

36.1 %

63.9 %

Free/Reduced Cost Testing