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
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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?
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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
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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
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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
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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)
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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?
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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
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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)
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"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