Steve Dunagan BS Special projects coordinator NJ doh Division of hiv std and tb services Good morning Updates Division of hiv std AND tb services The field staffs of the STD and HIV programs have been fully integrated and crosstrained and are now known as the Partner Services P ID: 679167
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new jersey std update 2017
Steve Dunagan, B.S.
Special projects coordinator – NJ doh Division of hiv, std, and tb servicesSlide2
Good morning!Slide3
Updates - Division of hiv, std, AND tb servicesThe field staffs of the STD and HIV programs have been fully integrated and cross-trained and are now known as the Partner Services (PS) unit. Carolyn Tunstall is the PS manager.
This merge provides efficiency in managing investigations and ensures that patients are notified by only one field services representative.
All Partner Services staff will investigate and interview STD patients, HIV patients, and STD-HIV coinfected patients.
Since the last update, our division has acquired seven new field staff and three have retired. Two new staff will start in October 2017.Slide4Slide5
Disease updates – congenital syphilisIn 2016, there was a marked increase in the number of congenital syphilis cases in US. NJ did not have any reportable cases before 2016. Per state protocol, we cannot discuss 2016 cases at this point.
In addition to Confirmed cases (Cases diagnosed based on clinical diagnosis), CDC is also concerned with Probable cases (mainly, women who delivered before receiving adequate treatment at least 30 days before delivery). It is imperative that women have complete prenatal care throughout the pregnancy.
Congenital cases increase when syphilis rates increase among the general population, which they have over the last 5 years
This issue is a priority at CDC and has been reflected in their communication to the states and will be reflected in our grant requirements
Pregnant women have always been the first priority of the NJ STD program (Positive tests, sex partners, and suspects)Slide6
Disease updates – congenital syphilis (cont.)Div. of hiv, std, and tb services initiatives
The STD surveillance unit will follow up on all disease reports of women in child-bearing years submitted without pregnancy status to confirm pregnancy status and provide appropriate counseling
The STD program plans to reach out to OB/Gyn clinics and ER’s in high-morbidity cities to alert them of CDC recommendations and advise them to refer pregnant women to prenatal care
The STD program will be training community health workers (CHW) to educate their client base on STD awareness and prevention. They will focus on the prevention of congenital syphilis and make referrals to prenatal care as needed.
The STD Program has a solid collaboration with Family Planning/Planned Parenthood clinics in placeSlide7
Statistics!!! Slide8
NJ std totals for 2016
Chlamydia
Gonorrhea
Primary & Secondary Syphilis
Early Latent Syphilis
Total Morbidity
34,314
8,103
472
755
Males
10,348
4,763
448 *
661*
Females
23,906 **
3,327
24
94
RACE/ETHNICITY
Black
8,333 **
3,299 **
171
307
Hispanic
4,549
745
138
232
White
6,573
1,513
256*
376*
Asian
332
56
16
44
Unknown
19,305 ***
3,309 ***
31
44Slide9
Primary SyphilisSlide10
12
Secondary Syphilis—
Palmar/Plantar Rash
Clinical Manifestations
Source
: CDC/NCHSTP/Division of STD Prevention, STD Clinical Slides Slide11
2016 Top Ten Cities with primary/secondary (p/S) Syphilis (* = less or equal 10)
Jersey City 56
Newark 55
East Orange 18
Paterson 14
Union 13
Elizabeth *
Hamilton *
Irvington *
West New York *
Camden *Slide12
2016 Statistics for early Latent syphilis (cont.)top 10 cities and top 7 counties
Newark 128 (60% of Essex Co)
Jersey City 116 (71% of Hudson Co)
Paterson 34
East Orange 30
West NY 24
Elizabeth 23
Irvington 18
Union 18
North Bergen 15
Orange 13
Essex 214
Hudson 163
Union 63
Middlesex 57
Passaic 49
Bergen 45
Camden 32Slide13
2016 Statistics for syphilis (cont.)
29% increase in male P & S cases from 2015 (346 to 448 cases)
5% increase in male Early Latent cases from 2015 ( 630 to 661 cases)
8% decrease in female P & S cases from 2015 (26 to 24 cases)
12% increase in female Early Latent cases from 2015 ( 84 to 94 cases)
The common factor among most congenital cases is inconsistent prenatal care throughout the pregnancy.
Mothers must be treated no later than 30 days prior to delivery to ensure adequate treatment of the fetus.
CDC recommendations and NJ health standards require a syphilis test in the 1
st
trimester. Another syphilis test in the 3
rd
trimester is highly recommended but not required. A test of the baby’s cord blood IS required at delivery.Slide14
NJ Syphilis 5-Year TrendSlide15
2016 Statistics for syphilis - MSM 2016: Approximately 70% of early syphilis male cases were MSM. The percentage has been approximately steady for the last six years.
2016: 92% of the MSM cases were HIV positive
Age
15-19: 3.3% 20-24: 17%
Race/Ethnicity
Asian – 3.2% Black – 37% Hispanic – 31% White – 25%
15 –
19
20 – 24
25 – 34
35 – 44
45 - 64
3.3%
17%
39% ***
20%
20%
Asian
Black
Hispanic
White
3.2%
37% ***
31% **
25%Slide16
Cdc Recommendations for testing of gay/bisexual men
The following screening tests should be performed at LEAST annually for sexually active MSM, including those with HIV infection:
HIV serology, if HIV status is unknown or negative and the patient himself or his sex partner(s) has had more than one sex partner since most recent HIV test.
Syphilis serology to establish whether persons with reactive tests have untreated syphilis
A test for urethral infection for gonorrhea and chlamydia in men who have had insertive intercourse during the preceding year (testing of the urine using NAAT† is the preferred approach).
A test for rectal infection for gonorrhea and chlamydia in men who have had receptive anal intercourse during the preceding year
A test for pharyngeal (throat) infection for gonorrhea in men who have had receptive oral intercourse during the preceding year. Testing for chlamydia pharyngeal (throat) infection is not recommended.Slide17
Cdc Recommendations for testing of gay/bisexual menTo follow up their recommendations for testing of gay/bisexual men, CDC requests yearly data on syphilis and rectal GC testing at HIV care sites in high morbidity counties
DAYAM, NJCRI, and Infectious Disease Practice are currently collaborating with the STD program to provide data
Increased syphilis rates COULD be attributed to increased testing for PrEP prescription protocols
Slide18
EARLY Syphilis and hiv infection - 2016
2015
2016
MALE
91%
92%
FEMALE
9%
8%
ALL GENDERS
65%
69%Slide19
Gonorrhea 2016sex
Males
4763
Females
3327
Unknown
13
Total
8103 ( 12% increase from 2015)
Race/ethnicity
Black
2,760 **
White
868
Hispanic
745
Asian
38
Other/Unknown
3,313****Slide20
Gonorrhea 2016 (cont.)top ten cities
Newark
Camden
Paterson
Jersey City
East Orange
Trenton
Atlantic City
Irvington
Elizabeth
Hamilton TownshipSlide21
Chlamydia - 2016sex
Males
10,348
Females
23,906 ***
Unknown
63
Total
34,317 (10% increase from 2015)
Race/ethnicity
Black
8,333
White
6,573
Hispanic
4,549
Asian
332
Other/Unknown
19,305****Slide22
chlamydia – 2016 (cont.)top ten cities
Newark
Paterson
Jersey City
Camden
Trenton
East Orange
Elizabeth
Irvington
New Brunswick
Passaic CitySlide23
Questions so far?Slide24
NJ std/hiv program action steps
The STD Program provides medications and test kits for state-approved non-profit medical providers
We provide technical assistance and training to city/county STD clinics, medical providers, and CBOs/ASOs as needed
The Rapid Syphilis Pilot Project –Excellent tool for community outreach projects w/mobile vans
A post in June 2017 went out on NJLINCS.net (NJ Local Information Network and Communications System) regarding CDC rectal and pharyngeal GC testing recommendations for MSMs. This is a great way to send out health alerts to medical providers!Slide25
NJ std/hiv program action steps (cont.)
Development of an internet partner notification program (Take that
Jack’d
, A4A, Grinder!
)
Developing policy for expedited partner therapy in NJ, allowing for non-traditional ways of testing and treating sex partners of GC or CT
Promotion of the InSpot.org online program that alerts STD patient’s partners anonymously. (See next slide)
Dontspreadit.com
Development of a NJ Division of HIV, STD, and TB Services information packet to be distributed by end of 2017 to NJ medical providers with details of the services provided by each unit and specific information such as: rising MSM STD rates, increases in congenital syphilis, and CDC recommendations.Slide26
anonymous referralSlide27
RAPID SYPHILIS PILOT PROJECTCurrently active at NJCRI and Visiting Nurses Association (VNA) – Asbury Park
Finger prick, 20 minutes, tests for syphilis antibodies
Previously infected patients should NOT take this test
If the test is positive, whole blood must be drawn and tested for an RPR and a confirmatory test (RPR, TPPA, EIA) as soon as possible.
Patients are usually tested for HIV at the same time
Approximately 172 tested and 20 newly identified cases since the beginning of the pilot. Over 11% positivity.Slide28
RAPID SYPHILIS PILOT PROJECT (CONT.)Five sites are scheduled to start testing soon: AAOGC, Camden AHEC, Hyacinth Trenton and JC, and Oasis Drop-In Center (SJAA).Slide29
County and city clinicsThe STD program does not have jurisdiction over these clinics. They are governed by the Office of Local Health and we can only advise and provide information on best practices for disease prevention.
We are aware that many clinics do not offer accommodating hours but that issue should be taken up by the county or city’s constituents and brought to the health officers and other local officials’ attention.
The STD Program provides technical assistance, medications, and test kits (or funding in high-morbidity cities).Slide30
Closing thoughtsPromote regular STD testing of your MSM and pregnant clients by referral to appropriate clinics, if your site does not provide testing
People infected with STDs are more likely to acquire HIV or transmit HIV (if they are positive)
Remind clients taking PrEP that they still HAVE to use condoms
Familiarize yourself with symptoms of STDs so that you can provide effective counseling to high-risk clients. (Diagnosis in Color: Sexually Transmitted Diseases – Wisdom and Hawkins)
Ensure that your medical staff have training in how to effectively counsel and make recommendations to priority populations ( MSM, pregnant females, sex workers, high-risk individuals, IV-drug use)
Encourage MSM clients to notify their sex partners! Inform clients of NJ DOH field staff’s
confidential
partner elicitation process. We simply need to get to the source of the infection!Slide31
Questions? STEVE DUNAGAN – SPECIAL PROJECTS COORDINATOR, DIV OF STD, HIV, TB SERVICES
(609) 826-4741
Contact me for: condoms, technical assistance, STD
education sessions
Steven.dunagan@doh.nj.gov
http://nj.gov/health/hivstdtb/stds/locations.shtml
http://cdc.gov/std
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Thank you!