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1.
Sex Transm Dis ; 50(8S Suppl 1): S64-S69, 2023 08 01.
Article in English | MEDLINE | ID: mdl-36976567

ABSTRACT

BACKGROUND: The COVID-19 pandemic changed the environment in which disease intervention specialists (DISs) operate, as their skills were in demand beyond sexually transmitted disease (STD) control programs. Workforce conditions generally have changed in the last 2 years, imposing additional challenges. Retaining STD DIS has become more difficult in the changed environment. MATERIALS AND METHODS: We conducted a landscape scan and obtained data from literature and personal observations to characterize current DIS workforce issues. We used published employment data to characterize current labor market conditions and described how cost-effectiveness analysis could be used to assess potential DIS retention interventions. An example illustrating cost-effectiveness concepts was developed. RESULTS: Many STD control programs faced difficulties in retaining STD DIS, because competing positions often could be done without field work. Economic and crime issues posed additional challenges. General workforce turnover has increased 33% since 2016. Turnover varies by age, sex, and education. Cost-effectiveness analysis can be used to assess DIS retention interventions, but data on costs and outcomes are needed on an ongoing basis. Changes in the workforce environment could impact both retention and the effectiveness of retention interventions. CONCLUSIONS: Workforce changes have impacted employee retention. Increased federal funding makes expansion of the DIS workforce possible, but the labor market environment will continue to pose challenges to recruitment and retention.


Subject(s)
COVID-19 , Sexually Transmitted Diseases , Humans , Pandemics , COVID-19/epidemiology , Personnel Turnover , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & control , Cost of Illness
2.
Sex Transm Dis ; 43(2 Suppl 1): S18-27, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26779684

ABSTRACT

School-based sexually transmitted disease (STD) screening (SBSS) was designed to provide chlamydia and gonorrhea testing, treatment, and counseling to adolescents in a school setting to overcome some of the difficulties of screening in this population. To inform STD control programs and other entities on decision making about potentially implementing this intervention, we reviewed existing published and gray literature on SBSS from 1998 to 2014. Although they are work-intensive to establish, school-based STD screening programs are a feasible and cost-effective way of testing large numbers of male and female adolescents for chlamydia and gonorrhea, and to provide counseling and treatment to almost all those who are found infected. School-based STD screening programs do not seem to reduce prevalence in either the school or the general adolescent population, although there are currently relatively few studies on large-scale SBSS. More research in this field is needed.


Subject(s)
Infection Control , Mass Screening/organization & administration , School Health Services , Sexually Transmitted Diseases/prevention & control , Adolescent , Child , Cost-Benefit Analysis , Feasibility Studies , Female , Guidelines as Topic , Humans , Infection Control/methods , Infection Control/standards , Infection Control/trends , Male , Mass Screening/economics , Prevalence , Program Development , Program Evaluation , School Health Services/organization & administration , School Health Services/standards , School Health Services/trends , Sexually Transmitted Diseases/economics , Sexually Transmitted Diseases/epidemiology , United States/epidemiology
3.
Sex Transm Dis ; 41(10): 605-10, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25211256

ABSTRACT

BACKGROUND: From 2003 to 2012, the Philadelphia High School STD Screening Program screened 126,053 students, identifying 8089 Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (GC) infections. We examined sociodemographic and behavioral factors associated with CT/GC diagnoses among a sample of this high-risk population. METHODS: Standardized interviews were given to infected students receiving in-school CT/GC treatment (2009-2012) and to uninfected students calling for results (2011-2012). Sex-stratified multivariable logistic models were created to examine factors independently associated with a CT/GC diagnosis. A simple risk index was developed using variables significant on multivariable analysis. RESULTS: A total of 1489 positive and 318 negative students were interviewed. Independent factors associated with a GC/CT diagnosis among females were black race (adjusted odds ratio [AOR], 2.27; confidence interval, 1.12-4.58), history of arrest (AOR, 2.26; 1.22-4.21), higher partner number (AOR, 1.75; 1.05-2.91), meeting partners in own neighborhood (AOR, 1.92; 1.29-2.86), and meeting partners in venues other than own school, neighborhood, or through friends ("all other"; AOR, 9.44; 3.70-24.09). For males, factors included early sexual debut (AOR, 1.99; 1.21-3.26) and meeting partners at "all other" venues (AOR, 2.76; 1.2-6.4); meeting through friends was protective (AOR, 0.63; 0.41-0.96). Meeting partners at own school was protective for both sexes (males: AOR, 0.33; 0.20-0.55; females: AOR, 0.65; 0.44-0.96). CONCLUSIONS: Although factors associated with a GC/CT infection differed between males and females in our sample, partner meeting place was associated with infection for both sexes. School-based screening programs could use this information to target high-risk students for effective interventions.


Subject(s)
Chlamydia Infections/epidemiology , Gonorrhea/epidemiology , Health Education/organization & administration , Sexual Behavior/psychology , Sexual Partners , Social Environment , Social Networking , Adolescent , Adolescent Behavior/ethnology , Adolescent Behavior/psychology , Chlamydia Infections/prevention & control , Chlamydia Infections/transmission , Female , Gonorrhea/prevention & control , Gonorrhea/transmission , Health Knowledge, Attitudes, Practice , Humans , Logistic Models , Male , Mass Screening/methods , Odds Ratio , Patient Education as Topic , Philadelphia/epidemiology , Prevalence , Risk Assessment , Risk Factors , School Health Services , Sexual Behavior/ethnology , Sexual Partners/psychology , Students/psychology , Surveys and Questionnaires
4.
Sex Transm Dis ; 41(1): 64-6, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24335745

ABSTRACT

After 2 notices with treatment recommendation changes for Neisseria gonorrhoeae, the Philadelphia Department of Public Health documented medical therapy for 92% (3279/3551) of cases; 3001 (92%) received a recommended therapy. Nonrecommended therapies were documented in 8% of cases. Providers diagnosing 2 or less N. gonorrhoeae cases were more likely to use nonrecommended therapy.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Drug Resistance, Microbial/drug effects , Gonorrhea/drug therapy , Neisseria gonorrhoeae/pathogenicity , Public Health , Drug Administration Schedule , Female , Humans , Male , Practice Guidelines as Topic , Sentinel Surveillance
5.
Am J Public Health ; 103(10): 1874-81, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23947325

ABSTRACT

OBJECTIVES: We estimated the risk of HIV associated with sexually transmitted infection (STI) history during adolescence. METHODS: We retrospectively studied a cohort of adolescents (n = 75 273, born in 1985-1993) who participated in the Philadelphia High School STD Screening Program between 2003 and 2010. We matched the cohort to STI and HIV surveillance data sets and death certificates and performed Poisson regression to estimate the association between adolescent STI exposures and subsequent HIV diagnosis. RESULTS: Compared with individuals reporting no STIs during adolescence, adolescents with STIs had an increased risk for subsequent HIV infection (incidence rate ratio [IRR] for adolescent girls = 2.6; 95% confidence interval [CI] = 1.5, 4.7; IRR for adolescent boys = 2.3; 95% CI = 1.7, 3.1). Risk increased with number of STIs. The risk of subsequent HIV infection was more than 3 times as high among those with multiple gonococcal infections during adolescence as among those with none. CONCLUSIONS: Effective interventions that reduce adolescent STIs are needed to avert future STI and HIV acquisition. Focusing on adolescents with gonococcal infections or multiple STIs might have the greatest impact on future HIV risk.


Subject(s)
HIV Infections/etiology , Sexually Transmitted Diseases, Bacterial/epidemiology , Adolescent , Child , Death Certificates , Female , HIV Infections/epidemiology , Humans , Male , Philadelphia/epidemiology , Poisson Distribution , Population Surveillance , Retrospective Studies , Risk Assessment , Sex Distribution , Sexually Transmitted Diseases, Bacterial/urine , Unsafe Sex , Young Adult
6.
J Public Health Manag Pract ; 17(6): 513-21, 2011.
Article in English | MEDLINE | ID: mdl-21964362

ABSTRACT

BACKGROUND: Screening for syphilis has been performed for decades, but it is unclear if the practice yields many cases at acceptable cost, and if so, at which venues. We attempted a retrospective study to determine the costs, yield, and feasibility of analyzing health department-funded syphilis outreach screening in 5 diverse US sites with significant disease burdens. METHODS: Data (venue, costs, number of tests, reactive tests, new diagnoses) from 2000 to 2007 were collected for screening efforts funded by public health departments from Philadelphia; New York City; Washington, District of Columbia; Maricopa County, Arizona (Phoenix); and the state of Florida. Crude cost per new case was calculated. RESULTS: Screening was conducted in multiple venues including jails, shelters, clubs, bars, and mobile vans. Over the study period, approximately 926 258 tests were performed and 4671 new syphilis cases were confirmed, of which 225 were primary and secondary, and 688 were early latent or high-titer late latent. Jail intake screening consistently identified the largest numbers of new cases (including 67.6% of early and high-titer late-latent cases) at a cost per case ranging from $144 to $3454. Data quality from other venues varied greatly between sites and was often poor. CONCLUSIONS: Though the yield of jail intake screening was good, poor data quality, particularly cost data, precluded accurate cost/yield comparisons at other venues. Few cases of infectious syphilis were identified through outreach screening at any venue. Health departments should routinely collect all cost and testing data for screening efforts so that their yield can be evaluated.


Subject(s)
Community-Institutional Relations , Mass Screening/statistics & numerical data , Syphilis/diagnosis , Humans , Mass Screening/economics , Retrospective Studies , Syphilis/epidemiology , United States/epidemiology
7.
Sex Transm Dis ; 36(1): 4-8, 2009 Jan.
Article in English | MEDLINE | ID: mdl-18813031

ABSTRACT

BACKGROUND: In response to high adolescent rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC), Philadelphia began screening in all public high schools in 2003. METHODS: Data from 14,862 students who tested more than once in the Philadelphia High School STD Screening Program (PHSSSP) during the 2002-2006 school years were analyzed for factors associated with CT and GC infection. Multivariable Cox proportional hazards models and logistic regression models were constructed to identify characteristics associated with measured STD rates. A secondary analysis assessed short-term reinfection rates among participants retesting within the same school year. RESULTS: In the primary analysis, over multiple years, the unadjusted female CT/GC rate was more than double that in males (6.0 vs. 2.4 cases per 100 person-years, respectively). Among students with a baseline positive, males had a higher rate than females (19.9 vs. 17.7 cases per 100 person-years, respectively). Among students with a positive test result, 13.6% were reinfected within the same school year. Females with named partners not treated had a higher reinfection rate than all others (85.5 vs. 40.1-45.2 cases per 100 person-years, respectively). CONCLUSIONS: Clinicians and screening programs that offer STD testing to urban high school students, regardless of gender, should encourage those with a prior STD history to test more frequently. Clinicians should work with infected patients, especially females, to ensure their partners are treated.


Subject(s)
Chlamydia Infections , Chlamydia trachomatis , Gonorrhea , Neisseria gonorrhoeae , Sexually Transmitted Diseases , Students , Adolescent , Adolescent Behavior , Adult , Child , Chlamydia Infections/diagnosis , Chlamydia Infections/epidemiology , Chlamydia Infections/microbiology , Chlamydia Infections/prevention & control , Female , Gonorrhea/diagnosis , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Gonorrhea/microbiology , Gonorrhea/prevention & control , Humans , Logistic Models , Male , Mass Screening , Philadelphia/epidemiology , Proportional Hazards Models , Recurrence , Schools , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/microbiology , Sexually Transmitted Diseases/prevention & control , Young Adult
8.
Sex Transm Dis ; 35(11 Suppl): S61-5, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18607306

ABSTRACT

BACKGROUND: The Philadelphia high-school STD Screening Program (PHSSP) represents an innovative approach to screening-based control of Chlamydia trachomatis infection. The program has been associated with significant reductions in Chlamydia trachomatis prevalence in young females in Philadelphia. We sought to assess program cost-effectiveness in a manner that allowed us to quantify the impact of including males students in the screened population. METHODS: We created a dynamic transmission model using a susceptible-infectious-resistant-susceptible framework. The model was parameterized using PHSSP program data, supplemented by available data from the medical and public health literature, and was used to project the impact of screening on disease burden, quality adjusted survival, and costs. RESULTS: A well-calibrated model suggests that high-school based screening is highly cost-effective in the Philadelphia context. Five important insights are gained through dynamic transmission modeling of the PHSSP: (i) the importance of screening males can be appreciated using a dynamic transmission model; (ii) the attractiveness of screening males is inversely related to equilibrium prevalence in males; (iii) including males enhances both effectiveness and economic attractiveness of screening; (iv) rebound in prevalence does not greatly diminish the cost-effectiveness of screening; and (v) increasing program expenditures via increased screening coverage decreases net societal costs, due to diminished disease transmission. CONCLUSIONS: The current PHSSP is highly cost-effective relative to other commonly accepted interventions. Effectiveness and cost-effectiveness of this program are enhanced by including males. This, and other important attributes of the program, is best appreciated when a dynamic transmission model is used for program evaluation.


Subject(s)
Chlamydia Infections , Chlamydia trachomatis , Mass Screening , Program Evaluation , Schools , Sexually Transmitted Diseases, Bacterial , Adolescent , Chlamydia Infections/diagnosis , Chlamydia Infections/economics , Chlamydia Infections/microbiology , Chlamydia Infections/transmission , Chlamydia trachomatis/isolation & purification , Cost-Benefit Analysis , Female , Humans , Male , Mass Screening/economics , Mass Screening/methods , Models, Economic , Philadelphia , Prevalence , Schools/economics , Sexually Transmitted Diseases, Bacterial/diagnosis , Sexually Transmitted Diseases, Bacterial/economics , Sexually Transmitted Diseases, Bacterial/microbiology , Sexually Transmitted Diseases, Bacterial/transmission , Students
9.
Sex Transm Dis ; 35(11 Suppl): S24-7, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18607316

ABSTRACT

OBJECTIVES: To evaluate the use of the Family Court System as a venue for screening adolescents, especially males for sexually transmitted diseases (STD). GOAL: To identify, treat, and describe the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections among adolescents on probation under the jurisdiction of the Family Court System of Philadelphia from April 2004 through December 2006. STUDY DESIGN: We analyzed data from the first several years of this program, which offered education and voluntary noninvasive screening for CT and GC to adolescents adjudicated delinquent and placed on probation through the Family Court of Philadelphia. RESULTS: Between April 1, 2004 and December 31, 2006, 2270 adolescents were counseled about STDs, of whom 1605 voluntarily submitted a urine specimen for STD testing. Among the 1594 unique individuals with a valid test result, 13.9% (44 of 317) of females, 7.0% (90 of 1277) of males, and 8.4% overall (134 of 1594) were found to be positive for either or both STD. In total, treatment was confirmed for 93.3% (84/90) of males and 100% (44/44) of females testing positive. CONCLUSIONS: Noninvasive STD testing was well accepted by adolescents in the Family Court System. Over several years of study, infection rates were found to be persistently high in both males and females. The Family Court is an effective venue to identify and treat adolescent males and females with chlamydia and/or gonorrhea infection.


Subject(s)
Chlamydia trachomatis/isolation & purification , Juvenile Delinquency/legislation & jurisprudence , Mass Screening/legislation & jurisprudence , Neisseria gonorrhoeae/isolation & purification , Program Evaluation , Sexually Transmitted Diseases , Adolescent , Adolescent Behavior , Child , Chlamydia Infections/diagnosis , Chlamydia Infections/drug therapy , Chlamydia Infections/epidemiology , Chlamydia Infections/microbiology , Female , Gonorrhea/diagnosis , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Gonorrhea/microbiology , Humans , Juvenile Delinquency/psychology , Juvenile Delinquency/rehabilitation , Juvenile Delinquency/statistics & numerical data , Local Government , Male , Mass Screening/methods , Mass Screening/statistics & numerical data , Philadelphia/epidemiology , Prevalence , Public Health , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/drug therapy , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/microbiology , Young Adult
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