Implementing a Gonorrhea and Chlamydia Screening Program in Philadelphia Public High Schools

1. Implementing a Gonorrhea and Chlamydia Screening Program in Philadelphia Public High Schools Melinda Salmon Philadelphia Department of Public Health

2. Why? How?

3. 2000 – present: New surveillance programs 1999 data analysis: shows high re-infection rates in women Citywide HS screening & 5 HRC HS Adult prisons Nov 2001: 2 HRC high schools (HS) 1997 & 1998: Increasingly sensitive laboratory technologies Youth Study Center 1994: Infertility Prevention Project (IPP) *Chlamydia reportable as of October 1991 Reported Cases of Chlamydia: Philadelphia, 1991-2003* (*2003 data are provisional) Number of cases Year

4. Figure 6. Rate of Chlamydia per 100,000 Population by Age and Gender: Philadelphia, 2002. Age Group Men Women Rate per 100,000 Population Chlamydia - Case Rates by Age and Sex, 2003

5. CY 2000 • Report Card 2000 issued – Phila. Coalition For Kids • STD’s given a failing grade • School District Legal Opinion (8/21): • No Screening in schools • Safe and Sound Initiative addresses all Report Card issues • Various Organizations on Committee • STD Program states key to control is school-based screening • School District Legal Opinion (12/19): • Screening in school-based HRC’s OK

6. CY 2001 • Meetings with PDPH/FPC/School District • November: Screening initiated in 1st Health Resource Center • December: Screening initiated in 2nd Health Resource Center

7. Health Resource Center STD Screening (2 schools)2001-2002

8. CY 2002 • January: Commissioner’s Forum on STD’s Held • Adolescent STD’s described as “EPIDEMIC” • February: New Health Commissioner Appointed: • Mr. John Domzalski • February-June: HRCdata presented to Commissioner and others

9. October: New CEO @ School District (Mr. Paul Vallas) & PDPH Commissioner Meet Commissioner proposes screening in 10 schools; Mr. Vallas counters with 44; Mr. Domzalski accepts. (54,000 Students) November : Television and Newspaper Press Coverage Generally positive; issue of “no parental consent” raised December: Meeting with All Principals Letter Given to Principals STD Program Presentation to Principals Parent Letter Developed w. Joint Signatures CY 2002 Cont’d.

10. CY 2003 • January 7th: Testing Begins • Meetings with: • Home & School Council Presidents • Individual School Councils • Scheduling of Individual High Schools for Screening Days and Treatment Clinics Ongoing

11. Philadelphia Department of Public HealthSTD Control Program 2002-2003 High School Screening Program Summary Data

12. How it all works…

13. Pre-meeting with the School • Usually involves the assistant principal, nurse, roster chair • Informational folder distributed • Explanation by health department staff of what occurs

14. Pre-meeting with the School (cont’d) • Communicate our needs to make screening work: • Commitment to see at least 300 students per day in classes of approximately 60 • A presentation room in proximity to rest rooms • Space to process specimens Tentative dates for screening set, as well as dates for the delivery of supplies, brochures, etc. • Explanation of our need return to treat and see additional students and identification of a process and tentative date(s)

15. Screening Begins • Presentation • Bags • Explanation of the process • All students receive a bag • All students complete the paperwork • All students go the bathroom • All bags must be returned • Based upon the information in the presentation, each student makes a decision, on their own, whether or not to be screened

16. During Screening • Specimens processed in separate room • Sort out empty specimen cups from those with urine • If time permits, aliquot specimens and create lab slips • Deal with other issues as they arise

17. At the close of the day • Return to the Health Department with specimens • Any remaining specimens are aliquoted and/or lab slips created • Specimens are submitted to the lab • Information form with a copy of lab slip attached are submitted for data entry

18. In the days following • Data entry of information slips with “pending” results indicated • As lab results are received, pending results changed to positive or negative • Test results given to students by telephone

19. Treatment • List of students to be seen submitted to nurse 1 day prior to the arrival of medical staff • Students issued call slips or called from class • Oral medications administered • Counseling, instructions for follow-up exams and partner referral cards given

20. Treatment • For students not treated at school, we continue to work through school nurse to refer for treatment • Use the “best way to contact” information

21. In summary…. • Process takes a solid commitment from many, including: • School personnel • Health Department screening staff • All other staff for data entry • Staff giving results • Clinical staff to give treatment • Laboratory staff to process tests • Administrative staff • But, most importantly…it takes the political will of those who have the power to make it happen