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US Virgin Islands IPP: Use of Limited Resources

US Virgin Islands IPP: Use of Limited Resources. Taetia Phillips-Dorsett, MS Territorial Director, USVI DOH STD/HIV/TB Program. Region II IPP Advisory Meeting November 1, 2006. USVI IPP Program Operations. Publicly Funded IPP Screening Venues:

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US Virgin Islands IPP: Use of Limited Resources

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  1. US Virgin Islands IPP:Use of Limited Resources Taetia Phillips-Dorsett, MS Territorial Director, USVI DOH STD/HIV/TB Program Region II IPP Advisory Meeting November 1, 2006

  2. USVI IPP Program Operations • Publicly Funded IPP Screening Venues: • STD Clinics, FP Clinics, Prenatal Sites, Community Health Centers • Treatment: • $6.00/dose for Azithromycin • FY2006 local govm’t allotment for STD meds=$8,000 ($7,360 actually spent) • Test Technology: • Gen-Probe APTIMA CT/GC Combo • Cost: $14.00 per test • Budget: • USVI has been actively addressing budget issues related to securing and forwarding payment to the New Jersey DHSS for laboratory screening services.

  3. USVI IPP Screening Criteria • Because of budget challenges USVI did not follow the recommended Region II IPP Screening Criteria from March 2005 through July 2006. • In March of 2005, in consultation with CDC, the USVI issued a memo to all participating clinical sites to test clients in the following categories: • Pregnant Females • Symptomatic Individuals, and • Contacts to persons confirmed with Gonorrhea and Chlamydia

  4. Impact of March 2005 Criteria Overall decline in test volume and case identification: • 28% decline in testing volume • from 4,453 tests in CY2004 to 3,207 tests in CY2005. • 20% reduction in identification of positive CT cases • from 597 cases in CY2004 to 476 cases in CY2005 • 54% reduction in identification of positive GC cases • from 129 cases in CY2004 to 59 cases in CY2005

  5. Impact of March 2005 Criteria (cont’d) Marked decline in test volume and case identification in FP and among females: • 50% decline in testing of females in FP clinics • from 2,103 tests in CY2004 to 1,061 in CY2005. • 31% decline in testing among females age 15-24 • from 2,003 tests in CY2004 to 1,392 tests in CY2005. • 33% reduction in identification of positive CT cases in FP • from 236 cases in CY2004 to 159 cases in CY2005 • 61% reduction in identification of positive GC cases in FP • from 44 cases in CY2004 to 17 cases in CY2005.

  6. # of CT/GC Tests* Among Females by HCPT and Year, USVI IPP 2003-2005 (N = 10,055) *Includes tests with valid (positive or negative) CT results only.

  7. Chlamydia Positivity* Among Females by HCPT and Year, USVI IPP 2003-2005 (N = 10,055) N = 3,199 N = 3,988 N = 2,868 *Adjusted for change in lab test type in 2003 from PACE to APTIMA

  8. Gonorrhea Positivity* Among Females by HCPT and Year, USVI IPP 2003-2005 (N = 10,089) N = 3,211 N = 3,999 N = 2,879 *Adjusted for change in lab test type in 2003 from PACE to APTIMA

  9. Implications of Underscreening • FP sites in particular noted that they were not able to screen new clients who had never had a chlamydia test because they did not fit the March 2005 criteria. • A clinical provider at the largest FP site on St. Croix noted a dramatic increase in diagnosis of PID for uninsured women: she recorded more than twice as many cases of PID in the first 5 months of 2006 (17 cases) as she recorded in all of CY2005 (8 cases). • In addition, staff expressed concern about the increased risk of HIV acquisition in the face of an undetected and untreated Chlamydial infection.

  10. Preliminary Analysis of # Tests Needed to Support Implementation of New Criteria Note: Current IPP budget can support 2,600 tests annually.

  11. Plan for Test Kit Allocation and Revised Screening Criteria – July 2006 Note: Current IPP budget can support 2,600 tests annually.

  12. Additional Guidelines for Screening Venues (FP, STD, & CHC) – July 2006 • Treat all symptomatic females and males -Males to be tested only at STD clinic sites • DO NOT test symptomatic clients • DO NOT test clients outside age criteria • Recommendation (FP): • Offer each client meeting criteria only 1 free IPP test per year. • FP to identify funds for additional screening once IPP allotment has been exhausted • Creation of an STD screening site @ the STJ DOH clinic to ensure availability to males for both screening & treatment on island with most limited resources

  13. Next Steps • Monitor implementation of revised guidelines • Monitor test kit allocation system • Identify additional sources of funding needed to expand screening program and maintain screening in prenatal clinics - VI Gov has allotted $35,000 suppl. funding for ~2,500 additional tests territory wide - VI Gov has allotted $22,000 suppl. funding for purchase of STD related medications bringing total budget to $30,000 (4x prior year funding). This will allow for routine distribution of meds supply to clinics. • Explore evidence of increase in PID - FP currently monitoring in STX, STD clinics have begun monitoring

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