2002 National STD Conference - Oral, Symposium, and Workshop Abstracts B2

B5D - Development of a Mechanism to Verify and Measure Adherence to Chlamydia Screening Criteria in Family Planning Clinics in Three New England States

J Day¹, F Cohen², H Jenkins³, E Kieltyka⁴, M Proulx⁵, M Ritson⁶, B Woods⁷

1John Snow, Inc. (JSI), Boston, MA; 2Planned Parenthood of Northern New England, Williston, VT; 3Connecticut Department of Public Health, STD Control Program, Hartford, CT; 4Family Planning Association of Maine, Augusta, ME; 5Vermont Department of Public Health, STD Program, Burlington, VT; 6Planned Parenthood of Connecticut, New Haven, CT; 7Maine Department of Public Health, HIV/STD Program, Augusta, ME

Background: The Title X Family Planning (FP) and STD Programs of Connecticut, Maine and Vermont and JSI received a CDC Infertility Prevention Project Innovation Award to evaluate adherence to chlamydia screening criteria. The states participate in the Region I Chlamydia project and selectively screen all women <25 years old for chlamydia.

Objectives: 1) To develop a data collection tool to measure adherence to regional chlamydia screening criteria; 2) To conduct a pilot study to test the tool via medical record review.

Methods: A data collection tool was developed to collect age, risk factors satisfying the regional screening criteria, chlamydia test results, and reasons for not screening. Medical records were randomly selected from clinic-specific lists of women undergoing pelvic exams. The tool was piloted in 6 FP clinics and 25 medical records per clinic were audited.

Results: Of the 72/112 (64%) women who met the regional screening criteria, 30/72 (42%) were not tested for chlamydia. The most frequent reasons for not testing included no recent change in sex partner (n = 12) and refusing testing (n = 10). The pilot study has been expanded to audit medical records 33 FP clinics. The results of this audit, documenting the percent of women meeting the screening criteria, chlamydia test results and reasons for not screening, will be presented.

Conclusions: The pilot study revealed valid reasons why women were not screened for chlamydia. Studies conducted to measure adherence to screening criteria should include documentation of reasons why screening did not occur.

Implications for Programs/Policy: Future mechanisms developed to measure adherence to screening criteria should include documentation of reasons why women are not screened. Regional screening criteria may need to be reevaluated.

Implications for Research: More studies are needed to document reasons why women are not screened for chlamydia and to determine how best to capture such information.

Learning Objectives: Participants will be able to identify key questions that should be asked in data collection tools used to measure adherence to chlamydia screening criteria and will be able describe reasons why women are not screened.

B5E - Chlamydia Screening and Test Type Utilization in California Publicly Funded Family Planning Services

JM Chow¹, M Bradsberry², J Treat³, C Maternowska², P Darney², A Ramirez³, G Bolan¹

1California Department of Health Services, Sexually Transmitted Disease Control, Berkeley, CA; 2University of California, San Francisco, Department of Obstetrics and Gynecology; 3California Department of Health Services, Office of Family Planning, Sacramento, CA

Background: Since 1998, the Centers for Disease Control have recommended and more recently, the USPS Task Force and HEDIS recommend annual chlamydia (CT) screening for sexually active females less than 25 years of age. Evaluation of adherence to CT screening requires data for services delivered to clients served by family planning providers.

Objective: To describe CT screening coverage and test type utilization among adolescent and young adult female family planning clients.

Methods: Administrative databases from Family PACT (FPACT), the California state-funded family planning program were analyzed. Client and clinician provider data were linked to paid laboratory claims for female clients served in FY 98/99 and 99/00. CT screening coverage was estimated as the proportion of CT tests that were performed on clients seen. Data were stratified by provider type (public sector versus private) and test type (CPT-4 code).

Results: During FY 99/00, 509,429 female clients were served by 586 public sector/non-profit and 1,301 private practice FPACT providers. Private practice providers tested 53.2% of females eligible for screening (age 15–26) while public sector/non-profit providers tested 68.4% (P<.0001). However, there was little difference in testing of females older than 26 years by provider type (57.0% private practice versus 59.6% public sector). Seventy-three percent of all CT tests ordered for females age 15–26 by public sector/ non-profit providers were amplified DNA tests as compared with 37.0% of CT tests performed by private sector providers.

Conclusions: There is considerable variation in CT screening coverage and test type utilization by family planning provider types with higher screening rates among young women and utilization of more sensitive tests among public sector providers.

Implications for Program/Policy: Claims data analysis is useful to identify targeted interventions among providers to improve program adherence to screening guidelines and appropriate selection of chlamydia tests.

Implications for Research: Further analysis of claims data relating to provider and client characteristics may aid in the interpretation of screening and test utilization patterns.

Learning Objectives: The participant will be able to: 1) Identify claims data elements that are needed to construct a chlamydia screening coverage measure, and

2) Describe differences in chlamydia screening coverage by client age, test type, and provider type.

Contact Information: Joan M. Chow / Phone 510-540-2493 / jchow@dhs.ca.gov

B5F - Repeat Chlamydia Infections in Region III Family Planning Clinics–Implications for Screening Programs

P Nathanson¹, M Sammel², M Berlin²

1Family Planning Council, Inc., Philadelphia, PA; 2University of Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA

Background: Since 1994, the Region III Chlamydia Project has routinely screened women for chlamydia who were seen in family planning clinics in the 6-state region.

Objectives: To determine rates of repeat infections among women screened in family planning (FP) clinics in Region III between 1996 and 1998.

Methods: Analysis was performed on 174,278 tests performed on 73,107 women from 1996 to 1998 in 6 of the 8 areas in the region. Positivity rates for patients with prior positive tests were compared to those for patients with prior negative tests.

Results: The overall positivity rate on first visit was 5.4% (3,953/69,039). The positivity rate was 19.7% among patients infected at a prior visit, versus 3.7% for patients not infected at a prior visit (RR 5.4). Repeat infection rates were highest among young women, women from urban areas, and women seen in FP clinics within 10 months of a prior visit.

Conclusions: Women seen in FP clinics in Region III who have an initial positive chlamydia test are at high risk for subsequent infection. This risk is greater among women who are young and from urban areas, reflecting the higher prevalence of disease in these populations. In addition, women seeking care more frequently than annually were at greater risk for infection.

Implications for Programs/Policy: These data support the re-screening of women testing positive for chlamydia who return for care to FP clinics, even if that visit is within one year. In addition, since the rate of infection for women testing negative on an initial visit was greater than 5% in women under age 20 overall, continued screening of all young women attending family planning is warranted.

Implications for Research: Future studies are necessary since many programs have converted to more sensitive testing methods since 1998. In addition, future re-infection studies may be useful in evaluating the effectiveness of current partner management strategies.

Learning Objectives:

By the end of this session, participants will be able to identify factors related to re-infection with chlamydia among women attending family planning clinics.

By the end of this session, participants will be able to discuss the importance of re-screening women testing positive for chlamydia at subsequent visits.

Presenting Author Contact Information: Pamela G. Nathanson / 215-985-6754 / pam@familyplanning.org

B6 - From Research to Practice and Policy Among Programs and Providers: The Role of the National Network of STD/HIV Prevention Training Centers (NNPTCs) in National STD Prevention Efforts

S Ratelle¹, P Coury-Doniger², T Hogan³, AM Rompalo⁴, HM Bauer⁵, B Stoner⁶, K Rietmeijer⁷, SA Payette⁸, D Tofoya⁹ and the National Network of STD/HIV Prevention Training Centers

1Division of STD Prevention, Massachusetts Department of Public Health, Boston, MA; 2University of Rochester School of Medicine, Rochester, NY; 3Baltimore STD/HIV Prevention Training Center; 4John Hopkins School of Medicine, Baltimore, MD; 5California Department of Health Services, STD Control Branch, Berkeley, CA; 6Washington University, St. Louis, MO; 7Denver Public Health, Denver, CO; 8New York State Department of Heath, Albany, NY; 9California STD/HIV Prevention Training Center, Anaheim Hills, CA

Background and Rationale: The structure of the STD/HIV PTCs is a collaboration between universities and public health departments. This enables the transfer of research findings to programs through training, which often results in practice and policy changes. All of the NNPTCs (clinical, behavioral and partner services) work collaboratively to promote national prevention efforts such as syphilis elimination and Chlamydia trachomatis screening efforts.

Objectives: To describe the involvement of NNPTCs, as well as their success and challenges, in projects promoting comprehensive care (clinical, behavioral and partner management) in support of national prevention efforts.

Content: Using needs assessments to direct efforts, the NNPTCs will describe how they have worked to support syphilis elimination efforts and STD/HIV intervention activities by integrating state-of-the-art STD screening and treatment guidelines, science-based behavioral counseling and partner management into clinical and community settings. Training needs, and strategies to promote comprehensive quality improvement in the management of chlamydial infections among managed care settings, community organizations and family planning clinics will be outlined.

Implications for Programs: These presentations will allow programs and providers to be aware of the scope of training opportunities available through the NNPTCs in support of their prevention efforts, appraise how this network has facilitated the integration of research findings into practice settings, and identify the opportunities and challenges in working with managed care settings to promote comprehensive prevention and management of chlamydial infections.

Implications for Research: Future research and evaluation is needed to identify the most effective methods of training (“best practices”) to ensure the integration of quality comprehensive STD management that will result in improvement of practice patterns in different settings.

Learning Objectives:By the end of this symposium, participants will be able to: 1. To identify training resources available through the NNPTCs 2. To describe how the NNPTCs can be utilized by programs and providers to facilitate national prevention efforts

B7A - Risky Environments: Neighborhood Characteristics Associated with Adolescent Females’ Sexual Risk Behaviors

C Sionean¹, R Zimmerman²

1Centers for Disease Control and Prevention, Atlanta, GA; 2University of Kentucky, Lexington, KY

Background: Previous research suggests that both individual characteristics and neighborhood characteristics are associated with adolescent sexual risk behaviors, yet the mechanisms through which such characteristics operate are less clear. Possible mediators of neighborhood conditions include socialization into adult roles via educational and parental influences.

Objectives: To assess associations among neighborhood characteristics and adolescent females’ sexual risk behaviors.

Methods: Data from 438 sexually experienced female adolescents in 33 neighborhoods were analyzed using multilevel modeling to examine the associations of both neighborhood and individual characteristics with adolescents’ age at first intercourse and number of recent (past year) sexual partners.

Results: The average age of first sex across all neighborhoods was 13 years. On an individual level, younger age of first intercourse was associated with indicators of family socioeconomic status (g = -0.23, p <.05) and early initiation of alcohol (g = 0.09, p<.01) and marijuana use (g = 0.15, p<.001). In addition, living in neighborhoods with a greater proportion of residents in poverty was independently associated with younger age of first intercourse, after controlling for individual factors. The average number of recent sexual partners across all neighborhoods was one partner. A greater number of recent partners was associated with lower individual academic achievement (g = 0.08, p<.01) and problem drinking (g = 0.47, p<.001). In addition, in neighborhoods with imbalanced gender ratios, adolescents reported a greater number of sexual partners than in other neighborhoods (g = 0.61, p<.01). Contrary to expectations, neither parental communication nor educational aspirations were associated with age of first intercourse or number of recent sexual partners.

Conclusions: In this study, sexual risk behaviors of adolescent females were associated with the socioeconomic and demographic characteristics of the neighborhoods in which they live, as well as their own individual characteristics.

Implications for Programs: Efforts to prevent sexually transmitted diseases among adolescent females may need to be targeted not only to individuals with risky behaviors, but also to those living in “risky” communities.

Implications for Research: Further research is needed to help delineate the direct and indirect associations among community-level characteristics and individual-level risk behaviors and disease outcomes.

Learning Objectives: By the end of the session, participants will be able to identify individual and neighborhood characteristics associated with adolescent females’ sexual risk behaviors.

B7B - Monitoring STD Prevalence and Reproductive Health Care Among Adolescent Women in Special Settings in the United States, 1999-2001

SA Wang¹, CA Rietmeijer², SC Matson³, WP Carr⁴, M Freeman⁵, DA Beete⁶, MK Oh⁷, S Conner¹, JR Braxton¹, HS Weinstock¹, and the Adolescent Women Reproductive Health Monitoring Work Group

1Centers for Disease Control & Prevention, Atlanta, GA; 2Denver Public Health, Denver, CO; 3Medical College of Wisconsin, Milwaukee, WI; 4Minnesota Dept of Health, Minneapolis, MN; 5New York City Dept of Health, New York, NY; 6Chicago Dept of Public Health, Chicago, IL; 7University of Alabama, Birmingham, AL, USA

Background: Adolescent women have the highest Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infection rates of any age group in the United States, yet systematic monitoring of their reproductive health is limited.

Objectives: We established a project to monitor STD prevalence and other reproductive health measures among adolescent women.

Methods: During 1999-2001, six health departments (Alabama, Chicago, Colorado, Minnesota, New York City, and Wisconsin) collected data on women <20 years old who received reproductive health services in juvenile detention centers (JDCs), drug treatment programs (DTPs), school-based clinics (SBCs), and organizations serving runaway youth (ORYs).

Results: Data were reported for 1732 adolescent women from 9 JDCs, 160 from 9 DTPs, 2282 from 27 SBCs, and 299 from 12 ORYs. Overall, median age was 16 years (range, 11–19), median school grade completed was 10^th grade (range, 3–15), and 97% were sexually experienced. Only 48% reported “current” birth control use; 25% reported having been pregnant. Across facility types, median test positivity for CT was 14.5% (range: 10.6–20.4), for GC was 4.1% (range: 3.4–9.8), and for pregnancy was 9.1% (range: 6.5–10.9). Across geographic locations, median CT positivity was 13.2% (range: 9.7–28.3); median GC positivity was 5.3% (range: 2.6–14.4). Overall, 16 of 1151 (1.4%) non-treponemal syphilis tests and 1 of 812 (0.1%) HIV tests were positive. STD counseling was received by 81% of adolescents, HIV counseling by 63%, family planning counseling by 68%, and substance abuse counseling by 41%. Contraceptives were dispensed or prescribed on-site to only 14.1% of sexually active adolescents who were not already using contraception.

Conclusions: Although adolescent women in these settings had high STD and pregnancy rates, access to STD and other reproductive health services is limited.

Implications for Program/Policy: Systematic monitoring of STD prevalence and reproductive health of this high-risk population is feasible and can assist in identifying gaps in services.

Learning Objectives: By the end of this session, participants will be able to describe reproductive health needs and STD prevalences among adolescent women in special settings.

B7C - Chlamydia Screening and STD Education for High-Risk Teens: A Peer Outreach Program

C Leah¹, L Jackson¹, K Guzman¹, A Arroyo¹, D Borntrager¹, R Gunn^1,2

1Health and Human Services Agency, San Diego, CA; 2Centers for Disease Control and Prevention, Atlanta, GA

Background: Numerous studies have shown that teens have a high prevalence of chlamydia. A teen–peer outreach program to provide sexually transmitted diseases (STDs) education and screening for chlamydia and gonorrhea was developed for non-clinical sites located in the STD high-risk area of San Diego, CA.

Objective: To provide STD education in conjunction with urine-based chlamydia (CT) and gonorrhea (GC) screening at teen recovery centers, schools for teens on probation, and other sites.

Methods: Teen–peer outreach workers conduct educational and testing services on site. For teens testing positive for CT/GC, treatment and partner notification services are provided. The program is repeated at each site, usually every 2–4 months, depending on client turnover.

Results: In 2000, educational presentations were given at 41 sites serving 1059 participants; 566 (53%) were tested. Of those, 23 (4.0%) tested positive for chlamydia (2.1% for males vs. 10.6% for females) and 6 (1.1%) tested positive for gonorrhea. All 29 positive cases were treated and 25 were offered partner services; 14 (56%) named 21 partners. Of those 21 partners, 6 (29%) were infected with either CT or GC and were treated, 9 (43%) were not infected but were given preventive treatment, and 6 (29%) were not treated. Findings from 2001, including results of post-presentation evaluations, will be presented.

Conclusion: Teen peer-based education and screening can reach a considerable number of high-risk adolescents and asymptomatic CT and GC infections can be identified. Partner services identified a considerable number of infections (29% partner infection rate).

Implications for Programs/Policy: STD programs should consider adding teen–peer outreach workers to their staff to carry out educational and screening programs at sites serving high-risk youth.

Implications for Research: Collecting information about STD programs with similar programs and development of a guidance document is needed with the ultimate objective of making such activities a standard component of local STD programs.

Learning Objectives: Each participant will learn about how a teen peer-based STD education and testing program operates and what chlamydia and gonorrhea prevalence can be expected.

Contact Information: Christine Leah / Phone 619-692-8503 / cleahxhe@co.san-diego.ca.us

B7D - Adolescent Screening Project in Special Settings

L Byer¹, B Draper¹, B Moss²

1Oakland County Children’s Village; 2Michigan Department of Community Health STD/HIV Division

Background: Non-invasive STD tests afford the opportunity for screening adolescents in non-traditional health care settings. Six sites within Oakland County (correctional, runaway/shelter care facilities and school clinics) participated in STD screening project which included testing, completion of a sexual questionnaire and risk reduction education.

Objective: To determine the incidence of gonorrhea and chlamydia in the adolescent population in special settings within one county. To assess reproductive health needs of females participating in project.

Methods: Upon admission adolescents 13–20 y.o. were offered STD tests for gonorrhea and chlamydia at two correctional facilities (juvenile detention and county jail) and two shelter care facilities. Students accessing a school-based clinic at two urban high schools were offered STD testing; additionally, screening occurred during sports physicals. All participants completed a sexual questionnaire. Females were encouraged to have a reproductive health exam. Risk reduction education and partner notification was included.

Results: Since 12/00, 775 (48% Caucasian, 50% African-American) adolescents have been screened reporting a high number of lifetime sexual partners (mean, 9 males, 6 females). Overall, there was high positivity for chlamydia (18%); gonorrhea (5%); 75% of the males were asymptomatic. Gender/age specific data showed 28% of 18 y.o females with chlamydia positivity. Comparison of sites revealed highest positivity at high schools (22% chlamydia). Screening at school physicals yielded 17% chlamydia positivity among healthy, asymptomatic athletes. Seventy females completed pelvic exams, and 28% had abnormal Pap smears.

Conclusions: Adolescents in special settings report multiple sexual partners and have high incidence of sexually transmitted infections. By mass screening, asymptomatic disease can be detected, treated, and partners notified, decreasing complications and spread of infection into broader community.

Implications for Programs/Policy: Will help determine if screening at non-traditional adolescent settings is viable in finding asymptomatic infections, therefore, decreasing burden of disease in community.

Implication for Research: Evaluate effectiveness of STD screening as part of sports physicals. Monitor rates of infection in community following adolescent screening projects. Explore other non-traditional adolescent settings within the community.

Learning Objective:

A. Participants will describe non-traditional adolescent health settings where STD screening and risk-reduction education can be incorporated into health programs. B. Participants will identify a creative way to offer STD screening to asymptomatic students at high schools.

B7E - Screening for Sexually Transmitted Diseases During Pre-participation Sports Examination of High School Adolescents

M Nsuami^1,2, SN Taylor¹, M Elie³, B Brooks², F Makonnen^1,2, L Sanders^1,2, T Nash³, D Cohen², DH Martin¹

Louisiana State University Health Sciences Center, New Orleans, LA; 1Department of Medicine, Section of Infectious Diseases and 2Department of Public Health and Preventive Medicine; 3New Orleans Public Schools Medical and Health Services Department, New Orleans, LA

Background: With the availability of DNA amplification tests for STD detection, it seems timely to explore possibilities for screening to improve early diagnosis and treatment of STDs in high-risk populations.

Objectives: To determine the feasibility of a urine-based chlamydia and gonorrhea screening during pre-participation sports examination of high school adolescents.

Methods: From September 4, 1998, through April 8, 1999, students presenting at the medical unit of an urban school district for sports physicals were given opportunities for chlamydia and gonorrhea testing using urine specimens collected during sports physical examination for glucose and protein dipstick tests. Only students who had parental consent and willing to be screened for STD could be tested. After the dipstick tests, specimens from athletes participating in the STD screening were retrieved, properly labeled, refrigerated then transported to the laboratory for STD testing using LCR. School nurses treated infected students at their school with 1 g oral azithromycin for chlamydia or 400 mg oral cefixime for gonorrhea.

Results: Among the 636 athletes (grades 9–12) screened, 2.8% of males and 6.5% of females tested positive for chlamydia, 0.7% of males and 2.0% of females tested positive for gonorrhea, and 3.2% of males and 7.5% of females tested positive for either or both STDs. Among students infected with either STD, 93.1% reported no symptom, and treatment was documented for 75.9%.

Conclusions: Testing high school adolescents for STDs during pre-participation sports examination is feasible.

Implications for Programs: Implementation of STD screening programs using currently available DNA amplification tests on urine samples obtained during sports physicals offers a unique opportunity to screen and treat adolescents in high-risk, medically underserved populations.

Implications for Research: STD screening in other non-traditional settings should be explored in high-risk and difficult to reach adolescent populations.

Learning Objectives: Participants will be able to discuss the implementation of STD screening during sports physical examination of high school adolescents and review non-traditional methods of STD screening in this population.

B7F - Should We Be Screening Sexually Active Adolescent Males for Chlamydia During Health Supervision Pediatric Visits?

K Tebb¹, M Shafer¹, S Cruz¹, S Brown¹, A Gyamfi¹, R Pantell¹, T Ko², C Wibbelsman²

1University of California, San Francisco, CA; 2Kaiser Permanente Medical Group Northern California, CA

Background: HEDIS guidelines recommend annual chlamydial (CT) screening for all sexually active adolescent females. No recommendations are offered for young males since insufficient data is currently available.

Objective: To evaluate the efficacy of a screening program and prevalence of CT among 14–18 yo sexually active adolescent males attending pediatric health supervision visits.

Methods: A large systems-based quality improvement model intervention was developed to increase the CT screening rate (the main outcome measure) among sexually active teens attending health supervision visits in a large HMO. During an 11-month period (n = 5 clinics randomized into study condition) urine collection was implemented on all males as part of routine clinic protocol. Teens were roomed alone so that clinicians could determine sexual activity, explain and order CT tests confidentially if the teen was sexually active. CT was processed in the central laboratory using LCx^R. Data was tracked centrally and reported as anonymous aggregate data.

Results: Among an ethnically diverse population of adolescent males, 21% were sexually active, and 270 (mean age 15.6 y) were screened. The screening rate among sexually active males increased from 5% at baseline to 42% at 11 months after the initiation of the intervention. The urine-based screening tests revealed 3 (1.1%) positive CT results.

Conclusions: It is feasible to screen sexually active adolescent males confidentially during pediatric health supervision visits. In this population, the CT screening rate was low (1.1%).

Implications for Program/Policy: The data indicates a low yield for screening asymptomatic males during pediatric health supervision visits in a large HMO.

Implications for Research: Screening rates for males should be established in a variety of settings, such as urgent care, to identify high-risk groups, which may yield higher rates of CT.

Learning Objectives: By the end of this session, participants will be able to demonstrate knowledge about how and when to screen adolescent males.

B8 - Making Collaborations Work: Thinking and Acting Outside the Lines

A Johnson¹; S Glass¹; L Nicholson²; K Williams³

1Access Community Health Network; 2Genesis House; 3Lawndale Christian Health Center

Background & Rationale: In 1999, the CDC funded Access Community Health Network to form a minority focused community coalition to serve the needs of hard-to-reach, hardly reached African American’s on Chicago’s West Side impacted by HIV, STDs, substance abuse and TB.

In the two years since, we have learned that there are different levels of collaboration and that institutional interests need to take a backseat to meeting patient needs. Furthermore, our experience has been a learning process for all seven participating agencies with lessons learned that can be useful to other community coalitions. By being creative, flexible and innovative, the Westside Collaborative Care has created a plan for operation that is comprehensive in its scope, meets community needs, and creates an integrated network of services with multiple access points for clients to receive services. Successes of our planning process include: establishing a working committee structure, completion of community asset mapping and a gap analysis, completion of a comprehensive community epi profile, identification of prevention interventions to be implemented, and identification of a shared computer-sharing system for program implementation.

Purpose:

To examine the complexities of establishing community coalitions and to determine if collaboration is right for you.

To present a framework for bringing varied organizations/participants together around a central issue.

To complete an integration matrix (developed by the Bureau of Primary Health Care, HRSA) identifying the level of collaboration and risk participants are willing to take.

Methods: Background information will be presented in a didactic format. All participants will complete the integration matrix during an interactive, participatory discussion.

Learning Objectives:

By the end of the session, participants will

1) Have a clear overview and summary of the Westside Collaborative Care’s planning work, including an overview of our needs assessment process and committee structure.

2) Have heard “lessons learned” on how to plan for service implementation, including leveraging additional resources.

3) Have completed an “Integration Matrix” exercise that will identify their level of collaboration with established or future community partners.

4) Be able to identify potential road blocks to services delivery.

Presenting Author Contact Information: Angelique Johnson / Phone 773-826-0369 / Fax 773-826- 1407, email: johang@sinai.org

B9B - Studying Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention: the Importance of Knowing Partner Infection Status

L Warner¹, D Newman¹, TA Peterman¹, ML Kamb¹, JM Douglas², J Zenilman³, K Malotte⁴, G Bolan⁵, J Rogers⁶, H Austin⁷, DK Kleinbaum⁷, M Macaluso¹, for the Project RESPECT Study Group

1Centers for Disease Control and Prevention, Atlanta, GA; 2Denver Public Health, Denver, CO; 3Baltimore City Health Dept, Baltimore, MD; 4Long Beach Health Dept, Long Beach, CA; 5San Francisco Health Dept, San Francisco, CA; 6New Jersey Health Dept, Newark, NJ; 7Rollins School of Public Health, Emory University, Atlanta, GA

Background: The recent NIH review of condom effectiveness found inconclusive evidence of protection against most STDs. Condoms are used more often with partners likely to be infected with STDs than with low risk partners. If studies do not control for partner infection status, they will underestimate condom effectiveness.

Objective: To design a retrospective study to control for partner infection status in condom effectiveness studies.

Methods: Baseline data were analyzed from Project RESPECT, a multi-center trial of counseling interventions of HIV-negative heterosexual STD clinic patients. We compared consistent (100%) condom use with inconsistent/nonuse (in last 3 months) for acquisition of gonorrhea (by culture) or chlamydia (by PCR) in 2 populations: (1) all patients (partner infection status unknown) (n = 5758) and (2) patients with infected partners (partner was diagnosed with STD) (n = 429).

Results: When partner infection status was unknown, consistent condom use was not significantly associated with STD in crude analyses [25% vs 27%, Odds Ratio (OR) = 0.9, 95% CI = (0.7–1.1)] or multivariable analyses adjusted for demographics and partner characteristics [OR = 0.8 (0.7–1.0)]. When partners were known to be infected, consistent condom use was somewhat protective against STD in crude analyses [30% vs 43%, OR = 0.6 (0.3–1.2)] and significantly protective in multivariable analyses [OR = 0.4 (0.2–0.9)]. Similarly, when partner infection status was unknown, the number of unprotected sex acts was not associated with STD (÷2 test for trend = 2.0, p=.15), but when partners were known to be infected, the number of unprotected sex acts was significantly associated with STD (÷2 test for trend = 4.3, p=.04). Similar trends were observed by gender and individual STD.

Conclusions: Knowledge of partner infection status is critical in condom effectiveness studies for STDs. Restricting the study population to persons with infected partners controls for partner infection status and suggests condoms protect against STD.

Implications for Programs: Condoms protect against gonorrhea and chlamydia, when patients have infected partners, regardless of gender.

Implications for Research: Investigators assessing condom effectiveness for STD prevention should control for partner infection status.

Learning Objectives: Participants will learn why investigators should control for partner infection status when studying condom effectiveness.

B9C - Comparison of STD Prevalence by Reported Condom Use Errors in 100% Condom Users of an Urban STD Clinic

JC Shlay^1,2,3, J Landrigan¹, JM Douglas^1,4

1Departments of Public Health and Family Medicine, 2Denver Health and Hospital Authority; 3Department of Family Medicine and Internal Medicine, 4University of Colorado Health Sciences Center, Denver, CO

Background: There is controversy about the protective effect of condom usage. Most studies evaluating the effectiveness of consistent condom use do not consider the importance of correct use.

Objective: To assess the association between any error in condom use in patients reporting 100% condom use over the past 4 months and prevalence of various STD among heterosexual men (MSW), women (F) and gay men (MSM) attending an urban STD clinic.

Methods: We performed a computerized medical record review of visits by men and women seen for a new problem. The prevalence rates of non-viral STD (i.e., N. gonorrhoeae, C. trachomatis, or T. vaginalis) and viral STD (i.e., recent onset symptomatic genital warts, 1^st episode genital herpes, or Molluscum conta-giosum) were stratified by any reported error in condom usage (i.e., break, leak, slip off, turned inside out, re-use, initiated sex prior to using condom, or removal of condom prior to sex completion) over the past 4 months.

Results: Over an 8 month period, 621 of 9,642 (6.4%) patients reported 100% condom use including 323 MSW, 193 F, and 105 MSM. Of this group, 332 (53%) reported Â⊃3;1 error, including 55% of MSW, 60% of F and 38% MSM. Prevalence rates of STD by any error vs. no error were as follows: MSW, non-viral STD 17.5% vs. 3.4% (p<.001) and viral STD 5.7% vs. 2.1% (p=.10); F, non-viral STD 13.9% vs. 12.8% (p=.83) and viral STD 8.7% vs. 3.9% (p=.19); and MSM, non-viral STD 20.0% vs. 10.8% (p=.19) and viral STD 0% vs. 3.1% (p=.52). Errors in condom use increased with more frequent sex for MSW (p=.004) and MSM (p=.007), but not F.

Conclusions: Among persons reporting consistent condom use, correct use was associated with a trend in reduction of non-viral STD, with the level of reduction for MSW>MSM>F. A similar trend was seen for viral STD among MSW and F, but not MSM.

Implications for Programs/Policy: Interventions should focus on enhancing correct condom use.

Implications for Research: Further research should focus on implementing strategies to improve consistent and correct condom usage.

Learning Objectives: Participants will be able to describe the association between errors in condom use in patients reporting 100% use and STD infection.

Contact Information: Judy Shlay / Phone 303-436-7200 / jshlay@dhha.org

B9D - Condom Protection Against STD: a Study Among Adolescents Attending a Primary Care Clinic In Atlanta

G Paz-Bailey¹, E Koumans¹, A Pierce¹, C Akers¹, J Papp¹, E Unger¹, M Sawyer², C Black¹, L Markowitz¹

1Centers for Disease Control and Prevention, Atlanta, GA; 2Emory University, Atlanta, GA

Background: While studies have examined the relationship between condom use and sexually transmitted diseases, few have collected data on correct condom use.

Objective: To evaluate the relationship between self-reported correct and consistent condom use and chlamydial and gonococcal infection using amplification tests among high risk adolescents.

Methods: Face-to-face interviews were conducted upon study enrollment. Urine specimens were tested for Chlamydia trachomatis (CT) and Neisseria gonorrheae (NG) by LCR or segment mediated amplification (SMA). Consistent condom use was defined as using condoms for every act of vaginal sex. Correct condom use was defined as not having experienced: beginning sex without a condom, taking a condom off before finishing sex, flipping condom over, condom breakage, or condom slippage.

Results: Data for 349 females who had vaginal sex in the previous 90 days were analyzed. They were predominantly African-American (96%), with a mean age of 16 years. Condom errors were reported by 73% (249); the most common error was to start sex without a condom, reported by 42% (131). Consistent condom use was reported by 35% (121); both correct and consistent condom use was reported by 17% (55). Fifteen percent (9) of correct and consistent condom users had CT infection compared to 30% (86) of inconsistent or incorrect condom users (OR = 0.41, p=.02). No correct and consistent condom users had NG infection compared to 12% (34) of inconsistent or incorrect condom users (p<.01). Further analysis will be performed to adjust for possible confounders.

Conclusions: This study suggests that assessing both correctness and consistency are important in evaluating condom effectiveness in preventing STD.

Implications for Program/Policy: To improve the effectiveness of condoms in preventing STD among adolescents, it might be important to address both consistency and correctness of condom use in prevention messages.

Implications for Research: Further research is needed assessing effectiveness of condoms when used correctly and consistently.

B9E - Condoms Protect Men and Women Against Herpes Simplex Virus Type 2 (HSV-2) Acquisition

A Wald, A Langenberg, E Kexel, A Izu, R Ashley, L Corey

University of Washington, Seattle, WA; Chiron Corp., Emeryville, CA

Background: The efficacy of condom use against HSV-2 has been shown for women but not for men. This study investigated condom use and other behavioral risk factors for the acquisition of HSV-2 among persons attending sexually transmitted disease (STD) clinics.

Objective: To measure the efficacy of condom use against HSV-2 acquisition.

Methods: A cohort of 1862 HSV-2 susceptible persons with Â⊃3;4 sexual partners or Â⊃3;1 STD in the past year was followed for 18 months to evaluate the efficacy of a candidate HSV-2 vaccine. Demographic and behavioral information were collected at enrollment and throughout the study and blood tested for HSV-2 antibody.

Results: One hundred eighteen (6.4%) persons acquired HSV-2, for an overall rate of 5.2/100 person years (p-y). The rates for women and men were similar, 5.7 vs. 5.1/100 p-y. In multivariate models, frequency of sexual activity, HR = 1.11 (95%CI: 1.04, 1.2) and STD in the year prior to study, HR = 1.31 (95%CI: 1.01, 1.71) were associated with increased risk of HSV-acquisition for men, HR = 0.56 (95% CI: 0.33, 0.97) as well as for the total population, HR = 0.58 (95%CI: 0.37, 0.92). The degree of protection was comparable in women, HR = 0.66 (95%CI: 0.30, 1.46), heterosexual men, HR = 0.59 (95%CI: 0.32, 1.08), and men who have sex with men, HR = 0.42 (95%CI: 0.12, 1.49). 2. Use of condoms for more than 65% of sex acts offered significant protection against HSV-2

Conclusions: Condoms protect men and women against HSV-2 acquisition.

Implications for Programs: People should be counseled to use condoms to prevent HSV-2 acquisition and transmission.

Implications for Research: Studies of HSV-2 acquisition and condom use in other populations would be useful; interventions to increase condom use for prevention of HSV acquisition and transmission should be assessed.

Learning Objectives: Participants will be able to describe risk factors for HSV-2 acquisition and the role of condoms in protecting against HSV-2.

Contact Information: Anna Wald / Phone 206-720-4340 / annawald@u.washington.edu