project red talon std/hiv prevention january 2007 northwest portland area indian health board

Project Red Talon STD/HIV Prevention

Project Red Talon STD/HIV Prevention

January 2007Northwest Portland Area Indian Health Board

MISSION:To assist Northwest tribes

to improve the health status and quality of life

of member tribes and Indian people in their delivery of culturally

appropriate and holistic health care.

Agenda

1. Red Talon STD/HIV Coalition

2. Red Talon Profile

3. Profile Findings: Statistics & Recommendations

4. Tribal Action Plan

5. Next Steps

Red Talon STD/HIV Coalition

Mission: Our goal is to reduce the prevalence of STDs among American Indians and Alaska Natives in the Pacific Northwest by uniting to share wisdom, data, and resources, identify and address common priorities, and develop strategies to eliminate STD-related disparities.

Red Talon Profile

• Project Red Talon (PRT) & Northern Plains Tribal Epidemiology Center (NPTEC)

• A comprehensive Tribal STD/HIV Capacity Assessment Survey

• Over 90 respondents in 2005• Over 60 respondents in 2006

Red Talon Profile

Chapter 1: Introduction Chapter 2: Tribal Clinic STD Testing and Treatment Practices Chapter 3: Tribal STD Prevention Activities Chapter 4: Chlamydia Chapter 5: GonorrheaChapter 6: Syphilis Chapter 7: HIV/AIDS Chapter 8: Hepatitis A, B, and C Chapter 9: NW Tribal STD Priorities and Recommendations Chapter 10: Related Definitions, Tables, and Appendices

Profile Findings: Statistics

Chlamydia: In Oregon, Washington, and Idaho, American Indian and Alaska Native (AI/AN) women are nearly three times more likely to be diagnosed with Chlamydia than non-Native women, and AI/AN men are twice as likely to be diagnosed.

Gonorrhea: In the U.S. as a whole, gonorrhea rates among AI/ANs are slightly lower than gonorrhea rates reported for “All Races” combined. This success is not demonstrated in the NW however, where AI/AN gonorrhea rates are nearly twice that of the total population.

Syphilis: Since 1997, AI/AN rates in the Northwest states have been lower than rates for the total population.

HIV / AIDS: At 10.4 cases per 100,000, American Indians and Alaska Natives had the 3rd highest AIDS rate in 2003, in relation to other ethnic groups.

Hepatitis: In 2002, the Hepatitis B rate among AI/ANs was second only to non- Hispanic blacks.

Red Talon Profile

• CDC – Reportable Infections

• Using these records, data by age, race, and sex are available from 1981-2003.

Chlamydia Chlamydia

Total Chlamydia Rates, by Sex and Age Group - 2003Portland Area I.H.S. States (ID, OR, WA)

0

500

1,000

1,500

2,000

2,500

3,000

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-54 55-64 65+

Age

Cas

es p

er 1

00,0

00 p

op

.

Total Male Rate Total Female Rate

Gonorrhea Gonorrhea

Syphilis Syphilis

HIV/AIDS HIV/AIDS

Estimated number of HIV/AIDS cases, by year of diagnosis and race/ethnicity: 35 areas with confidential name-based HIV infection reporting, 2001–2004

Year of Diagnosis

2001 2002 2003 2004

White, not Hispanic 11,242 11,352 11,097 11,806

Black, not Hispanic 21,556 20,237 19,310 19,206

Hispanic 7,714 6,964 7,078 6,970

Asian/Pacific Islander 279 319 367 394

American Indian/Alaska Native

171 202 187 208

Note. These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts are adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor. The estimates do not include adjustment for incomplete reporting. Data include persons with a diagnosis of HIV infection. This includes persons with a diagnosis of HIV infection only, a diagnosis of HIV infection and a later AIDS diagnosis, and concurrent diagnoses of HIV infection and AIDS. Since 2000, the following 35 areas have had laws or regulations requiring confidential name-based HIV infection reporting: AL, AK, AZ, AR, CO, FL, ID, IN, IA, KA, LO, MI, MN, MI, MO, NE, NV, NJ, NM, NY, NC, ND, OH, OK, SC, SD, TE, TX, UT, VI, WV, WI, WY, Guam and the U.S. Virgin Islands. Since July 1997, Florida has had confidential name-based HIV infection reporting only for new diagnoses.

Source: Table 1. Cases of HIV Infection and AIDS in the United States, 2004. HIV/AIDS Surveillance Report, Volume 16. CDC.

Estimated numbers of cases and rates of HIV/AIDS, by race/ethnicity: 33 states with confidential name-based HIV infection reporting, 2004

Adults and adolescents

Males Females Total

Race/ethnicity No. Rate No. Rate No. Rate

White, not Hispanic 10,010 18.7 1,782 3.2 11,791 10.7

Black, not Hispanic 12,048 131.6 7,009 67 19,057 97.2

Hispanic 5,517 60.2 1,400 16.3 6,916 39

Asian/Pacific Islander 299 13.9 94 4.1 393 8.9

American Indian/Alaska Native

148 20.8 57 7.7 205 14.1

Total 28,117 37.6 10,391 13.2 38,508 25.1Note. These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts are adjusted for reporting delays. The estimates do not include adjustment for incomplete reporting. Data include persons with a diagnosis of HIV infection. This includes persons with a diagnosis of HIV infection only, a diagnosis of HIV infection and a later AIDS diagnosis, and concurrent diagnoses of HIV infection and AIDS.

Source: Table 5b. Cases of HIV Infection and AIDS in the United States, 2004. CDC.

Cumulative Washington State HIV Cases by Race/Ethnicity: Through July 31, 2006

Race/EthnicityAdult/Adolescent

Pediatric TotalMale Female

White, not Hispanic 2,695 300 11 3,006

Black, not Hispanic 418 192 19 629

Hispanic (all races) 299 54 6 359


Asian 85 12 4 101

Hawaiian/Pacific Isl. 8 1 0 9

AI/AN 34 26 0 60

Multi-race 18 2 0 20

Unknown 34 3 0 37

Total 3,593 594 40 4,227Source: Table 3. Washington State HIV/AIDS Surveillance Report - 07/31/2006, WA DOH.

Cumulative Washington State AIDS Cases by Race/Ethnicity: Through July 31, 2006

Race/EthnicityAdult/Adolescent

Pediatric TotalMale Female

White, not Hispanic 8,285 552 15 8,852

Black, not Hispanic 1,016 283 10 1,309

Hispanic (all races) 760 91 4 855


Asian 135 18 0 153

Hawaiian/Pacific Isl. 21 8 0 29

AI/AN 160 52 1 213

Multi-race 35 5 1 41

Unknown 10 2 0 12

Total 10,453 1,024 32 11,509

Source: Table 4. Washington State HIV/AIDS Surveillance Report - 07/31/2006, WA DOH.

Clinic Capacity Clinic Capacity


2005 - Screening and Testing: For the most part, tribal health clinics did not

consider the majority of sexually transmitted diseases clinical priorities.

Almost all clinics represented in the survey provided at least some screening or testing for sexually transmitted diseases.

In all cases, treatment rates lagged well behind STD screening/testing rates (i.e. only 1/3 of those who reported testing for Hepatitis C also provided treatment for the disease).

On average, 3/4 of clinicians reported that their clinic regularly tests for sexually transmitted diseases, while only 40% reported capacity to treat the conditions.

Does your clinic offer treatment for Chlamydia?

NoYes

Per

cent

100

80

60

40

20

0

77

23

Does your clinic offer treatment for gonorrhea

NoYes

Per

cent

100

80

60

40

20

0

82

18

Treatment - 2005

Does your clinic offer treatment for HIV infection?

NoYes

Per

cent

100

80

60

40

20

0

89

11

Does your clinic offer treatment for hepatitis C?

NoYes

Per

cent

100

80

60

40

20

0

89

11

Treatment - 2005


2006 - Screening and Testing: All respondents indicated that that their clinic

provides testing for chlamydia, gonorrhea, and syphilis. Slightly fewer clinicians reported the ability to test for HIV, Hepatitis (A, B, and C), Herpes, and HPV. Several clinics indicated that AIDS diagnoses and treatment services were referred out.

All respondents indicated that that their clinic provides treatment for chlamydia, gonorrhea, and syphilis. Few respondents (36%) indicated that HIV/AIDS treatment was provided.

These rates suggest significant improvements from 2005, when 75-80% of clinic STD Capacity Assessment respondents indicated that they did not provide chlamydia, gonorrhea, or syphilis treatment. HIV treatment also appears to have increased, from 11% in 2005 to 36% in 2006.


2006 - Screening: Respondents that did not provide

asymptomatic STD screening to patients were most likely attribute this to “Patient discomfort with STD testing (43%)” and “Insufficient training on recommended guidelines (29%).”

Lab costs and a lack of consistent policies were also named as potential barriers.


2006 - Treatment: Of those respondents who indicated

their clinic did not provide treatment for one or more STDs/HIV: 60% attributed this to insufficient training on the

current STD treatment guidelines 40% attributed this to the cost of drugs 40% attributed this to referral to outside

practitioners 20% attributed this to drug unavailability on their

clinic’s formulary.


2005 - Reporting: Only 56% of respondents indicated that

their clinic upheld a clinical protocol to report STD cases to the local or state STD registry.

Reporting rates ranged from a high of 70% for gonorrhea and syphilis, to 67% for chlamydia, 64% for AIDS, 50% for Hepatitis C, and 43% for HIV.


2006 - Reporting: All respondents indicated that that their

clinic reports new cases of chlamydia and gonorrhea to their State or County Health Department. Slightly fewer indicated that syphilis, HIV, and Hepatitis (A, B, and C) were regularly reported. Nearly half of respondents indicated that they did not report Herpes or HPV, which is consistent with reporting requirements in the NW.

These rates suggest significant improvements from 2005.


2006 - Policies: When asked about specific clinic

policies, all respondents indicated that: All patients receive confidential STD/HIV

services in accordance with HIPPA regulations. Clinic Operations Manual contains policies and

procedures to manage occupational blood exposure for healthcare workers.

The clinic provides condoms and counseling on primary prevention to all patients.

Clinicians follow current CDC-recommended treatment guidelines for all STDs.


2006 - Policies: Inconsistent with these results,

respondents were least likely to indicate that the CDC’s STD screening guidelines were being met by their clinic for young, sexually active males (8%) and females (38%), though older males and females with known risk factors were slightly more likely to be screened at least once per year (54%).

Routine, voluntary HIV screening was somewhat more likely to occur (at 58%), and 82% of respondents indicated that STD screening regularly occurs during prenatal visits for all pregnant women.

Profile Findings: Recommendations

NW Tribal members identified three essential objectives:

Increase community awareness about STDs.

Strengthen local capacity to prevent STDs.

Improve STD screening and treatment in Tribal clinics.

Tribal Action Plan

Increase Community Awareness: Build awareness among Tribal

Council Members and decision-makers.

Educate community members at community gatherings.

Develop and implement a comprehensive, culturally appropriate STD media campaign.

Tribal Action Plan

Strengthen Local Capacity to Prevent STDs:

Increase funding. Improve collaboration and

networking. Increase STD training among tribal

health advocates. Support prevention programs.

Tribal Action Plan

Improve STD Screening and Treatment in Tribal Clinics:

Strengthen clinic screening and treatment policies.

Increase community participation in screening campaigns.

Minimize barriers to testing and treatment.

Tribal Action Plan

Next Steps

1. Year Two of the Action Plan

2. PRT Trainings

3. STD/HIV Media Campaign

4. Support the development of Clinic Policies

Questions?

project red talon std/hiv prevention january 2007 northwest portland area indian health board

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