results from the acha pap test and sti survey for calendar year 2008 american college health...
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Results from the ACHA Pap Test and STI Survey for
Calendar Year 2008
American College Health Association
Sexual Health Education and Clinical Care Coalition
September 2009
Participation
• CY 2008 survey (Web-based)– 176 Respondents
• CY 2007 survey (Web-based)– 128 Respondents
• CY 2006 survey (Web-based)– 128 Respondents
• CY 2005 survey (Web-based)– 147 Respondents
• CY 2004 survey (Web-based)– 135 Respondents
• CY 2003 survey (Paper-based)– 85 Respondents
Demographics
• Total Enrollment 2,822,008– Range 500-51,413– Mean 16,034– Mean Percent Female enrolled 55
Demographics cont’d
• Total Medical Visits 3,234,438– Range 47-91,079– Mean 19,139
• Percent Female Visits– Mean 64%
• Women’s Health Visits 533,699– Range 7-38,301– Mean 3656
Geographic Distribution
19 Southwest College Association 25 Southern College Health Associatioon 13 North Central College Health Association 5 Central College Health Association3 Rocky Mountain College Health Association
17 Mid-America College Health Association 8 Ohio College Health Association
27 Mid-Atlantic College Health Association 18 New York State College Health Association 10 New England College Health Association 27 Pacific College Health Association
AFFILIATE
302520151050
Southwest College Association
Southern College Health Associatioon
North Central College Health Association
Central College Health Association
Rocky Mountain College Health Association
Mid-America College Health Association
Ohio College Health Association
Mid-Atlantic College Health Association
New York State College Health Association
New England College Health Association
Pacific College Health Association
11.0 %
14.5 %
7.6 %
2.9 %
1.7 %
9.9 %
4.7 %
15.7 %
10.5 %
5.8 %
15.7 %
Campus Location
23 Urban >1,000,00049 Urban 100,000-1,000,00032 Urban < 100,00038 Suburban33 Rural1 Other
LOCALE
Urban >1,000,000 Urban 100,000-1,000,000 Urban < 100,000 Suburban Rural Other
52
5048
4644
4240
3836
34
3230
2826
2422
2018
1614
1210
86
42
0
13.1 %
27.8 %
18.2 %
21.6 %
18.8 %
0.6 %
Enrollment
73 0 thru 1199964 12000 thru 2399922 24000 thru 3599911 36000 thru 479995 48000 thru 59999
ENROLLMENT SIZE
Mean = 16057.99Min = 500.00, Max = 51413.00Median = 13664.00
757065605550454035302520151050
0 thru 11999
12000 thru 23999
24000 thru 35999
36000 thru 47999
48000 thru 59999
41.7 %
36.6 %
12.6 %
6.3 %
2.9 %
Modalities Offered
43 Conventional slide cytology105 Liquid-based cytology without reflex HPV testing145 Liquid-based cytology with reflex HPV testing51 Colposcopy44 Cryotherapy1 Laser
11 LEEP8 None of these are offered6 Other
Women's health modalities offered in-house
160140120100806040200
Conventional slide cytology
Liquid-based cytology without reflex HPV testing
Liquid-based cytology with reflex HPV testing
Colposcopy
Cryotherapy
Laser
LEEP
None of these are offered
Other
24.4 %
59.7 %
82.4 %
29.0 %
25.0 %
0.6 %
6.3 %
4.5 %
3.4 %
Trend in Modalities Offered
0
10
20
30
40
50
60
70
80
90
2004 2005 2006 2007 2008
Year
Per
cen
t U
se
Liquid with reflex
Liquid w/o reflex
Slide
Colpo
Cryo
LEEP
Document Age 1st Intercourse
140 Yes35 No
Document age first intercourse
Yes No
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
80.0 %
20.0 %
Recommend Pap Test
133 Three years after first intercourse or age 21, whichever comes first5 Age 181 Age 21
21 At onset of sexual activity14 Varies by provider, no standard practice
What is your usual recommendation for when to begin regular Pap testing?
150100500
Three years after first intercourse or age 21, whichever comes first
Age 18
Age 21
At onset of sexual activity
Varies by provider, no standard practice
76.4 %
2.9 %
0.6 %
12.1 %
8.0 %
Trends in 1st Pap Recommendation
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
2004 2005 2006 2007 2008
Year
Per
cen
t
Coitarche
1st IC + 3 yrs
Age 18
Age 21
Varies
Providers of Service
Nurse8%
APRN67%
non-GYN MD18%
Other0%
GYN3%
PA4%
Pap Test Results CY 2008
Long Term Result Trends
13.6
13.512.912.7
10.1
9.0
10.0
7.27.4
10.4
9.6
10.810.6
8.9
7.18.0
8.6
6.9 7.2 7.5
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year
Per
cen
t A
bn
orm
al
Usual management 1st ASC-US Age <20
51 HPV DNA test (reflex or otherwise)31 Repeat Pap in 4-6 months75 Repeat Pap in 12 months1 Immediate colposcopy7 Varies by provider, no standard practice
Usual practice management ASC-US Pap
80757065605550454035302520151050
HPV DNA test (reflex or otherwise)
Repeat Pap in 4-6 months
Repeat Pap in 12 months
Immediate colposcopy
Varies by provider, no standard practice
30.9 %
18.8 %
45.5 %
0.6 %
4.2 %
Usual management 1st ASC-US Age >20
124 HPV DNA test (reflex or otherwise)30 Repeat Pap in 4-6 months4 Repeat Pap in 12 months3 Immediate colposcopy8 Varies by provider, no standard practice
Usual practice management ASC-US Pap
120100806040200
HPV DNA test (reflex or otherwise)
Repeat Pap in 4-6 months
Repeat Pap in 12 months
Immediate colposcopy
Varies by provider, no standard practice
73.4 %
17.8 %
2.4 %
1.8 %
4.7 %
Management of ReportedASC-US Cases
HPV DNA58%
Repeat Cyto12%
Colpo17%
Unknown9%
Other4%
ASC-US Outcomes
• 6476 Documented first ASC-US Cases– 3786 (58.5%) HPV DNA testing
• 52.8% positive for HR HPV
– 797 (12.3%) for repeat cytology• 36.1% ≥ ASC-US
Results of Colpo by Indication
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Per
cen
tag
e
Normal CIN 1 CIN 2 or 3 Unk/Inc
Colpo for ASC-US
Positive HR HPV
ASC-US or greater
Preferred Method of Tracking
107 Logbook73 Tickler file74 Lab service provider generated prompts43 Electronic medical record41 Computerized tracking program3 No tracking system in place9 Other
How do you track Pap smear, Colposcopy, and biopsy results?
1201101009080706050403020100
Logbook
Tickler file
Lab service provider generated prompts
Electronic medical record
Computerized tracking program
No tracking system in place
Other
60.8 %
41.5 %
42.0 %
24.4 %
23.3 %
1.7 %
5.1 %
Screening Tests Offered
170 Chlamydia168 Gonorrhea115 Hepatitis B107 Hepatitis C117 Herpes158 HIV155 Syphilis106 Trichomoniasis
3 None of the above5 Other
Tests you offer STI Screening asymptomatic students
180160140120100806040200
Chlamydia
Gonorrhea
Hepatitis B
Hepatitis C
Herpes
HIV
Syphilis
Trichomoniasis
None of the above
Other
96.6 %
95.5 %
65.3 %
60.8 %
66.5 %
89.8 %
88.1 %
60.2 %
1.7 %
2.8 %
Coverage for STI Testing
5 Not applicable/STI testing is not provided by our health service19 STI testing is provided to students free of charge 79 Students are charged for lab tests but not the clinic visit16 Students are charged for both lab tests and the clinic visit38 Charges apply for some tests, but others (e.g. HIV) are provided for free15 Other
Which of the following statements best describes how the cost of STI testing is covered at your health service? (check one)
100500
Not applicable/STI testing is not provided by our health service
STI testing is provided to students free of charge
Students are charged for lab tests but not the clinic visit
Students are charged for both lab tests and the clinic visit
Charges apply for some tests, but others (e.g. HIV) are provided for free
Other
2.9 %
11.0 %
45.9 %
9.3 %
22.1 %
8.7 %
HEDIS Guideline Compliance
151 Yes24 No
Routinely screen sexually active women < 26 chlamydia
Yes No
160
150
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
86.3 %
13.7 %
Usual Chlamydia Specimen Type for Female Patients
131 Cervical swab7 Vaginal swab8 Urine
23 Varies3 None
What type of specimen do you usually/ preferentially collect for chlamydia testing in women? (check one)
Cervical swab Vaginal swab Urine Varies None
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
76.2 %
4.1 % 4.7 %
13.4 %
1.7 %
Usual Chlamydia Specimen Type for Male Patients
24 Urethral swab130 Urine12 Varies6 None
What type of specimen do you usually/ preferentially collect for chlamydia testing in men? (check one)
Urethral swab Urine Varies None
140
130
120
110
100
90
80
70
60
50
40
30
20
10
0
14.0 %
75.6 %
7.0 %
3.5 %
Routine Screening Offered
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
CT GC Hep B Hep C HSV HIV Syph Trich None Other
CT Testing Results
Respondents Total % Positive
CT tests Undiff’d 148 152,169
CT pos 6414 4.2
CT women 107 75,796
CT women pos 2648 3.5
CT men 102 22,170
CT men pos 1463 6.6
excludes respondents with missing or unpaired test result data
GC Testing Results
Respondents Total % Positive
GC tests Undiff’d 146 131,473
GC pos 767 0.6
GC women 109 67,325
GC women pos 273 0.4
GC men 103 21,257
GC men pos 239 1.1
excludes respondents with missing or unpaired test result data
HIV Test Modalities
132 Standard test, blood35 Rapid test, blood33 Rapid test, oral fluid21 Standard test, oral fluid5 None3 Other
What types of HIV antibody tests do you offer?
1401301201101009080706050403020100
Standard test, blood
Rapid test, blood
Rapid test, oral fluid
Standard test, oral fluid
None
Other
75.0 %
19.9 %
18.8 %
11.9 %
2.8 %
1.7 %
HIV Test Results
• 158 schools (89.8%) report offering HIV screening to their students
• 141 schools reporting reliable test data– 52,368 tests done
• 55 positive tests (0.11%)
excludes respondents with missing or unpaired test result data
Syphilis Testing
• 155 (87.6%) schools report offering syphilis testing
• 134 schools reporting reliable testing data• 34,047 tests done• 85 positive tests (0.25%)
excludes respondents with missing or unpaired test result data
Herpes Diagnosis
148 Viral culture36 PCR
122 Type specific serology16 Antigen tests4 Tzank smears4 Other
What laboratory tests do you use to diagnose herpes infection
1601501401301201101009080706050403020100
Viral culture
PCR
Type specific serology
Antigen tests
Tzank smears
Other
84.1 %
20.5 %
69.3 %
9.1 %
2.3 %
2.3 %
HSV Testing Results by HSV Type
Respondents Number% of
category
Undiff HSV tests 133 7327
HSV1 pos 839 54.8%
HSV2 pos 691 45.2%
Female HSV tests 93 2950
HSV1 pos 504 65.3%
HSV2 pos 268 34.7%
Male HSV tests 79 1131
HSV1 pos 102 65.4%
HSV2 pos 54 34.6%
note: many positive tests reported were of unknown type (n=1068 all, 258 female, 64 male)
HPV Vaccine
• 136 respondents reported:– 40,087 total doses HPV vaccine given– 23,342 total students vaccinated
• estimated female enrollment 1,058,555• vaccine provided to 2.2% of enrolled ♀ students
• Paired data was available from 114 respondents:– 33,192 doses given to 23,242 students– 1.4 doses per student
On-Site Contraceptive Services
169 Education advice regarding general family planning or contraception 165 Prescription of oral contraceptives128 Dispensation of oral contraceptives37 Insertion of intrauterine devices/systems (IUDs)
161 Administration of injectable contraception (e.g., Depo-Provera)160 Prescription or dispensing of other hormonal contraception 21 Administration/insertion of intradermal contraception
143 Dispensation of condoms for free86 Sale of condoms
117 Prescription of other barrier methods 47 Dispensation of other barrier methods 1 Performance of vasectomies
108 Education regarding recommended fertility awareness methods149 Dispensation, prescription, or sale of emergency contraception
4 None, no contraception services are provided on site
Which of the following contraception services do you provide to students on-site in your health center? (check all that apply)
200150100500
Education advice regarding general family planning or contraception
Prescription of oral contraceptives
Dispensation of oral contraceptives
Insertion of intrauterine devices/systems (IUDs)
Administration of injectable contraception (e.g., Depo-Provera)
Prescription or dispensing of other hormonal contraception
Administration/insertion of intradermal contraception
Dispensation of condoms for free
Sale of condoms
Prescription of other barrier methods
Dispensation of other barrier methods
Performance of vasectomies
Education regarding recommended fertility awareness methods
Dispensation, prescription, or sale of emergency contraception
None, no contraception services are provided on site
96.0 %
93.8 %
72.7 %
21.0 %
91.5 %
90.9 %
11.9 %
81.3 %
48.9 %
66.5 %
26.7 %
0.6 %
61.4 %
84.7 %
2.3 %
On-Site Pregnancy Services
139 "All options" counseling and education32 Limited counseling and education
118 Referral for adoption services125 Referral for abortion services135 Referral for prenatal care
2 Prenatal care services provided on-site0 Abortion services provided on-site1 No services are provided
For students with a positive pregnancy test, what services are available from your health center? (check all that apply)
1501401301201101009080706050403020100
"All options" counseling and education
Limited counseling and education
Referral for adoption services
Referral for abortion services
Referral for prenatal care
Prenatal care services provided on-site
Abortion services provided on-site
No services are provided
79.0 %
18.2 %
67.0 %
71.0 %
76.7 %
1.1 %
0.0 %
0.6 %