Transcript National Malaria Surveillance System (NMSS)

SSuN Cycle 2
Conference call #5
Population-based gonorrhea surveillance
Lori Newman & Kristen Mahle
November 13, 2008
SSuN Conference Call #5 Agenda
 Misc admin topics
 Population-based gonorrhea (GC)
surveillance
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Objectives
Sampling framework
Data elements
Data transmission
Analysis and use of data
Misc Admin Topics
 SSuN Collaborator’s Meeting room
reservations by Friday, November 14th
 Draft meeting agenda sent out
• Any feedback?
 Scheduling 30 min calls with new sites
SSuN: Population-based
gonorrhea (GC) surveillance
DSTD Goals & Objectives
 Goal 1: Prevent STI-related infertility
• Objective C: Reduce GC incidence
 Goal 6: Reduce STD health disparities
• Objective C: Reduce GC in African
Americans
Rationale for Population-based
GC Surveillance
 GC rates still far from Healthy People 2010
objectives, but we don’t understand why
 Case report data at national level limited to
sex, age, race/ethnicity, and crude provider
type
 Need a better understanding of patients with
GC, especially those outside of the STD
clinic setting
Objectives of Population-based
GC Surveillance in SSuN Cycle 1
1. Establish network of health departments
working collaboratively with standardized
methodology
2. Collect demographic, behavioral, and clinical
data on patients with gonorrhea
• Monitor trends over time
3. Use data to guide local, state, and national
STD programs and policies
SSuN Cycle 1 Methodology –
Sampling
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Data collected on sample of patients
reported with GC in selected counties
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Sample excludes patients who attend the
primary STD clinic(s)
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Phone or in-person interview of first
reported patients each month until
completed 10 male and 10 female
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San Francisco: weekly sample adjusted for
non-response for target of 100 men and 100
women per year
SSuN Cycle 1 Methodology –
Data Transmission
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Data transmitted with morbidity data for SSuN
counties
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Supplement to case reporting, NOT in lieu of
Assessment of representativeness, contact rate, etc.
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Data collection initiated between Feb 2006 and
Jan 2007
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Initially monthly, now quarterly
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Cumulative data file with each transmission
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Data stored and transmitted independently of
SSuN STD clinic data
SSuN Cycle 1 Population Size, Sample
Size, and Interview Success Rate
SF
WA
CO
MN
VA
Total
Number of Case Reports (A)
5,287
6,221
4,331
3,243
2,485
21,567
Number of Eligible Patients (B)
3,293
6,182
2,756
2,314
1,579
16,124
Number Eligible & Selected for
SSuN (C)
754
2,058
2,187
1,548
977
7,534
Number Eligible, Selected, and
Interviewed (D)
209
906
456
457
307
2,335
27.4% 44.0% 20.9% 29.5% 31.4%
31.0%
Interview Success Rate (E = D/C)
SSuN Cycle 1 Methodology Collaborative Data Elements
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Demographics
Sexual practices
Substance use
Partner
characteristics
HIV history
STD history
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Clinical history
Treatment
Census tract
Patient-provider
distance
 Provider point data
SSuN Cycle 1: Comparison
between STD clinic & population-based
data elements
 Population-based data elements mirror STD
clinic data elements whenever possible
• All population questions asked retrospectively
(after GC diagnosis made)
• Allows for additional questions about provider
type, most recent sex partner, spatial data, etc.
• No lab data (info obtained from patients)
SSuN Data dissemination
 Quarterly reports
• Data quality review
• Data dissemination
 Encouragement of joint
analyses by local and CDC
collaborators
• National STD Conference
presentations
• Overview in OASIS special
issue
• Ongoing analyses
 Single site analysis &
dissemination
SSuN Data Uses (1)
• MN, VA, CO: large numbers of GC patients not
informed of GC diagnosis
• SF, WA: value in improving provider type
categorization
• CO: need for additional STD clinic on eastern edge
of city
• MN: identification & follow-up of HIV-GC co-infection
in “real time”
SSuN Data Uses (2)
• CO & CDC: need to improve following
of CDC recommendations in private,
non-STD clinic settings
• CDC: how to focus GC control
strategies?
• CDC: what data are useful for program
guidance?
SSuN Cycle 1 - Limitations
 Limited ability to generalize
• Only 5 geographic sites and 11 counties
• Excludes “primary” STD clinic patients
 Possible response bias
• Only able to contact ~ 1/3 patients with GC due to poor
contact information
 Slight variability in methodology between sites
since integrated into routine activities
 No trends over time available yet
 Lengthy interview (~ 8-10 minutes)
Moving from SSuN Cycle 1
to Cycle 2……..
Do the SSuN Cycle 1
objectives still hold?
1. Establish network of health departments
working collaboratively with standardized
methodology
2. Collect demographic, behavioral, and
clinical data on patients with gonorrhea
•
Monitor trends over time
3. Use data to guide local, state, and national
STD programs and policies
Methodology changes?
 Sampling population
• Non-STD clinic vs. all morbidity?
 Sample size
• 10 men and 10 women per month?
 Data elements
• Should we design a shorter interview?
• What to delete, add, or change?
SSuN Cycle 2: Participating project areas (n=12)
How to handle different numbers of counties per project area?
Washington
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Connecticut
Chicago
Philadelphia
New York City
Baltimore
San Francisco
Colorado
Virginia
Los Angeles/CA
Alabama
Louisiana
~ 100 counties:
Range: 1 to 61
Increasing use and dissemination of
population-based data
 Quarterly report modifications?
 How to foster more multisite analyses?
 How to make data more useful for
program?
Questions & Comments?