State Action Plan Summary
From the Regional Meetings on Gonorrhea Control
‘Optimizing Strategies to Reduce Morbidity’
DRAFT
Includes Regions I, III, IV, and X
October 4, 2009
Background
This document provides a summary of priority populations and action plans proposed at the
Regional Meetings on GC Control. The reader should be aware that these items were collected from
oral presentations at the end of the full-day discussions and may include errors from several sources
either at the meeting or after. Our intent is that this document will provide the reader with a general
appreciation of the priority populations and proposed activities that were discussed at the meeting.
Readers should also be aware that plans may have changed after further consideration. If you note
an error in this document, please inform Michael Bender at MSB3@CDC.GOV.
Priority Populations
Baltimore: 15-19 year olds in/out of HS
Delaware: 15 – 24 y.o. African Americans residing in Wilmington
DC: 15-19 year olds; particularly those who participate in school and summer jobs programs.
Maryland: African Americans 15 – 24 year olds
Pennsylvania: 15 – 24 year olds African Americans
Philadelphia: 15 – 24 year olds. Residents of identified gcHMA census tracts
Virginia: African Americans in gcHMAs; females’ 15 – 19 y.o; males 20 – 24 y.o.
West Virginia: African-American and White males & females under 25 living in the seven counties
with highest rates.
Alabama: 15- 24 year old African American females/males
Mississippi: 15-24 year old African American females
Georgia: 15-24 year old African American males and females
Florida: 15-24 year old African American male and females.
Kentucky: 15-24 year old African American male and females
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Tennessee: 15-24 year old African American females and males
North Carolina: 15-25 year old African American males
South Carolina: 15-25 year olds African American males and females
Alaska: all GC cases.
Idaho: 20 to 24-year-olds, American Indians, Whites, gcHMAs: Districts 3 and 4 (Central and
Southwestern Idaho).
Oregon: pregnant women, women with PID, and those with resistant gonorrhea.
Washington: MSM, African Americans ages 15 – 24, 5 HMA census tracts, recent cases that were
not treated/ improperly treated.
Connecticut: African-American, 15 - 29 year olds; Bridgeport, Hartford, New Haven gcHMAs
Massachusetts: 15-29 year old African American, Hispanic, MSM; Boston & Springfield gcHMAs
Maine: African-American 15-29 year olds; Portland area
New Hampshire: African American
Rhode Island: African American 15 – 24 year olds in Providence gcHMA
Vermont: All cases throughout the state, all ages, all sexes
Additional Data Analysis (including epi analysis and program evaluation)
Baltimore:
 Review H. S. and other data; give better data back to providers.
Connecticut:
 Meet with RI and learn to use mapping to better target efforts
Rhode Island:
 Become more involved in the DIS effort in order to have a better idea of the issues they have.
Delaware:
 Look at data from sites to redirect funding to areas of greater need.
Pennsylvania:
 Pilot collection of SsuN data in selected high prevalence clinics; need to improve data collection
on 15-and-under clients.
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Philadelphia:
 Look at more data to better understand population and behaviors in specified ZIP codes.
West Virginia:
 Monitor the data (little confidence prior to 2008) through 2009 before taking other actions.
Identified site types for data; are now looking at the data for each type; 40/145 of IPP sites do not
meet the positivity requirements. Look at reporting of positives and treatment in certain counties.
Alabama:
 More thorough review of data in Alabama
Georgia:
 Engage in a more thorough examination of data available.
Kentucky:
 Engage in a closer examination of our data. Examine screening coverage among sites we have
some influence over in target area
Tennessee:
 Rates for men have always been higher now rates for women are higher – don’t know why and
will do more investigation. We are implementing PRISM which is replacing STD/MIS we will
utilize this system to examine data. Engage CHCs in census tracks where the majority of GC
cases come from. Engage those sites to get a better understanding of how they approach GC
screening and treatment.
Connecticut:
 Learn how STD-MIS data can inform program focus
Massachusetts:
 Zip code analysis of GC rates in Springfield, Boston and Brockton.
Maine:
 Discuss/assess with state lab the total tests for GC from all providers (with the hope that this
information is available)
New Hampshire:
 Assess/Analyze GC positive data to see more specificity where positive tests are and who.
Rhode Island:
 Cross-match GC male cases with the HIV registry
Vermont:
 Create an Infectious Disease Bulletin on GC that captures both age distribution of cases and the
issue of health disparities and distribute to providers.
 Explore GIS mapping of Burlington, Colchester, Essex and Williston by census tracks and
diagnosis.
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Screening
Alabama:
 Conduct Model State Meeting – Create a user friendly report describing GC morbidity, practicespecific morbidity (if available), and utilize to facilitate discussions at the state, local and
community level. Include FQHCs, private providers, high schools and colleges. Utilize to learn
more about their GC screening approach
Connecticut:
 Discuss plan with local providers
Kentucky:
 Partner with Family Health Centers in Jefferson County
Philadelphia:
 Cut at least 2 low-positivity sites from current screening program.
 Add the ED and another clinic as a screening site in gcHMA zip code that had no screening
activities.
West Virginia:
 Monitor and redirect screening efforts to higher positivity clinics, women under 25,
 Continue provider education efforts around reporting, screening, and treatment, and PS.
Maine:
 Have conversation with Office of Local Public Health.
Mississippi:
 Expand screening in HS – some success and found significant CT/GC morbidity.
 Have screened in 18 Colleges and Universities – continue screening.
 Collaborate with CHC to increase screening.
Georgia:
 Better assessment of screening coverage needed in target area by census track
 Disseminate a GC Alert – Notice Letter – to providers describing burden of GC along with
specific break-down of data by zip code [3-6 months]
 Develop a GC Letter and disseminate through existing AAFP (American Academy of Family
Physicians) partnership - we can utilize that partnership to spread the word
Idaho:
 Target private providers in the geographic areas determined to be high morbidity to assist with
targeted education to the clientele they are diagnosing.
 Target gay friendly providers in the state for education about the latest epidemiology of
gonorrhea, treatment guidelines, reporting disease and oral or anal sites of infection and how to
test at those sites.
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Oregon:
 Develop a memo encouraging providers serving higher risk persons and communities
(e.g., MSM), to screen their patients for GC.
 Encourage GC screening of persons in correctional facilities, especially county jails and juvenile
facilities.
Maryland:
 Do multiple outreach levels to providers (form will vary by need and entity). At state level, work
with HMOs and other state agencies.
Massachusetts:
 Explore CT/GC screening (?) integration into HIV van for testing at high schools and
community- colleges.
New Hampshire:
 Make Manchester providers – both public and private – aware of need for screening
Rhode Island:
 Try to identify providers in South Providence and see if they are screening sexually active
females that they see in their practice.
Vermont:
 Focus on gcHMA, for VT, and obtain from VDH lab and FAHC lab a total number of
individuals that are screened by the provider.
 Once provider screening information is captured, create an overlay of providers for that area.
Virginia:
 As part of DIS certification process, train 25% of DIS annually to conduct urine testing for
gonorrhea and Chlamydia. This would require annual re-certification through conducting a
certain number of urine screenings.
 Health commissioner will write a letter to public and private providers to describe at-risk
populations and encourage enhanced efforts to routinely screen for GC.
West Virginia:
 Look at GC screening pilot projects of pregnancy test clients in CHL data and consider
expanding to other sites.
 Continue provider education efforts around reporting, screening, and treatment.
Treatment
Oregon
 Continue to send treatment alerts to providers who treat GC cases with a quinolone
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Washington:
 Confirm that untreated and improperly treated cases are being followed up by local health
jurisdictions.
Kentucky:
 Enhance communication with STD and FP clinics about time to treatment rates utilizing the IPP
PM
Work with Medical Care Providers:
Baltimore:
 Work with the private sector; stratify data and identify sites; work with the training center to
offer CME classes. Note: Can you add what steps you plan to take with private sector providers?
Virginia:
 Evaluate HMOs performance on HEDIS CT screening and encourage providers to increase
CT/GC testing and improve their performance on the HEDIS measure.
 Partners to Use CHCs partner-notification model to work with other increase GC PS.
Alabama:
 In order to get a better sense of testing activity invite providers in target area to submit
prevalence monitoring data to the state.
Georgia:
 Provider Visits will now focus on GC. Work closer with private providers to promote screening we can’t expand we need to partner to ensure that they are following CDC screening and
treatment guidelines.
Tennessee:
 Talk with TENCARE – we worked with them to include a CT screening component in their
contract with Managed Care Organizations, will engage them in a conversation about adding GC
to contractual requirements.
 Need to get more info to private providers and rates of GC.
New Hampshire:
 Make Manchester providers- both private and public aware of need for screening. Identity two
key leaders in African American communities who would help spread the word of the need for
screening.
Rhode Island:
 Try to identify providers in South Providence and see if they are screening sexually active
females that they see in their practices.
Connecticut:
 Work with local HDs in gcHMAs (Bridgeport, Hartford, New Haven)
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Massachusetts:
 Work with local HDs in gcHMAs (Boston, Springfield)
Maine:
 Have conversation and engage Office of Rural Health and Primary Care to have STD discussion.
Access to Care
Washington:
 Identify where MSM are accessing care outside King County.
 Assess level of care at these providers.
Mississippi:
 Heinz County in MS- look at capacity of the school system to provide STD services – schools
have nurses but don’t know what they do – conduct a survey with schools to determine what
services they provide and explore opportunities to partner
North Carolina:
 As part of routine site assessments conducted by state DOH to facilitate county health
department accreditation, examine triage process to ensure that all symptomatic are provided
appropriate services that day and not turned away.
Partner Services (including EPT and developing materials to promote PS)
Massachusetts:
 Explore models for DIS to be assigned to high risk schools and certain cities
Baltimore:
 Do a look-back study to determine if partner-delivered therapy is effective.
 Evaluate EPT.
DC:
 STD is beginning to assume responsibility for all HIV PS in DC. As part of that process, we will
train community partners to offer PS to GC patients; and enhance our GC PS efforts. (i.e. look
at leveraging community partners. See how many can provide staff to assist).
Maryland:
 Look at how to expand EPT to the state level to be part of PS.
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Pennsylvania:
 Develop a statewide EPT policy.
 HIV-surveillance information sharing protocol is awaiting approval; it will improve PS rates.
 Start GC interviews for HIV+ and MSM
 Design a system to capture info on scope and magnitude of PS.
Alabama:
 Pursue expanding age for GC interviews; current DIS interview 15-19 – extend to 29 and
incorporate GC
Mississippi:
 EPT pilot in 1 STD clinic in Jackson – look at findings and expand – with that information
approach officials to promote EPT
Georgia:
 We are not currently interviewing cases of GC and we are relying on nurses to do follow-up.
We’ll develop a system to monitor efficacy of current efforts by nurses in bringing partners to
treatment (develop a referral card systems that is color coded)
 4 DIS in Albany – Albany has highest rate of GC and has low syphilis; consider deploying them
to conduct GC interviews.
Florida:
 DIS currently verify treatment on all STDs reported to Florida DOH. Create a decentralized
phone bank staffed by clerical support to verify treatment instead of having DIS conduct this
activity
 Break the barrier of doing phone interviews to verify treatment rather than going to the to index
patient to give to partners. The card will be universally recognized by non-county health
department providers – develop tracking system ????? I don’t understand KO
Kentucky:
 In January 2009 initiated interviewing symptomatic males who tested positive via gram stain for
GC – continue this effort and monitor. DIS – 8 for whole state of Kentucky and 3 for Jefferson
County
Tennessee:
 We do EPT for CT and want to add GC (would take a rule change)
Alaska:
 Collecting more information on the characteristics of the recent increased GC incidence through,
testing habits, chart review, interviews with patients and providers. We follow up on all GC
cases, and target individuals with confirmed tests results and their partners.
Oregon:
 Provide partner services for all reported GC cases that can be located. For all reported GC cases,
verify treatment and request approval to offer partner services.
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Washington:
 Address the disparity in disease among African Americans by increasing activities in the 5
census tracts with highest reported GC morbidity.
Connecticut:
 Bring in DIS to discuss next steps in addressing GC.
Massachusetts:
 Explore models for DIS to be assigned to high risk schools and certain cities.
Rhode Island:
 Perform analysis of cases among African Americans to look at demographics and see how
successful DIS efforts are in that population.
 With 2 new DIS joining the RI/STD program RI hopes to have a better defined method for DIS
efforts into the city of Providence so that 90-95% of the GC cases are interviewed.
Community Engagement (including community level interventions)
Baltimore:
 Work with school-based clinics. Note: can you add what services you hope to see them offer?
 Look at teen incidence and find partners to assist in locating and reaching out-of-school youth.
Delaware:
 Explore working with the military regarding reporting to seek out possible missed opportunities;
seek liaison.
Pennsylvania:
 Follow up with key objectives from Allegheny County pursuant to prior stakeholders’ Disparities
meeting in PA.
West Virginia:
 Work with the Department of Minority of Affairs to identify members for a coalition to address
minority STD issues
Alabama:
 Conduct Model State Meeting – Create a user friendly report describing GC morbidity, practicespecific morbidity (if available), and utilize to facilitate discussions at the state, local and
community level. Include FQHCs, private providers, high schools and colleges. Utilize to learn
more about their GC screening approach
 Look at Community-level engagement. Gather qualitative information about community
perceptions, needs in order to inform GC strategy in target community, at the same time share
morbidity data with community in order to raise awareness.
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Georgia:
 Do better job working with community leaders
 We’re not giving appropriate messages to appropriate groups – improve development and
dissemination of STD prevention messages to the community
Tennessee:
 Engage a CBO in Memphis who currently partners with DOH on Syphilis Elimination to see if
they will add GC to their efforts
 Develop and disseminate an article on GC in newsletters to providers in target communities
Alaska:
 Meeting with key providers in the Bethel area (where an outbreak is occurring) to discuss plans
(Including the Alaska Native Tribal Health Consortium [ANTHC} and CDC)
Massachusetts:
 Explore adding a question to the YRBS: “Have you been tested for STDs”
Maine:
 Have conversation with Office of Local Public Health.
New Hampshire:
 Make Manchester providers- both private and public aware of need for screening. Identity two
key leaders in African American communities who would help spread the word of the need for
screening.
Vermont:
 Through PCSI TA that is being provided to HIV prevention providers, create targeted messages
on GC for communities of color, particularly African Americans.
Health Education/Risk Reduction (behavioral interventions; i.e. condom promotion,
promoting comprehensive sex education, including STD prevention messages in HIVP EBIs
targeting at-risk populations, etc.)
Baltimore:
 Find out the person in charge of health education for the school district and discuss ways to
promote safer behaviors(?)
Pennsylvania:
 Give enhanced informational packs to sexual partners (has been shown to be effective as EPT);
institute in selected high prevalence clinics.
Other Activities
South Carolina:
 Implement zero budget plan
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