Columbus County Health Department
STD Clinic Overview
Columbus County Health Department (CCHD) management and staff view the Sexually
Transmitted Disease (STD) Program as being an organized system for prevention of
disease/morbidity, and premature death. This includes but not limited to STD related
infertility, adverse pregnancy outcomes, cancers, and HIV transmission. This task will
be accomplished by the following: organized community efforts utilizing the 10
Essential Public Health Functions (Intense focus on Assessment and Assurance), North
Carolina Disease Surveillance System, N.C. STD Assessment, Prevention and Treatment
Protocol, and guidance from our state Public Health Communicable Disease Branch and
Center for Disease Control (CDC) for identification and treatment of STDs.
Understanding the Effect of Socio-Economic Factors
Columbus County Health Department understands that socio- economic factors or
determinates which contribute to health care outcomes. The Columbus County STD
Comparison report for years 2012 and 2013 shows a slight decrease in all categories.
Target populations include racial and ethnic minorities, adolescents, MSM, clients who
have multiple sex partners and clients who have repeat STD as seen in the 2008-2012
NC Surveillance Report information. 2010 Census shows our county grew from 54,212
to 58,098. 65% are Caucasian, 30.4 are African American, 3.3 are American Indian, and
3.5 are Hispanic and/or Latino. Columbus County is a largely rural county and identified
as a Tier 1 County which means we are one of the most economically distressed counties
in the state. An estimated 21.9 % of our residents live below the poverty level.
STD Clinic Staff and Supervision
The Adult Health clinical staff consists of certified STD ERRN’s, trained, and certified
in Physical Assessment as mandated by policy and job description. The Family Nurse
Practitioner and CCHD Medical Director are available as needed for complex or
complicated cases. Generally the ERRN’s follow the CCHD Medical Directors signed
standing orders for testing and treatment. Nurse(s) are to attend annual STD updates and
are encouraged to take additional educational courses such as cultural diversity,
customer service, Public Health Law, etc.
Clinic Procedures
The clinic is a walk in clinic, first come first serve basis which provides testing and
treatment for many types of STD’s. All clients requesting testing for STDs will be seen
within 24 hrs or one working day of their request. The clinic is generally open every day
but may vary slightly depending on staff availability, meetings, training, and/or
clinician’s discretion.
Additional services include but are not limited to include: prevention of STD’s through
vaccination, safe sex education, outreach immunization service within the county and
city school systems, diagnosis of STD/HIV through physical exams, laboratory testing,
confidential counseling, and education regarding STDs and HIV, dispensing of free
condoms on request, referral, and follow up services such as social work etc.
STD ERRN(s) will not evaluate a patient under the age of 13 and will refer him or her to
the Nurse Practitioner or M.D. A client under the age of 13 diagnosed with an STD will
be referred to a social worker as follow up. Persons seeking care after a sexual assault
will be referred to the local emergency department for proper care and gathering of
evidence.
STD Clinic Services Provided
The CCHD STD clinic provides STD exams and Treatment in accordance with the
 10A NCAC 41A .0101 REPORTABLE DISEASES AND CONDITIONS
 10A NCAC 41A .0201 CONTROL MEASURES - GENERAL
 10A NCAC 41A .0201 CONTROL MEASURES - GENERAL
 10A NCAC 41A .0202 CONTROL MEASURES – HIV
 G. S. 90-21.5. Minor's consent sufficient for certain medical health services
Community Partners and Collaboration
CCHD Adult Health staff collaborates with the New Hanover Regional Medical Center
Infectious Disease Program to provide a satellite clinic twice a month monitor and treat
those diagnosed with HIV. All individuals with a reactive HIV PCR will be referred to
the N.C. SLPH to a Disease Intervention Specialist (DIS) for follow up investigation
within 72 hours.
CCHD has a signed agreement with the Dream Center (Community Based Non-Profit
Agency) to assist them with:
1. HIV/AIDS/STD screening and treatment including laboratory services when needed
2. Tuberculosis screening and treatment as needed.
3. HIV early intervention and prevention and client case management.
4. Use of relevant Hive/AIDS/STD standing orders, policies, and procedures
5. Use of CCHD confidentiality Policy
6. Staff member to serve on a Program Review Panel, as needed.
7. Provide training on health care issues as classroom space allows.
8. Place orders for DREAM Center at cost for the medical supplies.
CCHD Health Educator provides pregnancy prevention education to high schools
which include STD prevention.
Staff attends health fairs the college, the local hospital, as well as various
other venues providing literature and answering questions.
Utilize out electronic messaging sign at times throughout the year promoting safe sex
and use of condoms.
Last but not least CCHD provides free condoms.
Quality Assurance
Quarterly Audits are done in all clinical areas including STD clinic per audit policy
utilizing the state audit tool. If there are compliance issues the staff involved are
requested to complete a corrective action plan stating how they will make
improvements and follow up chart reviews as needed.
N.C. 2012 HIV/STD Surveillance Report 2013
Communicable Disease Branch Columbus County
NC Communicable
Disease Branch
HIV
(rate)
AIDS
(rate)
Gonorrhea
(rate)
Chlamydia
(rate)
Syphilis (Primary
And Secondary)
(rate)
Syphilis (Primary
Secondary, Early
Latent
(rate)
2009 Cases
(rate)
9
(16.6)
6
(11.1)
82
(151.2)
264
(486.9)
2010 Cases
(rate)
13
(22.4)
8
(13.8)
78
(134.5)
192
(331.2)
2011 Cases
(rate)
10
(17.3)
6
(10.4)
149
(258.2)
375
(649.8)
2012 Cases
(rate)
5
(8.7)
8
(13.9)
81
(140.4)
257
(445.3)
2013 Cases
(rate)
6
(10.4)
7
(12.1)
75
130.1
226
(392.1)
2013 N.C.
Average Rate
Table 3
18.7
Table 6
11.0
Table 8
140.1
Table 7
499.9
1
(1.8)
1
(1.7)
0
(0.0)
1
(1.7)
0
0
Table 9
4.3
1
1
1
3
1
Table 10
1.8
1.7
1.7
5.2
1.7
6.9
(Rate per 100,000- Population)
http://epi.publichealth.nc.gov/cd/stds/figures/std13rpt.pdf
As seen in the table above Columbus County AIDS rate has decreased from 13.9 in
2012 to 12.1 in the year 2013. This is above the NC state average of 11.0. The primary,
secondary, Early Latent Syphilis has decreased from 5.2 in 2012 to 1.7 in 2013.
However, the county remains below the state average of 6.2. There is obvious
improvement all other areas and are below the state average.
The 2009-2013 demographic shows HIV infection more prevalent in AA males and
females. The report shows Gonorrhea more prevalent among the African American
population and females. The Hispanic/Latino population is shown as being 1.59% without
taking into consideration the variance of unknown or missing classification. Again you
will find the prevalence of Chlamydia and Gonorrhea higher in the African American
Population. The Hispanic population shows the second highest prevalence for these STIs.
See the attached link above for the more detail regarding percentages, gender and age.
See highlighted details below.
As well we have the highlights of the N.C. 2009-2013 STD Surveillance Report
Highlights
HIV Infection
• As of December 31, 2013, the estimated number of living HIV infection cases
diagnosed and reported in North Carolina was 28,101 (Table 1).
• For 2013, 1,525 new diagnoses of HIV infection were reported (Table 3). Please
note this number is inflated as the interstate deduplication analysis was delayed
and not conducted for 2013 (see technical notes).
• In 2012, 1,347 new diagnoses of HIV infection were reported. This is a
noteworthy number, as it continues to show a decreasing trend in North Carolina
for the number of newly diagnosed HIV infections over the last five years. For
North Carolina, we expect the 2013 number of new diagnoses to be closer to that
of 2012, after the interstate deduplication analysis is conducted.
• The three-year (2011-2013) average rate of diagnosed HIV infection in North
Carolina was 15.0 per 100,000 population. The top five counties with highest rates
were Mecklenburg (31.0 per 100,000), Edgecombe (31.0 per 100,000),
Cumberland (26.0 per 100,000), Durham (25.7 per 100,000), and Guilford County
(23.5 per 100,000) (Table2).
• Among the HIV infection cases diagnosed in 2013, African Americans
represented 64 percent of all cases with a rate of 55.8 per 100,000 adult/adolescent
population. The highest rate (92.3 per 100,000) was among adult/adolescent
African American males (Table 11).
• For the newly diagnosed adult/adolescent HIV infection cases in 2013, men who
have sex with men(MSM) was the principal risk factor indicated in 61 percent of
total cases, heterosexual transmission risk was indicated in 33 percent, injection
drug use (IDU) was indicated in 4 percent, and MSM/IDU was indicated in 2
percent of total cases (Table 14). Early Syphilis
Early Syphilis
• The number of early syphilis cases diagnosed in North Carolina in 2013 was 677,
with a rate of 6.9 per 100,000 population. In 2012, 598 early syphilis cases were
diagnosed, with a rate of 6.2 per100, 000 population (Table 10).
• The top five counties with the most early syphilis diagnoses in 2013 were
Mecklenburg (151), Wake (102), Guilford (51), Forsyth (50), and Cumberland (47)
(Table 10).
• African American males had the highest rate of early syphilis (37.7 per 100,000),
and represented 56 percent of total early syphilis cases in 2013 (Table 23).
Chlamydia
• The reported number of chlamydia cases in 2013 was 48,417 (Table 7).
• Among female chlamydia reports in 2013, the age groups with highest rates were
20-24 year olds (4,560.5 per 100,000), followed by 15-19 year olds (3,871.3 per
100,000) (Table 18).
Gonorrhea
• The reported number of gonorrhea cases in 2013 was 13,665 (Table 8).
• In 2013, African American females and males had the highest gonorrhea rates
(356.6 and 333.8 per 100,000 respectively), and represented 30 percent and 25
percent of total cases (Table 19).
N.C. 2013 HIV/STD Surveillance Report 2013
Communicable Disease Branch
STD updated 4/8/2015