Service Area Strategic Plan
11/23/2009   4:58 am
Department of Health (601)
Biennium: 2008-10
Service Area 1 of 1
Sexually Transmitted Disease Prevention and Control (601 405 04)
Description

Sexually Transmitted Disease (STD) prevention and Control Services provides for the prevention and control of morbidity and mortality associated with STDs and their complications, including assistance to local health departments and community organizations. Activities include:
Oversight of statewide program activities;

Policy and guidelines development;

Grants management for STD Prevention and Control;

Diagnostic and laboratory support for gonorrhea and chlamydia testing;

Partner services (patient counseling, interviewing and partner referral);

Early detection, referral, and treatment;

Technical assistance and consultation;

Targeted outreach to high-risk individuals;

Clinical and field screening;

Community-based organization funding to provide syphilis and other STD interventions;

Deployment of the Virginia Epidemiology Response Team (VERT) for outbreak situations;

Risk reduction counseling;

Oversight and management of surveillance activities, including forms completion, data management, trend analyses and disease monitoring, reporting and STD research initiatives;

Program evaluation and quality assurance assessments; and

Health care provider training and education.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    This service area directly aligns with the Virginia Department of Health (VDH) mission to promote and protect the health of Virginians. This program improves the health of people and their communities, particularly those populations infected with and impacted by STDs, through STD prevention initiatives, referral and treatment services, and surveillance activities.
  • Describe the Statutory Authority of this Service
    Chapter 2 of Title 32.1 of the Code of Virginia pertains to the reporting and control of diseases.

    § 32.1-35 and 12-VAC-5 90-80 and 12-VAC-90-90 of the Board of Health Regulations for Disease Reporting and Control specify which STDs are to be reported and the method by which they are to be reported.

    § 32.1-36 requires physicians to report persons with STDs to the local health department.

    § 32.1-39 provides for STD surveillance, investigation of reports, and conducting counseling and partner notification.

    § 32.1-57 through 32.1-60 requires STD examination, testing, and treatment.

    § 32.1-64 requires treatment for ophthalmia neonatorum.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Community Health Clinics 3 10
Community-Based Organizations 45 45
Gay/Bisexual Men 1,500 175,000
Institutionalized populations 1,200 1,200
Local Health Departments 119 119
Patients screened for chlamydia/gonorrhea in public health clinics (i.e. STD, Prenatal, and Family Planning) 92,852 120,000
Private Physicians 6,500 6,500
STD Clinic Patients (includes some patients referenced above) 54,109 60,000
Surveillance/Data Report Recipients (data requests, reports, etc.) 9,750 71,000

Anticipated Changes To Agency Customer Base
Increased number of persons screened for Sexually Transmitted Diseases (STDs) in public clinics:
As part of a national campaign to reduce infertility in women, Congress allocated funds to provide early detection for chlamydia in women attending STD and family planning clinics. This has since been expanded to include other relevant clinics serving women of reproductive age. Women under 25 years old in family planning/prenatal clinics and all women in STD clinics are eligible. Most women eligible for chlamydia screening are also tested for gonorrhea. The screening criteria have been expanded to allow for male screening and an increasing number of men are also screened for both STDs. An estimated 120,000 patients annually meet the criteria, which has been in place for women since 1993. Screening criteria for women is not likely to change substantially in the foreseeable future.

Increased number of gay/bisexual men reported with syphilis and other STDs:
Over the past four years, the proportion of early syphilis cases attributed to males increased from 56% to 87%. In 2004, almost all male syphilis cases were among gay or bisexual men, about half of which were HIV
co-infected. Virginia’s cases are consistent with national trends which are expected to change slightly over
time as more female partners become infected. This population is difficult to reach as there are very few
venues in Virginia that provide targeted health care to gay/bisexual men.

Community-Based Organizations (CBO) are likely to become more involved in assisting with STD-services, especially related to partner notification and referral.

Two CBOs currently receive funding from the Division to provide STD services. All funded CBOs statewide (~45) incorporate STD interventions whenever possible as a stipulation of funding for HIV Prevention. These CBOs receive STD materials at no charge.
Partners
Partner Description
[None entered]
Products and Services
  • Factors Impacting the Products and/or Services:
    Level funding and recent reductions in federal funds for STD prevention and control have resulted in
    growing difficulty to maintain current program services.

    Advances in testing technology offer many benefits for increasing the number of people identified with
    STDs; however, costs associated with advanced testing technology combined with level funding limits the
    expansion of this service.

    Hepatitis C became a reportable condition in 2001, at which time federal and state funds were available for hepatitis initiatives, including awareness campaigns, testing, and vaccinations. These funds have since ceased to exist. Federal funds that support a hepatitis coordinator and hepatitis B vaccine through a collaborative effort with the Division of Immunization are the only currently available resources. As such, activities to support hepatitis services are nonexistent.

    Cultural and shifting demographic changes highly impact service needs. Examples include
    internet use for meeting partners, recreational drug use and use of performance enhancing drugs (i.e., Viagra,
    Cialis, Levitra).

    STD clinic patients are a high-risk population that represents the core area
    for STD prevention and control services. Comparatively, there are specific geographical areas within the
    Commonwealth that have clinic populations with significantly higher STD rates.

    Historically, screening programs have been implemented in jails targeting inmates related to specific
    outbreak-related populations. Examples include prostitutes in Norfolk and inmates meeting certain age/race criteria in Danville. Most of these programs are temporary arrangements established to assist
    with specific outbreak situations. Additionally, chlamydia and gonorrhea screenings are provided in Virginia’s central medical site serving incarcerated youth.

    All Local Health Departments (LHD) in Virginia have a collaborative relationship with the Division for the provision of STD services. The level of collaboration is affected by factors such as morbidity, population, geography and need.

    Private health care providers of STD services and diagnoses receive STD-related information
    from the Division. These practitioners are primarily from disciplines such as Obstetrics/Gynecology,
    Infectious Disease, and Preventative Health. Most routine private sector screening for STDs is performed
    within the above-mentioned specialties.

    Statistical analyses, reports and data sets of disease trends are provided for a wide range of customers,
    including LHDs, CBOs, STD patients, private physicians, academia, media and the general public. Such
    reports are made available via published documents (hard copies and web-accessible), electronic media such
    as compact disks, and non-routine data requests. Confidentiality of data is maintained at all times.
  • Anticipated Changes to the Products and/or Services
    Emerging program needs will revolve around ongoing research findings. For example, vaccine development is underway for both human papillomavirus (HPV) and herpes. Data collection for genital warts has begun in some health departments.

    Screening tests for cervical cancer have been developed, which will impact our customers. Increased numbers of persons identified with HPV, as a result of cervical cancer screening, will necessitate the need to
    identify providers for referral and treatment.

    As antibiotic resistance continues to increase, a greater need will be placed on the necessity to use new,
    expensive classes of drugs. There is also a need to develop capacity to monitor for resistance to all available drugs.

    Recent enhancements to existing surveillance activities will continue to occur via targeted surveying of
    high-risk populations and behavioral based surveillance initiatives. Additional collaborations with the
    Virginia Commonwealth University School of Public Health are also anticipated as a means of strengthening
    surveillance and analytic capacity.

    The Centers for Disease Control and Prevention (CDC) continues to embrace its existing surveillance system for STDs. This system is referred to as the Sexually Transmitted Disease Management Information System (STD*MIS). Advances to this applicatiaon as well as the laboratory information system will allow for new initiatives such as the initiation of Electronic Laboratory Records (ELRs). It is unknown at present what impact ELRs will have on staffing requirements.

    STD clinic attendance has not fluctuated much over time and is not expected to change significantly in the
    future, although a higher number of male clients will receive screening.

    The number of persons screened for STDs in incarcerated settings fluctuates depending on current disease
    investigation needs. It is unknown whether the number of persons screened will increase or decrease in the foreseeable future.

    The number and specificity of requests for data and data sets has increased in recent years. Additionally,
    specific data needs such as assessments of HIV unmet needs and enhanced development of epidemiology
    profiles are expanding needs for data expertise. The need for Statistical Analysis Software (SAS)
    expertise has also increased dramatically in recent years and will continue to become a more
    important skill set for epidemiologists and data managers.
  • Listing of Products and/or Services
    • Leadership and Program Management Thorough and consistent oversight, policy development and guidance are provided for STD prevention services, including technical assistance to local health departments and community organizations. Grants related to STD Prevention and Control, including the Comprehensive STD Prevention Services grant, as well as those related to enhanced STD surveillance, are managed and maintained. Allocating personnel resources to local health departments is handled through Memoranda of Agreement.
    • Program Evaluation Program Assessment and Review (PAAR) evaluations are conducted for local health department STD programs. Formal reports with findings and recommendations are provided to local health directors.
    • Surveillance and Data Management Surveillance staff conducts and provides guidance to local health department disease investigators regarding patient and partner interviews and follow-up procedures. Surveillance staff conducts data management activities, including form and system development, data collection and entry, epidemiologic analyses and quality assurance. Time-scaled reports are provided to relevant personnel and the public via Local and Wide Area Networks, the internet, Compact Disks and data publications.
    • Training and Professional Development Health care provider training and education is provided on an ongoing basis. Knowledgeable staff are assigned to provide consultation services and technical assistance for specified areas of the Commonwealth. Laws and regulations pertaining to STDs are provided and the HIV/STD Operations Manual is maintained and distributed to appropriate staff. The Division of Disease Prevention (Division) has a collaborative partnership with the Region III HIV/STD Prevention Training Center to provide an annual 5-day STD clinical training to providers. Training that addresses STD partner notification procedures for medical providers is conducted by the Virginia HIV/AIDS Resource and Consultation Center.
    • Medical and Laboratory Services Diagnostic and therapeutic services for gonorrhea and chlamydia are supported through a contract with the Division of Consolidated Laboratory Services and the provision of laboratory testing supplies to local health departments. Funding for testing is also provided to some community health clinics. Assessment to determine implementation of new testing technology is also performed in order to improve service delivery. Testing, vaccines and medications related to Hepatitis are provided to specific populations and/or locations, based on available funding.
    • Partner Services Staff conducts and provides guidance to local health department disease investigators related to risk reduction counseling, interviewing and referral services for STD patients and sexual partners. Early detection, referral and treatment are paramount to avoiding lasting health consequences such as Pelvic Inflammatory Disease or infertility.
    • Community and Individual Behavior Change Interventions Community Based Organizations (CBOs) are funded to provide syphilis and other STD interventions. Social networking techniques are employed when working with patients, partners and acquaintances. Staff work within affected communities to establish “local ownership” of disease conditions as well as community coalitions.
    • Outbreak Response Plan An Outbreak Response unit, inclusive of VERT, was established in 1999, as a result of dramatic increases of syphilis in Danville. VERT staff addresses programmatic needs in the National Syphilis Elimination Plan, as well as other STDs. Additionally, this unit participates in other disease investigations throughout the Commonwealth, including anthrax, tuberculosis, etc. An accrediation process was developed for VERT staff to ensure their skills are maintained at a high level. VERT staff have to be re-certified annually.
    • Areas of Special Interest Clinical screenings are provided for gonorrhea and chlamydia, targeting specific high-risk populations. Hepatitis screening and/or vaccines are provided in some health departments as funds are available. Targeted field screenings are provided by VERT staff for various STDs. Surveys and research activities regarding specific high risk populations are conducted as a means of collecting enhanced surveillance data to better assess outcomes associated with STD transmission.
Finance
  • Financial Overview
    The chief source of funding for Sexually Transmitted Disease Prevention and Control is federal funds from the Centers for Disease Control and Prevention. Federal funds are intended to supplement (not replace or supplant) state and local resources but matching of these funds is not required. The nongeneral base budget is the previous year base-level award and the general base budget is the prior year's legislative appropriation. The service area also receives some general funds. Within the general fund, 75% of the funds are used for central office personnel and the remaining 25% supports STD testing and travel.
  • Financial Breakdown
    FY 2009    FY 2010
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $278,436 $1,762,060    $278,436 $1,762,060
    Change To Base $0 $0    $0 $0
               
    Service Area Total   $278,436  $1,762,060     $278,436  $1,762,060 
Human Resources
  • Human Resources Overview
    [Nothing entered]
  • Human Resource Levels
    Effective Date      
    Total Authorized Position level Ø    
    Vacant Positions Ø    
    Current Employment Level 0.0    
    Non-Classified (Filled)    
    Full-Time Classified (Filled)    breakout of Current Employment Level
    Part-Time Classified (Filled)    
    Faculty (Filled)    
    Wage    
    Contract Employees    
    Total Human Resource Level 0.0   = Current Employment Level + Wage and Contract Employees
  • Factors Impacting HR
    [Nothing entered]
  • Anticipated HR Changes
    [Nothing entered]
Service Area Objectives
 
  • Reduce the incidence of Sexually Transmitted Diseases (STD) among Virginia’s citizens.
    Objective Description
    Prevention and control of STDs is of critical importance to ensure the health of Virginians. Undiagnosed or untreated STDs may lead to disease outbreaks, as well as severe health consequences such as congenital deaths, infertility, ectopic pregnancy and blindness.
    Alignment to Agency Goals
    • Agency Goal: Prevent and control the transmission of communicable diseases.
    • Agency Goal: Collaborate with partners in the health care and human services system to assure access to quality health care and human services.
    • Agency Goal:
    • Agency Goal:
    Objective Strategies
    • The Division of Disease Prevention (Division) will continue efforts aimed at reducing the incidence of STDs through effective surveillance initiatives by: • Employing methods to capture, analyze and make available relevant surveillance information necessary for appropriate STD program development and evaluation activities, including tabular and graphical data reports and enhancing the Division’s Strategic Aberration Monitoring (SAM) system. • Using historical methods of surveillance monitoring combined with enhanced surveillance initiatives. • Educating and/or enforcing STD reporting laws mandated through the Code of Virginia § 32.1 and the Board of Health’s Regulations for Disease Reporting and Control (12-VAC-5 90-80 and 12-VAC-90-90).
    • The Division will continue efforts aimed at reducing STD transmission through appropriate treatment and referral services by: • Providing funding and support for STD clinical services within the LHDs. • Ensuring the development and dissemination of HIV/STD Operations Manuals and well-defined treatment guidelines, including newly emerging antibiotic resistance protocols. • Maintaining collaboration with private sector physicians most likely to diagnose and treat STDs (i.e., obstetrics/gynecology, infectious disease).
    • The Division will provide efforts aimed at reducing STD transmission through screening services by: • Providing funding for STD screening services in various public health clinics. • Conducting outreach activities to locate and sreen hard to reach, high-risk populations. • Providing STD screening, as needed, in institutionalized populations. • Funding and recommending use of more efficacious screening technologies that improve upon quality and convenience for the patient and/or provider.
    • The Division will provide for and employ efforts aimed at reducing STD transmission through intensive case follow-up activities by: • Training local health department staff regarding contact tracing (partner notification) used to identify and refer persons exposed to STDs. • Maintaining a highly skilled VERT staff that can rapidly and efficiently respond to outbreaks. • Maintaining up to date internet guidelines regarding partner notification procedures.
    • The Division will continue to promote STD-related prevention and education services by: Developing materials to educate health practitioners and the general public on topics such as STD signs and symptoms, reporting guidelines, and risk factors. Employing various social marketing strategies. Continuing the use of individualized and group level education strategies.
    • The Division will continue efforts aimed at reducing STD incidence and prevalence in high risk environments and/or populations by: Targeting core areas of STD transmission and/or high risk populations with various intervention methods. Developing and maintaining collaborative partnerships with establishments and special populations frequented by or considered to be at increased risk for STDs. Attempting to secure funding to support vaccine delivery for various STDs which are at or near the federal approval stages for vaccine administration, including herpes.
    Objective Measures
    • Primary/secondary Syphilis incidence rate
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Down
      Measure Baseline Value:
      1.37
      Date:
      12/31/2004

      Measure Baseline Description: Number of cases per 100,000 persons on a five-year moving average

      Measure Target Value:
      1
      Date:
      6/30/2009

      Measure Target Description: Number of cases per 100,000 persons on a five-year moving average

      Data Source and Calculation: Data is collected from morbidity and interview reports related to each case of reported syphilis. The data is submitted by local health department staff, as well as VERT staff. All related data is entered into the Sexually Transmitted Disease Management Information System (STD*MIS). The disease rates are calculated as the number of cases reported for a given calendar year divided by Virginia’s population estimate (U.S. Census Bureau), multiplied by 100,000. The five-year moving average of cases and rates are used as a means of assessing long-term changes in disease trends, while attempting to limit the effects of sudden increases or decreases in morbidity. Data related to HIV co-infection will also be assessed routinely, as ulcerative STDs provide greater opportunity for HIV transmission. At present, approximately 50% of syphilis case reports are co-infected with HIV.

    • Gonorrhea incidence rate
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Down
      Measure Baseline Value:
      135.9
      Date:
      12/31/2004

      Measure Baseline Description: Number of cases per 100,000 persons on a five-year moving average

      Measure Target Value:
      122.6
      Date:
      6/30/2010

      Measure Target Description: Number of cases per 100,000 persons on a five-year moving average

      Data Source and Calculation: Data is collected primarily from morbidity and laboratory reports, although some gonorrhea interview reports are received. The data is submitted by local health department staff, as well as VERT staff. All related data is entered into STD*MIS. The disease rates are calculated as the number of cases reported for a given calendar year divided by Virginia’s population estimate (U.S. Census Bureau), multiplied by 100,000. The five-year moving average of cases and rates are used as a means of assessing long term changes in disease trends, while attempting to limit the effects of sudden increases or decreases in morbidity.

    • Chlamydia Positivity
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Down
      Measure Baseline Value:
      7.2
      Date:
      12/31/2005

      Measure Baseline Description: Percent of chlamydia tests that are positive

      Measure Target Value:
      7
      Date:
      6/30/2009

      Measure Target Description: Percent of chlamydia tests that are positive

      Data Source and Calculation: Chlamydia case reports among women are continuing to increase annually as testing technology improves and screening of women expands. Approximately three-fourths of the cases occur among 15 – 24 year olds. Chlamydia data is collected through morbidity and laboratory reports. The data is submitted by local health departments and is entered into STD*MIS. In 1999, 40% of all chlamydia screening in Virginia was performed using amplified (more sensitive) testing. In 2004, amplified testing constituted 92% of all tests. By the end of CY2006, all of VDH's family planning clinics had implemented amplified testing.


Back to the Strategic Planning Page
http://www.vaperforms.virgina.gov