REGION VI — Infertility Prevention Project

Advisory Committee (RIPAC) Meeting

October 15-16, 2009

Hampton Inn & Suites

New Orleans, LA

Attendees:

Arkansas: Tracy Bradford (Family Planning in place of Sharon Ashcraft); Kellye McCartney (STD); Randy Owens (Laboratory)

Louisiana: Stephen Martin (Laboratory); Elease Lewis (Family Planning); Lisa Longfellow (STD)

New Mexico: Dan Burke (STD); Margie Montoya (Family Planning); Erica Pierce (STD)

Oklahoma: Maggie Baum (Laboratory); Ann Benson (Family Planning); Terrainia Harris (STD, in place of Martin Lansdale)

Texas: Mary Cullinane (STD); Elizabeth Delamater (Laboratory); Alicia Nelson (Family Planning)

Associate Members: Jennifer Curtiss (Texas IPP Coordinator); Kristen Eberly (Oklahoma STD); Jim Lee (CDC Assignee to Texas); Kelly Smith (Louisiana STD); Shondra Williams (Louisiana Family Planning)

Ex-Officio Medical Director: Stephanie Taylor

CDC Representatives: Susan Arrowsmith (Unit Chief); Thom Cylar (Program Consultant for Arkansas and Oklahoma); Victoria Moody (Program Consultant for Louisiana);Steve Shapiro (National IPP Coordinator); Rick Steece (National Laboratory Consultant); David Sullivan (Program Consultant for New Mexico and Texas)

Indian Health Service: Christina Compher (United South and Eastern Tribes); Cuyler Snider (Oklahoma City Area Inter-Tribal Health Board); Scott Tulloch

OFP Representative: Liese Sherwood-Fabre

Guests: Al Absher (Gen-Probe); Philip Fabacher (Louisiana Family Planning Medical Director); John Golobic (SED Laboratories); Avis Gray (Louisiana Office of Public Health Region I Administrator); Mohammad Rahman (Louisiana STD Epidemiologist)

CHT Staff: Allison Atterberry; David Fine

Day 1: Thursday, October 15, 2009

Back to top

Welcome and Introductions

Liz Delamater, PhD, RIPAC Chair, Texas Microbiological Sciences Laboratory Manager, Ann Benson, MSN, ARNP, RIPAC Vice Chair, Nurse Consultant, Oklahoma State Department of Health Perinatal and Reproductive Health.

Welcome to Louisiana

Avis Gray, Regional Administration, DHH/OPH Metropolitan Region I

DHHS Office of Population Affairs/Office of Family Planning Update Liese Sherwood-Fabre, PhD, Program Officer, Family Planning Program

1. Under a continuing resolution – currently through the month of October.
2. The Family Planning Annual Report (FPAR), information on all the users that we serve across the country under the family planning program, for 2008 will be out shortly. There was a slight rise in the number of users both nationally and regionally from 2007.
3. The Region is currently supporting several projects of interest to the group:
• Clinic efficiency – CHT will be continuing their work on this topic with learning groups where clinics will share ideas of how to address efficiency. Evaluation is part of this effort.
• Oklahoma and Texas received funds to support outreach efforts to African-Americans in three cities which have seen a drop in percentage of overall users: Tulsa, Oklahoma City, and Dallas. Despite no real change in city demographics, user demographics have shifted to more Hispanics.
• Male projects were just funded in Texas, Louisiana, and Planned Parenthood of Oklahoma.
• HIV integration projects continued for another year – all in Texas.
• Health Literacy – follow-up to the March Joint Alliance meeting (next one scheduled for end of March) with the Office on Women’s Health and the Office of Minority Health. Will be working with SageWords to do literature review, discussion groups to determine needs for oral contraceptive information in easy-to-read format, and fact sheet from this information. Up to 90% of the population is not able to understand the directions that are given to them for taking medications. The video Unnatural Causes, done through PBS addresses this issue. For more information on the video, visit www.unnaturalcauses.org/ or www.unnaturalcauses.org/about_the_series.php . To purchase the DVD, visit www.unnaturalcauses.org/buy_the_dvd.php.
4. OFP has identified a new priority this year – family planning through the lifecycle, specifically addressing interconception care.
5. Institute of Medicine released an evaluation of Title X program in May 2009. Still being reviewed in Washington as to how to address issues raised in the report. Major finding: no clear, evidence-based process for establishing or revising program priorities or guidelines. This requires a strategic plan that will reflect the program’s original mission, provide vision for leadership, address family planning needs for individuals, and grounded in high-quality evidence. Free report brief and the full report available at www.iom.edu/en/Reports/2009/A-Review-of-the-HHS-Family-Planning-Program-Mission-Management-and-Measurement-of-Results.aspx.  Can be downloaded as a PDF for $38. Hard copy is $50.

Indian Health Services Update, Scott Tulloch, IHS
Christina Compher, MHS, United South and Eastern Tribes
Cuyler Snider, Oklahoma City Area Inter-Tribal Health Board

See presentation, “Tulloch IHS RIPAC Oct 2009”

The following are brief notes on Mr. Tulloch’s PowerPoint presentation:

Kaiser Family Foundation (KFF) released a report on American Indians/Alaska Natives (AI/AN) and their healthcare – a brief overview of the population.

In the U.S., there are currently 560+ sovereign AI/AN nations with different beliefs.  The AI/AN population as a whole is a very small group with very localized groups that are geographically isolated. The groups as a whole share a unique relationship with the government on how healthcare is afforded to them.

About 1/3 of Native American families live below the federal poverty level. With low education levels, it is harder to obtain higher paying jobs, and low education levels puts them at higher risk for disease morbidity. Approximately one in five Native Americans has a chronic condition. Natives have higher rates of Diabetes Mellitus and obesity. About ¼ of the population smokes.

The Federal government is responsible for providing care to the AI community. Those who rely on IHS for their healthcare are often restricted to the healthcare on their reservations. With the majority of IHS facilities on reservations, they haven’t been able to meet the needs of the fluid populations who travel outside the community.

About ½ AI/AN families are low income – have low employer-sponsored healthcare. These families are often unable to support copayments and deductibles of the insurance they do have. American Indian and Alaska Native adults without dependents are eligible for Medicaid in many states. For this community, accessing appropriate and timely care is further complicated by accessing an underfunded service.

Native STAND Students Together Against Negative Decisions

Peer Education Curriculum for Native Youth piloted in four off-reservation boarding schools. Boarding schools are residential schools managed by the Bureau of Indian Education. The school population very at risk. Students get their health information from their peers. A lot of high risk activities occur at the boarding schools. Some boarding schools have relationship with IHS where they can do screening or others will do screening on site, but most schools don’t do testing.

Indian Health Surveillance Report, STDs 2007 to be available soon.

Cuyler Snider – epidemiologist with Oklahoma City Area Inter-Tribal Health Board – works for 43 tribes, 38 of which are in Oklahoma.

Christina “Chris” Compher – epidemiologist with the United South and Eastern Tribes which serves 25 tribes.

Epicenters – 12 around the country serving tribes in that part of the country

Chris is the epidemiologist for all health conditions, not just STDs. Gets data to use it to show them what their health status is – obesity, e.g.

Historically, federal tribes have a relationship with federal government but no relationship with states’ governments. Tribes generally have NO idea who to contact, except for an emergency.

Differences – in western clinics, we have “alternative care.” In tribal clinics, there are traditional medicine men.

In tribal populations, there are a lot of cultural differences,E.g. “Don’t smoke. You’re going to have a small baby.” In Native communities, that’s a positive message because most Native women have big babies and want smaller babies.

Why is there a communication gap between the tribes and the state agencies? – Federally recognized tribes have a historical relationship with the federal government. They’ve never had to go to the state for services. If something happens on a reservation, the federal police come on the reservation instead of the state police. Also, the tribal population is excessively small. When states make plans, they focus on the largest population to get the best bang for their buck. There’s also a major communication issue.

Medicine men provide mental health services. Some medicine men practice outside the clinics. Tribal members make choices about when to go to western medicine and when to go to medicine men.  Traditionally western medicine and traditional medicine don’t mix.

CDC Update

See presentation, “Shapiro CDC Region VI Update October 2009 RIPAC mtg New Orleans”

Steven Shapiro, CDC Prevention and Training Branch, National IPP Coordinator.

Gonorrhea meeting overview

See presentation, “Shapiro Gonorrhea Meeting Presentation RIPAC meeting October 2009 New Orleans”

Region VI Supplemental Analyses

See presentation, "Fine Region VI STD conf abstracts submitted Oct 2009 RIPAC mtg”

David Fine, Center for Health Training, Region VI Data Manager

IPP should consider how accurately clinics are carrying out the testing guidelines. The CDC says there should be universal testing of all women 25 and younger and the CDC also recommends testing all young women in family planning, but by and large, in most states, only about half of young women are actually tested in family planning sites. Thus, the CDC’s policy may not be entirely practical. If we’re only testing 50% of clients, should we be discussing ways to test the right 50%?

David Fine recommends reading an article by Bill Miller
Miller, W. C. (2008). Epidemiology of Chlamydial Infection: Are we losing ground? Sexually Transmitted Infections. 84 (3) 82-86.

ABSTRACT

Screening programmes to identify and treat young women with chlamydial infection have been developed in several countries. The goals of these screening programmes are, for the individual, to reduce a woman’s likelihood of experiencing important reproductive health complications, and, for the population, to reduce the incidence and prevalence of chlamydial infection in the population at risk. The primary objective of this commentary is to address whether we are losing ground in our efforts to prevent chlamydial infection and its complications.

Ask Allison if you would like a copy of this article. aatterberry@jba-cht.com

Arrested immunity hypothesis – if you test and treat too quickly after contraction, she may not build up immunity and will put herself at risk for future infections

Region VI Data Presentation

See presentation, “Fine Data Summary Jan-June 2009 RIPAC October 2009 New Orleans”

Special Project Update

Allison Atterberry, RN, BSN, Region VI IPP Coordinator, Center for Health Training
David Fine, PhD, Region VI Data Manager, Center for Health Training

After conferring with the project partners and with the CDC, we have determined that we cannot carry out the Quality Assurance special project with the goals as it was written. To that end, we will put this project aside and create a new special project with which to use the funds. If you have any ideas, please tell Allison.

Region VI IPP Coordinator’s Update

Allison Atterberry

IPP Digest
CHT Seattle’s office compiles a monthly digest of STD related resources that Allison sends out to all Region VI IPP participants and associates. Please let Allison know if you would like to be added to that list. For specific Chlamydia- and Gonorrhea-related articles highlighted from the October Digest, See IPP Digest Supplement October 2009. Ask Allison if you would like the full article of any highlighted in the Supplement.

David Fine is stepping down as Region VI’s data manager. Center for Health Training is in the process of transitioning this role over to Sarah Goldenkranz, also in the Seattle office. Sarah will be at our spring RIPAC meeting. She can be reached at (206) 447-9538 or sarah@jba-cht.com

CHT has added several resources to the IPP website. centerforhealthtraining.org/projects/pr_ipp.html Email Allison if you have suggestions. Please also visit centerforhealthtraining.org/projects/pr_ipp_VI.html for Region VI’s IPP page.

The autumn issue of the Chlamydia Challenge newsletter will be out in late November or December. The lead article is on American Indian issues in Region VI.

Subcommittee Meetings

• Clinical Subcommittee Minutes (PDF 22KB)
• Data Subcommittee Minutes (PDF 19KB)
• Laboratory Subcommittee Minutes (PDF 23KB)

 

Day 2: Friday, October 16, 2009

Back to top

State Caucuses

State Reports

Arkansas

• Two people are traveling to Birmingham to work with HIV STD training center to reestablish AR as part of the national PTCs.
• HIV section is entering into an agreement with Pulaski Co JDC and adult prison to screen for GC and CT.
• Lab has added second Tigris instrument for CT and GC testing. First one was added about 2 years ago. Second was a few months ago.
• Lab converting from CLIA to CAP.
• Trying to develop common customer interface with LIMS systems in prison systems.
• Effective September 14, FP converted from conventional Pap to liquid Pap.

Louisiana

• Will explore ways to collaborate with United South and Eastern Tribes. There are 4 federally recognized tribes in Louisiana. There is a lot of difficulty becoming a federally recognized tribe. Lisa provided Chris Compher from USET data. Chris will take it to her superiors.
• Louisiana is currently providing data on screening done in the prison system. Screening has been done in the Orleans parish system. Will explore doing it in JDC.
• Urine PTO pilot project. A work group convened in September 2009. As a result, a protocol was developed that will be implemented statewide. Will be implemented sometime in 2010. Delayed because of H1N1 activities. With Urine PTO, they will offer gonorrhea and CT screening on an opt-out basis in the entire state in public health units. (Not Title X)
• State is going to fully implement the STARLIMS system by November 1. Currently 60%.

New Mexico

• Budget – New Mexico is experiencing cuts in the state budget which are likely to impact on services. State funded positions remain frozen whenever they become vacant, and we will probably need to put some restrictions on some testing activities this fiscal year. Contracted services have already seen cuts this year and probably will be cut more next year.
• Targeting gonorrhea in places where syphilis is very low such as the southeast of the state – work on increasing gonorrhea services such as partner investigations.
• In Albuquerque, where more than half the state’s morbidity is found, a County operated juvenile detention center is starting universal Aptima testing of females at intake. So far, high rates of GC and chlamydia are being found.
• Have EPT, want to keep pushing it and want to find out what the uptake is.
• New Mexico Medical Society has a work group on CT and GC. Is very active on promotion. The state wants to work with them. One proposal is to include testing in sports physicals in interested districts. Also work with HMOs to bring up rates of testing among providers they cover.
• Continue informing private providers. About 70% of morbidity is found through private providers.

Oklahoma

• Posted the IPP Coordinator position. Will have monthly meetings with all IPP partners to get everyone up to speed and create plans. Will review MOAs in place to make sure they’re with the right people.
• Shared gonorrhea goals and objectives from meeting earlier this week.
• Have requested TA for when the new IPP coordinator is hired.

Texas

• Expedited Partner Therapy (EPT) was approved in Texas by a change in language in the Texas Medical Board. The Texas Department of State Health Services has a link on their website dedicated to EPT – the language, resources, procedure forms, etc. more resources to be added as collected. (www.dshs.state.tx.us/hivstd/ept/default.shtm) This language change was finalized in June 2009. There’s currently a work group on how to communicate this change to the rest of the state.
• Texas IPP (TIPP) hosted their every other year IPP workshop in conjunction with the Adolescent Health Symposium. The morning session was a TIPP business meeting in which 50 participants attended from TIPP sentinel sites to discuss Expedited Partner Therapy (EPT), changes in test technology and other TIPP updates. In the afternoon, the Adolescent Health Symposium was held, with 150 participants from across the state with an overarching goal on how to reach out to adolescent patients. Plenary topics included Motivational interviewing, how to get adolescents in clinic, and legal and ethical issues. Three breakout sessions included reaching out to males, female issues, and an info blast on several issues.
• The Texas HIV/STD Conference will be held in May 2010.
• TX has been converting to amplified testing since 2002. Three state and local labs still using Pace 2. By Feb 2010, all will use amplified.
• Texas had limited funds to sponsor participants to the 2010 National STD Conference in Atlanta, so they held an essay contest asking potential delegates to describe why they think they should get to go. Two people from local clinics will be able to go. RIPAC meeting participants judged essays.
• Two new nurse consultants to RIPAC. Alicia Nelson now Family Planning nurse consultant. Mary Cullinane is STD nurse consultant.

Laboratory Update

Laboratory, Randy Owens, PhD, Branch Chief, Arkansas Clinical and Biological Science Laboratory

See presentation, “Steece National Lab Update RIPAC Meeting October 2009 New Orleans”

New Business

Bi-Regional Meeting – Region IV

The committee expressed some interest in co-hosting a bi-regional meeting. The best region with which to hold a meeting would be Region IV, the Southeast, because they have a similar Chlamydia and gonorrhea prevalence as Region VI. In the past, the regional meeting was held a half day in the morning. The rest of the regional work was via email and conference call beforehand. The afternoon and the next day would be the interregional meeting.

Spring Dates to Avoid due to Conflicting Meetings
National STD Conference March 8-11
National FP Summit RTAC March 30-April 1
NFPRHA meeting April 11-14

Bylaws – Voted on bylaws amendments. See new bylaws (PDF 18KB). Amendments highlighted.

Wrap Up and Announcements

UPDATE: Allison spoke with the Region IV IPP Coordinator, and they are unable to co-host a bi-regional meeting spring 2010. She will propose to them hosting a bi-regional meeting in the autumn of 2010.

NEXT MEETING: next meeting in Little Rock April 22-23

 

Back to top