Project Stomp Out Syphilis (SOS)

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Project Stomp Out Syphilis(SOS)

• Larry P. Foster, BS-STD Coordinator
• Antoine Thompson, MPA-CDC/PHA
• STD Interagency Team Members
• Navajo STD Project

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Dine Be Keyah
Southwest U.S. Four Corners Area 27,000 sq.
mi./17.5 mil. acres
NAIHS 2008 Population Reservation Area
237,030 Reservation plus Navajos living in major
border towns 298,197
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SCOPE OF SERVICESSocial Hygiene Branch

• To reduce STD transmission and prevent
  complications
• Monitor STD/HIV burdens and trends
• Identify the population with high risks
• Monitor and evaluate surveillance data
• Increase STD/HIV education and awareness
• MISSION
• The STD Program will facilitate early detection,
  intervention
• and prevention of STD/syphilis transmission
  on/near the Indian
• Health Area and Reservation.

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TARGET AREA

• Year 2004 Report by CDC-David Wong,MD
  identified 50 of cases investigated are within
  30-mile radius in Gallup Service Area.
• Cases common factors include usage of
  alcohol,local bars, motels, social network
  incarceration at the local detention and
  treatment centers.

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South Central Navajo NationCommunity Location of
syphilis case-patients (n326)
syphilis case/patients are clustered within 30
mile radius of Gallup Service Area (Apache Co.,
McKinley and San Juan Co.)
one syphilis case-patient
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Adult Syphilis Cases By Service Area Cumulative
Total 502 Jan. 2001-Aug, 2009
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19
2
46
2
49
29
30
16
08
11
12
277
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Total Syphilis Cases 1980-2009
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Project SOS(Stomp Out Syphilis)

• Background/Genesis
• Expansion from Window Rock and Shiprock Jail
  screening.
• Review of Epi Case Data.
• Coordinated with NM Department of Health Office,
  Navajo Social Hygiene, Navajo AIDS Network,
  Navajo HIV Prevention Program and CDC-Public
  Health Advisor.
• Dine Unity Screening Project
• Navajo Division of Health
• Funded by Centers for Disease Control and
  Prevention

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OBJECTIVE

• Community and Programs Mobilization
• Targeted Screening
• STD/syphilis education in the Gallup Service
  Area, and the 30-mile radius.
• Leading to a Reduction in Syphilis Morbidity

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Mobilize The Navajo Nation/State/IHS
ProgramsWorking Method

• Navajo Social Hygiene Program-Lead
• State of NM/Az.--DIS and CDC-PHA
• DINE Unity Screening Project
• Navajo AIDS Network
• Navajo HIV Prevention/Health Education Program
• Navajo CHR

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Interagency Team Members
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Interagency and Disease Intervention
BenefitsWorking Method

• 1. Build Relationships
• 2. Early detection
• 3. Rapid Treatment
• 4. Consistent Presence
• 5. Community Education
• 6. Partner Notification

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Benefits of Collaboration Working Method

• Communication
• Increased interaction between interagency and
  organizations.
• Capacity Building
• Interagency gained knowledge on how to take
  primary responsibility.
• Project provides grounds and not to repeat
  mistakes.
• Helping detention centers get policies in place
  for arrestees.
• Provide recommendations for detention/Detox
  facilities on how to improve medical units.
• Staffing
• Gained knowledge and skills on multidisciplinary
  approach.
• Local bar owners and detention center very
  welcoming to increased Outreach Staff and PHA
  presence.
• Happy Field Staff got involved because need
  acknowledgement.

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Perceived Benefits for ClientsWorking Method

• Prevention/Education
• Health information important for all.
• Stimulates interest in other health issues.
• Audiences receives health education that
  otherwise would not have.
• Increased awareness of STD programs and services.
• Public Health Outreach
• High-risk captive audience found and tested.
• Identify co-infections and improve services for
  clients.
• Cultural
• Address health literacy issues.
• Promote prevention, which is often overlooked in
  Navajo Culture.
• Social
• Positive interactions with staff, clients,
  patrons and others.
• Felt Outreach Staff cares and is following-up
  with needs.

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STREET OUTREACHTeams

• Representatives from the Navajo Social Hygiene,
  NM Department of Health Office, Navajo HIV
  Prevention Program, Navajo AIDS Network and Dine
  Unity Screening Project.
• Areas covered were Hamburger Hill, Wally World
  Hill, Broke Back Mtn. Tent City, under bridges,
  arroyos, under trees, in non-public places,
  streets of Gallup/Gamerco and (burro) highway.

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Processing of Specimen

• Used the State of New Mexico Lab
• to process the specimens.
• Used the New Mexico laboratory forms.
• Performed quality check before specimen was sent
  to the State Lab.
• Turn around time- about 10 days.

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Recent OutcomesJuly 08- June 09

• Patients Educated 1546
• Screened 681
• Positive serology's 27
• Positivity Rate 4
• New Early Cases 09

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Other SOS Activities

• Halloween activities at Navajo AIDS Network
  Office.
• Family Health Fair- Rio West Mall
• UNM Gallup Branch-Health Fair
• Walmart Outreach
• Gallup Walkway Area

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Barriers-Not Working

• Slow process for patients and f/u-No phones.
• 3-6 months to be found.
• Patients having outdate address, divorced.
• Transportation problems.
• Patients waiting-time in clinics.
• Substance abuse issuesgtName each other.
• Non-complainant, dont want to come in.

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• Barriers
• Distances between communities and homes are
  great.
• Families live 10 to 50 miles to the nearest IHS
  facilities.
• Distance may be a dirt road and becomes
  impassible in weather changes.

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Lines of Distinction

• State Lines
• County Lines
• Service Area Lines
• BIA Lines
• Chapter Area lines
• Agency
• Intra-State Regional Lines
• Reservation Line

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Expand to Arizona Service Areas

• The SOS Model has proven our capability,
  expansion will work in Western Navajo.
• Need support from 638 Facilities and IHS
• PHNs at these site areas.
• Lab capacity and support at these Service Units.
• Need interagency collaboration from State of Az.
• Assist other Az. Tribes during outbreaks.

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Challenges to Screening for Additional STDs

• Communication
• Concern about overwhelming clients with
  information.
• May dilute syphilis screening efforts.
• Work Process
• Specimen collection issues with urine-based
  tests.
• Patient privacy and counseling issues with HIV
  screening.
• Additional requirements will be disruptive to
  facilities.
• Resources
• Commitment and time from State of Arizona, County
  and NSHP others.
• Lab capacity

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Future Plans

• SOS and Department of Health Office will continue
  screening at NCI and the Gallup Detention Center.
• SOS Project will continue Street Outreach
  Screening.
• The case management sessions between the IHS, NM
  Department of Health Office, CDC Public Health
  Advisor and the Navajo Social Hygiene will
  continue.
• Expand the use of NN CHRs in the Gallup Service
  Area who have been trained to provide preventive
  education and draw bloods.

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Special Thanks To

• Social Hygiene and the assigned CDC- PHA
• McKinley Co Health Dept.
• Navajo AIDS Network
• Navajo Health Education/HIV Prevention
• State of Az.-CDI
• DINE Unity Project
• IHS, CHR, NAIHS Infection Control Officer

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Interagency Outreach Team
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Ahehee do Hagooee'

• Gallup [phone]/1773
• Shiprock [phone]
• Crownpoint [phone]
• Fort Defiance [phone]
• Winslow/Dilkon [phone]
• Tuba City [phone]
• Kayenta [phone]
• Chinle [phone]
• Gallup-PHA_at_MCHO [phone]
• Gallup Social Hygiene Branch
• Telephone number 505. 722.1740
• Toll free number 1. 866. 503.3074
• fax number 505. 863.4884