Effectiveness of a Highly Mobile, IncidenceBased, Community Outreach Screening Program

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Effectiveness of a Highly Mobile,
Incidence-Based, Community Outreach Screening
Program

• Chris Serio-Chapman, BS
• STD/HIV Outreach Coordinator
• Baltimore City Health Department
• Baltimore, MD

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Background

• In 1997 Baltimore led the nation in the rate of
  Primary and Secondary Syphilis (P S).
• Despite significant progress in decreasing the
  prevalence of Syphilis from 1998-2002 the rates
  were still above the national rates and the goal
  of eliminating Syphilis in the United States.
• In 2003 the P S rates in Baltimore began to
  climb again and if the trend observed in the
  first half of 2004 had continued Baltimore would
  have experienced 1997 rates by the end of the
  year.

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Baltimore City Health DepartmentPrimary and
Secondary Syphilis Rates 1997 2004
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Outbreak Response

• The Baltimore City Health Department (BCHD)
  implemented its outbreak response plan to
  intervene in the increase.
• A key component of this plan was to expand real
  time targeted outreach

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Response

• An outreach team was formed to spearhead this
  effort.
• The teams main objective was to take to the city
  streets and provide testing and screening for
  Syphilis and HIV.
• The team would set up screening sites on city
  street corners in the same fashion as you would a
  lemonade stand.

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Screening Goal

• The Outreach team was given the charge to
  serologically test 1200 individuals via street
  outreach in a 3 month time period.
• This goal was based on the fact that in any year
  prior to 2004, outreach testing yielded only
  about 2000 tests per year.

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Location, Location, Location(Not just important
in real estate anymore!)

• Locations for screening would be incidence based.
  In order to do this type of outreach, there would
  be a necessity for daily communication between
  all of the management players including the
  Assistant Program Manager, Field Operations
  Manager, Front Line Supervisors and the Outreach
  Coordinator.

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Need for Mobilization

• An unmarked cargo van was purchased and designed
  for street outreach. The van was equipped with
  special lighting and blinds to ensure patient
  confidentiality. The back area of the van was
  left open so blood could be drawn on the van.
• The team also made use of a retro-fitted RV for
  evening outreach as well as larger screening
  events and special events. The RV was equipped
  with a bathroom, large waiting area and 2 lab
  spaces for phlebotomy.

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Building a Team

• Initially the Outreach Team consisted of 2
  outreach workers and 1 supervisor.
• We were trained according to Maryland AIDS
  Administration and BCHD guidelines including
  certifications in HIV Counseling, and phlebotomy.
  The team also received the BCHDs Syphilis
  training.

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Approach to Outreach

• The team was groomed to be assertive as outreach
  workers. In the past outreach performed at the
  city level was often passive. Workers relied on
  patients to approach them regarding testing and
  screening services.

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Course of Action-traditional hours

• During warm weather months the team hit the
  streets and tested on street corners as well as
  on front stoops.
• During cold weather months the team sought
  partnerships with local shelters, soup kitchens,
  recovery houses and prisoner assistance programs
  who would allow us to test their program
  participants inside their facilities.

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Course of Action non-traditional hours

• The evening and weekend outreach team was a
  combination of DIS staff and health department
  employees willing to work overtime after hours.
• Our staff also collaborated with Community Based
  Organizations to provide joint screening or to
  use their facilities during inclement weather.

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Screening Challenges

• At the onset of testing
• No uniform system existed for the management of
  data including risk information
• The outreach team had to return to the site or
  refer clients to the STD clinic to give results
• Each client tested required the completion of
  four forms and a lab slip

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Solutions

• STDMIS was modified to collect all screening
  data
• A call back system was implemented to allow
  clients to phone for test results. Positive
  tests were initiated to DIS for follow-up
• Forms were revised reducing the number of forms
  to one form and a lab slip

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Syphilis Results

• During the first 12 months of screening our
  outreach team tested 8,179 individuals total. Of
  that 7, 930 were screened for Syphilis. As a
  result, we identified 7 cases of P S Syphilis,
  15 cases of early latent syphilis and 15 cases of
  unknown duration.
• The overall RPR positivity rate was 2.9 due to
  previous patient histories of syphilis infection

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HIV Results

• Out of the 8,179 individuals tested by the
  outreach team, 7,605 were tested for HIV. The
  results of the tests were 394 patients with
  positive HIV western blot results for a 6.4
  positivity rate.
• Due to state-specific HIV surveillance issues, it
  was difficult to establish how many of these were
  new infections.
• All HIV persons are assessed for either
  interview and partner notification or referred
  directly to Minority AIDS Initiative Outreach to
  facilitate access to primary care.

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Self Reported Risk Data
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Benefit

• One of the greatest successes of the newly formed
  outreach team cant be measured in numbers or in
  statistical data. The overall image of the
  health department in the community has been
  greatly improved. People now feel like the
  health department is accessible and caring.
  Communities are grateful for our presence and
  interest in them.

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Conclusion

• A Health Department Outreach Program can have a
  significant positive impact on both syphilis and
  HIV prevention in the community when well
  organized and focused on high risk populations.
• A key to the success is for the Health Department
  to function as a Community Based Organization.

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Special acknowledgement of contributors to this
presentation

• Jamaal, Abdul (1)
• Burnett, Phyllis (1)(2)
• Olthoff, Glen (1)(2)
• Freeman, Denise (1)(2)
• (1) Baltimore City Health Department
• (2) Centers for Disease Control and Prevention