Results from the ACHA Pap Test and STI Survey for Calendar Year 2007 American College Health...
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Transcript of Results from the ACHA Pap Test and STI Survey for Calendar Year 2007 American College Health...
Results from the ACHA Pap Test and STI Survey for
Calendar Year 2007
American College Health Association
Sexual Health Education and Clinical Care Coalition
August 2008
Participation
• CY 2007 survey (Web-based)– 128 Respondents
• CY 2006 survey (Web-based)– 128 Respondents
• CY 2005 survey (Web-based)– 147 Respondents
• CY 2004 survey (Web-based)– 135 Respondents
• CY 2003 survey (Paper-based)– 85 Respondents
Demographics cont’d
• Total Medical Visits 2,410,526– Range 300-86,353– Mean 21,332
• Percent Female Visits– Mean 63%
• Women’s Health Visits 329,536– Range 25-18,383– Mean 3329
Campus Location
20 Urban >1,000,00040 Urban 100,000-1,000,00022 Urban < 100,00020 Suburban24 Rural2 Other
LOCALE
Urban >1,000,000 Urban 100,000-1,000,000 Urban < 100,000 Suburban Rural Other
42
40
38
36
34
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0
15.6 %
31.3 %
17.2 %
15.6 %
18.8 %
1.6 %
Enrollment
51 0 thru 1199941 12000 thru 2399925 24000 thru 359998 36000 thru 479993 48000 thru 59999
ENROLLMENT SIZE
Mean = 17307.02Min = 1650.00, Max = 52270.00Median = 14623.50
50454035302520151050
0 thru 11999
12000 thru 23999
24000 thru 35999
36000 thru 47999
48000 thru 59999
39.8 %
32.0 %
19.5 %
6.3 %
2.3 %
Modalities Offered
31 Conventional slide cytology69 Liquid-based cytology without reflex HPV testing
104 Liquid-based cytology with reflex HPV testing44 Colposcopy31 Cryotherapy3 Laser
13 LEEP10 Other
Women's health modalities offered in-house
120100806040200
Conventional slide cytology
Liquid-based cytology without reflex HPV testing
Liquid-based cytology with reflex HPV testing
Colposcopy
Cryotherapy
Laser
LEEP
Other
24.2 %
53.9 %
81.3 %
34.4 %
24.2 %
2.3 %
10.2 %
7.8 %
Trend in Modalities Offered
0
10
20
30
40
50
60
70
80
90
2004 2005 2006 2007
Year
Per
cen
t U
se
Liquid with reflex
Liquid w/o reflex
Slide
Colpo
Cryo
LEEP
Document Age 1st Intercourse
92 Yes35 No
Document age first intercourse
Yes No
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
72.4 %
27.6 %
Recommend Pap Test
79 Three years after first intercourse or age 21, whichever comes first6 Age 183 Age 21
20 At onset of sexual activity20 Varies by provider, no standard practice
What is your usual recommendation for when to begin regular Pap testing?
100806040200
Three years after first intercourse or age 21, whichever comes first
Age 18
Age 21
At onset of sexual activity
Varies by provider, no standard practice
61.7 %
4.7 %
2.3 %
15.6 %
15.6 %
Trends in 1st Pap Recommendation
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Varies Coitarche Age 21 Age 18 1st IC + 3 yrs
Per
cen
t
2004
2005
2006
2007
Trends in 1st Pap Recommendation
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
2004 2005 2006 2007
Year
Per
cen
t
Varies
Coitarche
Age 21
Age 18
1st IC + 3 yrs
Long Term Result Trends
13.6
7.57.26.9
8.68.0
7.1
8.9
10.610.8
9.6
10.4
7.4 7.2
10.09.0
10.1
12.7 12.9
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Year
Per
cen
t A
bn
orm
al
Usual management 1st ASC-US Age <20
51 HPV DNA test (reflex or otherwise)20 Repeat Pap in 4-6 months38 Repeat Pap in 12 months1 Immediate colposcopy8 Varies by provider, no standard practice
Usual practice management ASC-US Pap
5550454035302520151050
HPV DNA test (reflex or otherwise)
Repeat Pap in 4-6 months
Repeat Pap in 12 months
Immediate colposcopy
Varies by provider, no standard practice
43.2 %
16.9 %
32.2 %
0.8 %
6.8 %
Usual management 1st ASC-US Age >20
80 HPV DNA test (reflex or otherwise)21 Repeat Pap in 4-6 months0 Repeat Pap in 12 months
10 Immediate colposcopy12 Varies by provider, no standard practice
Usual practice management ASC-US Pap
80706050403020100
HPV DNA test (reflex or otherwise)
Repeat Pap in 4-6 months
Repeat Pap in 12 months
Immediate colposcopy
Varies by provider, no standard practice
65.0 %
17.1 %
0.0 %
8.1 %
9.8 %
ASC-US Outcomes
• 5257 Documented first ASC-US Cases– 3001 (57.1%) HPV DNA testing
• 55.4% (1662) positive for HR HPV
– 855 (16.3%) for repeat cytology• 28.0% (239) ≥ ASC-US
Results of Colpo by Indication
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Normal CIN 1 CIN 2 or 3 Unk/Inc
1st ASC-US
HR HPV
Pos Re-Pap
Results of Colpo by Indication
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Normal CIN 1 CIN 2 or 3
1st ASC-US
HR HPV
Pos Re-Pap
Preferred Method of Tracking
82 Logbook47 Tickler file42 Lab service provider generated prompts33 Electronic medical record28 Computerized tracking program8 No tracking system in place7 Other
How do you track Pap smear, Colposcopy, and biopsy results?
9080706050403020100
Logbook
Tickler file
Lab service provider generated prompts
Electronic medical record
Computerized tracking program
No tracking system in place
Other
64.1 %
36.7 %
32.8 %
25.8 %
21.9 %
6.3 %
5.5 %
Screening Tests Offered
124 Chlamydia122 Gonorrhea85 Hepatitis B92 Herpes
111 HIV109 Syphilis83 Trichomoniasis3 None of the above
11 Other
Tests you offer STI Screening asymptomatic students
1301201101009080706050403020100
Chlamydia
Gonorrhea
Hepatitis B
Herpes
HIV
Syphilis
Trichomoniasis
None of the above
Other
96.9 %
95.3 %
66.4 %
71.9 %
86.7 %
85.2 %
64.8 %
2.3 %
8.6 %
Coverage for STI Testing
3 Not applicable/STI testing is not provided by our health service18 STI testing is provided to students free of charge 56 Students are charged for lab tests but not the clinic visit16 Students are charged for both lab tests and the clinic visit23 Charges apply for some tests, but others (e.g. HIV) are provided for free10 Other
Which of the following statements best describes how the cost of STI testing is covered at your health service? (check one)
6040200
Not applicable/STI testing is not provided by our health service
STI testing is provided to students free of charge
Students are charged for lab tests but not the clinic visit
Students are charged for both lab tests and the clinic visit
Charges apply for some tests, but others (e.g. HIV) are provided for free
Other
2.4 %
14.3 %
44.4 %
12.7 %
18.3 %
7.9 %
HEDIS Guideline Compliance
102 Yes24 No
Routinely screen sexually active women < 26 chlamydia
Yes No
110
105
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
81.0 %
19.0 %
Usual Chlamydia Specimen Type for Female Patients
97 Cervical swab2 Vaginal swab7 Urine
18 Varies3 None
What type of specimen do you usually/ preferentially collect for chlamydia testing in women? (check one)
Cervical swab Vaginal swab Urine Varies None
105
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
76.4 %
1.6 %
5.5 %
14.2 %
2.4 %
Usual Chlamydia Specimen Type for Male Patients
16 Urethral swab92 Urine12 Varies3 None
What type of specimen do you usually/ preferentially collect for chlamydia testing in men? (check one)
Urethral swab Urine Varies None
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
13.0 %
74.8 %
9.8 %
2.4 %
Routine Screening Offered
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
120.0%
Women
Men CT
GC
Hep B
Herpes HIV
Syphilis
Trich
None
Other
Per
cen
t
CT Testing Results
Respondents Total % Positive
CT tests Undiff’d 111 124441
CT pos 4635 3.7
CT women 88 80517
CT women pos 2558 3.2
CT men 86 20244
CT men pos 1330 6.6
GC Testing Results
Respondents Total % Positive
GC tests Undiff’d 110 102156
GC pos 639 0.6
GC women 83 62998
GC women pos 276 0.4
GC men 83 20644
GC men pos 269 1.3
HIV Testing
• 111 (86.7%) schools offer HIV testing– 67.5% confidential tests only– 25.2% confidential & anonymous testing
HIV Test Modalities
103 Standard test, blood25 Rapid test, blood24 Rapid test, oral fluid18 Standard test, oral fluid3 Other3 None
What types of HIV antibody tests do you offer?
1101009080706050403020100
Standard test, blood
Rapid test, blood
Rapid test, oral fluid
Standard test, oral fluid
Other
None
80.5 %
19.5 %
18.8 %
14.1 %
2.3 %
2.3 %
Syphilis Testing
• 109 (85.2%) schools offer Syphilis testing• 105 schools reporting test data• 29,755 tests done• 89 positive tests (0.30%)
Herpes Diagnosis
110 Viral culture32 PCR88 Type specific serology12 Antigen tests9 Tzank smears2 Other
What laboratory tests do you use to diagnose herpes infection
1101009080706050403020100
Viral culture
PCR
Type specific serology
Antigen tests
Tzank smears
Other
85.9 %
25.0 %
68.8 %
9.4 %
7.0 %
1.6 %
HSV Testing (Genital)
• 80 schools reported HSV test results• 36% of positives were not typed• Gender-specific data essentially identical with
regard to type breakdown
HSV-158%
HSV-242%
Trichomonas
• 83 (64.8%) schools offer testing.– 58 schools report positive findings
• 336 cases reported.