Program Guidelines - Overview

Program Operations Guidelines for STD Prevention
Overview

Table of Contents

COMPONENTS AND OPERATION OF A SURVEILLANCE SYSTEM (GENERAL PRINCIPLES) (S-2)

STD prevention programs should work with state/local health officers, epidemiologists, and departments/boards of health to determine which STDs and which accompanying case data should be mandated according to local needs and priorities.
Health departments should accept all reports of laboratory-confirmed gonococcal or chlamydial infection as case reports, in addition to reports from clinicians. A report from either should be considered sufficient for case-reporting purposes.
Programs should consider untreated disease as morbidity and report as such (when the patient's symptom, serology, or sex partner history indicate new infection).
National surveillance case definitions should be used when analyzing case reports so surveillance reports over time and between jurisdictions are interpretable.
State and local STD prevention programs should have a written protocol that outlines health department procedures for interacting with providers and provider responsibilities and procedures for case reporting.
Depending on how health department activities are organized, this protocol may be part of a larger protocol that addresses syphilis, HIV, AIDS, tuberculosis, and other communicable diseases.
STD surveillance programs should be able to identify and monitor those providers reporting significant STD morbidity or serving high-risk populations.
STD prevention programs can facilitate provider based reporting by making available multiple methods for receiving STD case reports including toll free phone numbers, FAX machines, and direct electronic reporting (e.g., Internet-based systems).
Programs should approach medical and nursing schools, medical societies, and state licensing boards to provide information about reporting requirements and the diseases that are reportable to newly licensed physicians and upon renewal of license.
Programs should develop opportunities to interact with providers in their community. This interaction could include presentations at hospital in-services, presenting at local and state medical conferences, monthly news letters, etc.
State and local STD prevention programs should routinely provide feedback, (e.g., statistical reports or newsletters) to providers, emphasizing the importance of the data to public health prevention efforts.
Programs should establish a system to assure that local health jurisdictions are aware of laboratories newly licensed to perform STD testing services.
Laboratories performing STD testing should be surveyed at least once yearly to determine the type, level, and results (positive or negative) of testing performed.
Programs are encouraged to establish close working relationships with both public and private laboratories determined to be priority.
State and local STD prevention programs should routinely provide feedback, (e.g., statistical reports or newsletters) to laboratories, emphasizing the importance of the data to public health prevention efforts.
STD surveillance programs should have separate fields for provider and laboratory reporting information.
STD prevention programs should encourage laboratories to report data electronically. STD prevention programs should develop the expertise to import and use these data electronically.
STD prevention programs should work with laboratories to electronically capture all of the essential data variables for case reporting. Revision of lab slips may help capture the necessary data from providers.
STD prevention programs should adopt and support the use of the CSTE algorithm described above to resolve disease source when there are multiple jurisdictions involved.
If states have laws that require reporting to counties, the CSTE algorithm should be reviewed by state STD prevention programs, county health departments, and laboratories, and revised if necessary.
State and local STD prevention programs should collaborate with public health programs that are conducting laboratory-based surveillance for other notifiable conditions to minimize the redundancy of efforts, to efficiently utilize the laboratory's reporting resources, and to ensure that core information required for case reporting is being consistently captured and reported.
The STD prevention program's written protocol for laboratory-based surveillance should include discussion of prevalence monitoring. Health department and laboratory responsibilities and procedures for prevalence monitoring should be clearly stated.
Visits to laboratories should address prevalence monitoring. For laboratories where these data have not yet been collected or examined, site visits can be a starting point for discussions, leading to the collection of these data.
The laboratory registry should indicate those sites that are providing data on prevalence, type of tests performed, and provider types served.
STD prevention programs should work with laboratories to determine whether line-listed data on persons testing negative should be submitted or whether aggregate data by sex, age group, race or ethnicity, provider type, test type, and testing period should be submitted electronically.
STD prevention programs that support jail, juvenile detention, correctional STD screening programs, or other STD screening programs in teen clinics or managed care organizations should conduct prevalence monitoring among populations being screened.
STD prevention programs should work with providers participating in prevalence monitoring to ensure they provide needed data to the laboratories.
STD prevention programs should have screening protocols with providers who participate in prevalence monitoring.

METHODS OF SURVEILLANCE (S-10)

STD prevention programs should develop active surveillance protocols to be initiated when there is a suspected outbreak of disease, when an evaluation of the surveillance system is occurring, or in other instances when active surveillance is appropriate (e.g., elimination and eradication campaigns).

SURVEILLANCE SYSTEM ATTRIBUTES (S-12)

STD prevention programs should apply the information presented in the Appendix to determine the individual strengths of current surveillance activities and to identify those areas where changes may be needed to better monitor disease levels within the program area.

PERSONNEL, TRAINING, AND RESOURCES (S-12)

Each program should designate a coordinator who is responsible for surveillance activities. Depending upon program size, additional staff may also be necessary.
State and local STD prevention programs should consider establishing formal staff training and career development activities in the area of surveillance information systems.
To develop and maintain a well-trained surveillance staff, STD prevention programs should build on public health system initiatives that support the core public health functions of assessment and assurance and work closely with other public health surveillance programs such as HIV and TB.

DATA ANALYSIS, INTERPRETATION, AND DISSEMINATION (S-13)

State STD prevention programs should send linelisted, electronic prevalence data, not just summary data reports, to those local control programs with participating providers in their jurisdictions.
State and local STD prevention programs should consider media other than hard copy for dissemination of case-reporting and prevalence monitoring information, e.g., Internet distribution via a state or local web site.
STD prevention programs should obtain input from partners about types of reports needed and disseminate data in a timely fashion.
Dissemination protocols should be in place, should include the providers or laboratories who provided the data, and should be periodically evaluated in terms of utility and timeliness.

DATA MANAGEMENT (S-17)

STD prevention programs should have an efficient, up-to-date central registry that includes the following: 1) patient name, 2) address, including zip code or census tract, at time of diagnosis, 3) date of birth and age, 4) race/ethnic origin, 5) sex, 6) diagnosis, 7) date and results of all positive anatomic sites, 8) treatment dates and regimens, 9) provider of services, and 10) laboratory, date of report by provider and laboratory. Additional data that are important and should be considered are pregnancy and HIV status. Other local variables should be added, as needed.
All STD prevention programs should have a plan for increasing their capacity to develop, maintain, and evaluate information systems.
State and local STD prevention programs should develop the information system capacity for electronic laboratory reporting of all reportable STDs.
STD information systems should allow for the collection, management, and analysis of line-listed data on persons infected with all reportable STDs.
Information systems used for electronic reporting of persons testing positive for syphilis, chlamydia or gonorrhea should be modified to include data on persons testing negative.
Once electronic laboratory reporting procedures and protocols have been developed and implementation has begun, STD prevention programs should evaluate other sources of electronically reported information to determine their potential contribution to STD surveillance activities. This evaluation should identify the standards, relationships, and protocols that will need to be developed.
E-mail and Internet access should be readily available to STD surveillance coordinators and other STD prevention program staff.
All health departments should familiarize the general informatics and health informatics community to public health concepts and increase their familiarity with public health information systems.
STD prevention programs should have policies in place and implement them to ensure confidentiality of data and data security.
STD prevention programs should work with other programs such as TB and HIV/AIDS to standardize confidentiality protocols.

EVALUATION AND QUALITY ASSURANCE (S-21)

STD prevention programs should evaluate STD surveillance systems at least annually.
STD data quality should be routinely evaluated.
STD prevention programs should routinely evaluate the effectiveness and sensitivity of their reactor grid.

PROGRAM EVALUATION APPENDICES

S-A SURVEILLANCE CASE DEFINITIONS (S-23)

S-B EXAMPLE REACTOR SURVEILLANCE FOLLOW-UP GRID (S-27)

S-C SAMPLE SEROLOGY LABORATORY SITE VISIT REPORT (S-30)

SAMPLE SEROLOGY LABORATORY SITE VISIT REPORT WORKSHEET (S-31)

S-D EXAMPLE: ANNUAL CLINICAL LABORATORY SURVEY CALENDAR YEAR -(S-32)

S-E SURVEILLANCE SYSTEM ATTRIBUTES (S-36)