IV. Infectious Diseases

FY 2000 Performance Plan - Revised Final FY 1999 Performance Plan

Sexually Transmitted Diseases

Sexually Transmitted Diseases (STDs) are one of the most critical challenges in the nation today because of their severe, costly consequences for women and infants; their tremendous impact on the health of adolescents and young adults (especially among minority populations); and the integral role they play in the transmission of HIV infection. CDC recently reported that over 85% of the most common infectious diseases in the U.S. are sexually transmitted. The immediate and long-term disease burden and costs associated with STDs globally and in the U.S. are immense. Conversely, an investment in STD prevention is leveraged several ways--it improves the health of women, infants, and young people, and slows down the spread of HIV infection in our most vulnerable and disadvantaged populations. In addition to the human costs, STDs other than AIDS add 10 billion dollars to the nation's health care costs each year.

The U.S. has one of the highest STD rates in the industrialized world. U.S. rates of gonorrhea are 50 to 100 times higher than rates in Sweden. Canada and some Western European countries have nearly eliminated infectious syphilis. In the U.S., large-scale regional screening demonstration programs have rapidly, dramatically, and reproducibly reduced chlamydia prevalence in women. Chlamydia, a serious reproductive tract infection with many associated negative health consequences, is currently the most frequently reported infectious disease in the U.S. Estimates are that 4 million new cases occur annually, as many as one-half occurring among women ages 15-19. Chlamydia often causes severe medical conditions that are also costly, especially in women (pelvic inflammatory disease, ectopic pregnancy, and infertility) and in newborns (eye infections and pneumonia). Conservatively, these reproductive consequences in women result in an estimated annual cost of chlamydia infection in the U.S. of $1.5 billion, $1.1 billion of which is attributed to treatment of preventable, serious after-effects in women. In recent years, a number of effective biomedical interventions that prevent these consequences and save money have been implemented in some parts of the country. To date, however, most women in need of these interventions are not being served.

Although STD prevention is technically feasible today in the U.S., an effective national system for STD prevention currently does not exist. Among the obstacles to establishing such a system are: (1) profound cultural and social barriers to adoption of healthy sexual behaviors; (2) a fragmented system of informational and educational services that leads to inadequate awareness of STDs and misperceptions of risk among high risk individuals; (3) a fragmented system of STD-related clinical services manifested by inadequate training of health care providers, the under-recognition of the importance of private sector providers in STD prevention, and the absence of innovative services targeted to youth and disenfranchised populations that lead to inadequate diagnosis and treatment of STDs or missed clinical opportunities; (4) inadequate integration and coordination of STD, HIV, unintended pregnancy, and cancer prevention programs at the local level despite the STRONGinterrelationships among these conditions; and (5) inadequate human and financial resources in both the public and private sectors to meet recognized needs for behavioral and biomedical solutions.

Performance Goals and Measures

Performance Goal: Reduce STD rates by providing chlamydia and gonorrhea screening, treatment, and partner treatment to 50% of women in publicly funded family planning and STD clinics nationally.

Performance Measures:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
11.6% (1995) (FY 1999 Data available May/June 2000).	The prevalence of Chlamydia trachomatis among high risk women under 25 will be reduced from 11.6% (1995) to less than 8%.	The prevalence of Chlamydia trachomatis among high risk women under 25 will be reduced from 11.6% (1995) to less than 8%.
9% (1996) (FY 1999 Data available May/June 2000).	The prevalence of Chlamydia trachomatis among women under the age of 25 in publicly funded family planning clinics will be reduced from 9% (1996) to less than 6%.	The prevalence of Chlamydia trachomatis among women under the age of 25 in publicly funded family planning clinics will be reduced from 9% (1996) to less than 6%.
300 per 100,000 (1995). (FY 1999 Data available May/June 2000).	The incidence for gonorrhea in women aged 15-44 will be reduced from 300 per 100,000 (1995) to less than 250 per 100,000.1	The incidence for gonorrhea in women aged 15-44 will be reduced from 300 per 100,000 (1995) to less than 235 per 100,000.1
162 per 100,000 (1995). (FY 1999 Data available 2002).	The incidence of PID, as measured by a reduction in hospitalizations for PID, will be reduced from 162 per 100,000 (1995) to less than 125 per 100,000 women aged 15-44, and	The incidence of PID, as measured by a reduction in hospitalizations for PID, will be reduced from 162 per 100,000 (1995) to less than 125 per 100,000 women aged 15-44, and
245,000 (1995). (FY 1999 Data available 2002).	the number of initial visits to physicians for PID will be reduced from 245,000 (1995) to less than 225,000.	the number of initial visits to physicians for PID will be reduced from 245,000 (1995) to less than 225,000.

¹ The measure was changed from 200 per 100,000 to 250 per 100,000 (FY 1999) based on a slowing in the rate of decrease in gonorrhea since the base year (1995). The focus of the STD program over the next several years will be syphilis elimination rather than gonorrhea, with the primary gonorrhea prevention effort devoted to identification and treatment of females through screening to prevent the complications of gonorrhea.

Performance Goal:

Reduce the incidence of congenital syphilis through the following strategies:

• More than 95% of women attending publicly funded prenatal clinics will be screened for syphilis (subject to development of state and local surveillance).
• More than 80% of women attending publicly funded prenatal clinics who have untreated or inadequately treated syphilis will be treated within 2 weeks of their initial prenatal visit (subject to development of state and local surveillance).
• More than 95% of pregnant women in counties with a syphilis rate greater than 4 per 100,000 will be screened for syphilis in hospitals at the time of delivery (subject to development of state and local surveillance).

Performance Measure:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
47.4 per 100,000 (1995).1 (FY 1999 Data available May/June 2000).	The incidence of congenital syphilis in the general population will be reduced from 39 per 100,000 live births (1995) to less than 20 per 100,000 live births.2	The incidence of congenital syphilis in the general population will be reduced from 39 per 100,000 live births (1995) to less than 20 per 100,000 live births.

¹ Changes in baseline data from 39 per 100,000 to 47.4 per 100,000 was due to a correction in data received from STD data collection system.
² Because of the drastic decrease in adult infectious syphilis, the previous 1999 goal of 30 per 100,000 live births was exceeded in 1998 (24.6 per 100,000 live births).

Performance Goal: Reduce the incidence of primary and secondary syphilis through the development of syphilis elimination action plans for each state that had a primary and secondary syphilis rate in 1995 of greater than or equal to 4 per 100,000 population and an HIV prevalence in childbearing women of greater than 1 per 1,000.

Performance Measure:

FY Baseline	FY 1999 Appropriated	FY 2000 Estimate
81% (1995).	At least 85% of U.S. counties will have an incidence of primary and secondary syphilis in the general population of less than or equal to 4 per 100,000. This is an increase from 81% in 1995.	At least 85% of U.S. counties will have an incidence of primary and secondary syphilis in the general population of less than or equal to 4 per 100,000. This is an increase from 81% in 1995.
Total Program Funding	$123,753	$130,649

Verification/Validation of Performance Measures: Data will be collected through the National STD Surveillance System. Data will be verified through the National Comprehensive STD Prevention System and the National Infertility Prevention Program.

Links to DHHS Strategic Plan

These performance measures relate to DHHS Goal 1: Reduce major threats to the health and productivity of all Americans.

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