What is the Region I Infertility Prevention Project
(AKA Chlamydia Project)?
The US Department of Health and Human Services has established 10
regions throughout the United States. Region I is composed of the six New England states (Connecticut, Maine, Massachusetts, New Hampshire,
Rhode Island, and Vermont). The overall goal of the Region I Infertility
Prevention Project is to assess and reduce the prevalence of chlamydia
and chlamydia-related complications in populations at risk for the
disease through the collaborative efforts of STD and family planning
providers and public health laboratories in Region I. An advisory
board for the project was formed in February 1995 to develop guidelines
and standards to assess and reduce the prevalence of chlamydia in
Region I. As of August 2001, the Region I Infertility Prevention Project
advisory board has met 22 times and has been successful in operationalizing
the project.
The regional advisory board is composed of representatives from the
ten regional Title X family planning agencies, six state STD programs,
and six state public health laboratories. Each agency has appointed
one official representative to the advisory board. Several agencies
have also appointed an alternate to the advisory board with the understanding
that only one person per agency can take part in the decision making
process. Consensus rather than voting is the method of decision making. Also attending the advisory board
meetings are affiliated public health representatives who do not take
part in the decision making process and include representatives from
CDC, PHS, medical advisors to the board, and JSI infrastructure staff.
The primary role of the advisory board is to oversee and approve the
Infertility Prevention Project activities. The advisory board plans
the necessary strategies for implementing the key areas of the regional
chlamydia plan. In order to address the specific key areas of the
regional plan, three subcommittees have been established - Screening
and Treatment, Data, and Laboratory. Each subcommittee has representation
from family planning, STD, and public health laboratories. These subcommittees
explore issues, keep abreast of new information related to chlamydia,
develop guidelines and standards and provide recommendations to the
full advisory board for consideration. Each subcommittee has elected
a chairperson or co-chair people. As needed, subcommittees participate
in conference calls between the regional advisory meetings.
An Executive Committee to the Advisory Board was formed in March 1996.
Each state in Region I has representation on the Executive Committee
and each subcommittee chairperson is also a member. The primary role
of the Executive Committee is to facilitate communication between
the advisory board and JSI if the need arises between advisory board
meetings. The Executive Committee has the authority to make decisions
and committee members have the responsibility of contacting their
state colleagues if their input is needed in the decision-making process.
In October 1998, an ad hoc funding subcommittee was established to
assist and advise the Region I funding workgroup representative. Each
state in Region I has representation on the ad hoc funding subcommittee
and one member of this subcommittee has been chosen to be the Region
I funding workgroup representative.
Since 1996, Region I Infertility Prevention Project accomplishments
include:
- Developed project infrastructure
- Established regional selective screening criteria
- Designed a regional data collection system
- Defined criteria for eligible laboratories
- Developed education and counseling protocols
- Implemented a specimen adequacy study
- Conducted a needs assessment regarding specific training needs
of sites participating in the Infertility Prevention Project
- Provided appropriate training for clinical, laboratory and data
systems
- Performed regional analyses of chlamydia data collected
John Snow Research and Training
Institute in Boston, MA administers the project in Region I specifically
by coordinating the day-to-day management of the project, organizing
and conducting the advisory board meetings and developing and managing
the data collection and analysis systems.
Region I State Updates
Connecticut
Local
Statistics
In the past few months, Connecticut has increased the number of Infertility
Prevention Project sites. Connecticut now has eleven Planned Parenthood
Infertility Prevention Project sites in the state. Overall positivity
for the state project is running at approximately 3%. Connecticut
sites have developed a number of innovative methods of promoting chlamydia
counseling and testing. Planned Parenthood of Connecticut staff funded
a booth and carnival wheel at a number of rock concerts around the
state. Thousands of people stopped by the booth and received educational information on chlamydia and other
STIs. In addition, 2,500 people filled out a chlamydia survey and
had answers reviewed individually with a staff participants, who spun
the carnival wheel and were asked to answer questions based on which
"subject" they landed on. In addition to funding the rock concerts,
Planned Parenthood developed and continues to air professionally produced
radio commercials recommending chlamydia testing. To date, the radio
commercials have been aired in a variety of different markets and
have been very well received.
Maine
Local
Statistics
Maine is a large, rural state with people widely dispersed over an
area roughly the size of the five other New England states combined.
The Maine Infertility Prevention Project provides screening and treatment
to eligible females and to the partners of positive females at 31
sites throughout the state. There are 22 Family Planning Association
of Maine sites, four
Planned Parenthood of New England sites, three STD clinics, and two
school-based clinic sites.
The Maine IPP uses GenProbe Pace 2 for the majority of its testing.
The GenProbe TMA system is used for select urine screening. The Maine
Health and Environmental Testing Laboratory has been exploring the
possible use of amplified combined gonorrhea and chlamydia tests for
calendar year 2001.
Massachusetts
Local
Statistics
The STD Prevention Division and the STD Laboratory of the State Laboratory
Institute have been part of the IPP project since 1996. In addition
to the STD clinics, we are now supporting screening in 12 family planning
clinics, two jails, one adolescent clinic, one homeless shelter, DYS
facilities in two cities, and two HIV multi-service centers. The focus
of the IPP in Massachusetts has been on expanding the extent of screening
services to women who would not ordinarily have access to such a service.
Accordingly, we are concentrating our efforts on those sites that
serve young women. An agreement has been made to expand screening
into additional lock-up facilities of the Department of Youth Services
(DYS). Two are located in Springfield, at the Chestnut St. Girls Center
and the Terry Thomas Girls Unit, as well as the Pelletier Center in
Waltham and Cornerstone in Boston. Lock-up facility sites in Boston
and Brockton will also soon begin chlamydia screening. In Springfield,
two adolescent clinics that are part of Baystate Medical Center are
now submitting urine specimens for chlamydia screening. The Division
of STD Prevention received funding from the CDC to begin screening
for chlamydia at a county jail. Screening began in February 1999 at
the Hampden County Correctional Center (HCCC) in Ludlow and in March
1999 at the Nashua Street Jail in Boston. Positivity rates for the
HCCC in 1999 were 5.2% for females 6.1% for males; and in 2000 were 8.3%
for female
and 5.2% for male. Positivity rates in the Nashua Street Jail in 1999
were 3.5% female and 10.0% male; and in 2000 were 4.3% female and
7.0% male. The great majority of clients are asymptomatic.
New Hampshire
Local
Statistics
In the second half of 2000, the New Hampshire Infertility Project
(NHIP) was expanded to include screening of all clients under the
age of 25 seen at the participating family planning clinics. This
expansion was based in part on data from the Infertility Project,
which are confirming a national trend toward higher rates of asymptomatic
chlamydia infection among women under 25. National data suggest that
such an expansion could result in access to screening for approximately
40% of sexually active young women in the state.
The New Hampshire Infertility Prevention Project focuses on increasing
the availability of the most accurate chlamydia testing technologies
to young women and their partners. This has been accomplished to date
by providing testing at Family Planning clinics in Manchester, Nashua,
Dover and Rochester, all communities in counties with rates of chlamydia
higher than the State average.
At the end of 2000, the project added the Manchester Community Health
Center as a site. With these changes, the project is supporting free
screening for chlamydia for young women at all safety net provider
sites in Manchester, the New Hampshire city with the highest rate
of infection.
Rhode Island
Local
Statistics
Rhode Island has the highest rates of Chlamydia in New England. In
Rhode Island five family planning agencies and a school based health
center through Providence Community Health Centers, Inc. are participating
in the Region I Infertility Prevention Project. The five family planning
agencies have been participating since the summer of 1998.
In March of 2001, the Rhode Island Department of Health (RIDOH) partnered
with the Rhode Island Department of Corrections (RIDOC), to begin
enrolling incarcerated women into the Infertility Prevention Project
(IPP). The RIDOC facilities include a combination jail and prison
for all incarcerated women at a single campus in Cranston, RI.
Vermont
Local
Statistics
Partners in Vermont's Infertility Prevention Project include the Vermont
Department of Health's Sexually Transmitted Disease Program, the Vermont
Department of Health's Laboratory, and Planned Parenthood of Northern
New England (PPNNE), Vermont's only Title X family planning agency.
The Project's goal is to focus on the assessment and reduction of
the incidence of chlamydia and its complications within the state.
Screening to those underinsured and uninsured remains available at
the 13 PPNNE clinic sites located throughout the state.
Throughout 2000, Vermont continued to participate in an innovative
award project in conjunction with Maine and Connecticut to determine
if those meeting the IPP screening criteria are receiving screening.
Preliminary data has served as a discussion tool regarding changes
that may be appropriate within the screening criteria based on clinician
compliance with the criteria.
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