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DHWDC News Archives
News Updates from the Michigan Department of Community Health, Division of
Health, Wellness and Disease Control (DHWDC)
SPRING, 2007
Division of Health Wellness and Disease Control Newsletter
Division PN Enhancement Effort
Although Michigan’s syphilis rates are being maintained at a low
level, it needs to be recognized that our neighbors, as close as Chicago, are
experiencing substantial outbreaks, so another large outbreak in Michigan is
only a matter of time. Also, chlamydia and gonorrhea remain the 2nd and 3rd most
reported diseases in the state (see above IPP item), and cause a substantial
expenditure of public and private resources to manage associated acute and
chronic conditions. CDC is also emphasizing rapid and comprehensive testing of
high risk individuals for HIV, to identify those who don’t yet know their
status, and conducting effective and timely partner notification (PN) for those
found positive.
Many persons, across Michigan, perform PN for one or more of the above four
diseases identified above. Efforts to improve PN for one disease will likely
improve the quality of the process for other diseases. Therefore, the Division
will be implementing a comprehensive plan to improve PN for patients with
gonorrhea, chlamydia, syphilis, and/or HIV. The effort will concentrate on three
major goals:
1) Rapid identification and interview of those infected
2) Initiation of high quality partners, suspects and associates
3) Rapid investigation and management of partners, suspects and associates
Expected Outcomes:
1) Early Treatment
2) Less Transmission
3) Less Morbidity and Mortality
4) Less Complications
5) Long term savings in healthcare expenses
Central Michigan District Health Department, Summary Report
The Central Michigan District Health Department (CMDHD) has been engaged in
disease management activities for the 26 low morbidity health departments since
2005 to conduct HIV/AIDS Partner Counseling & Referral Services (PCRS) and
Syphilis epidemiology. Here’s a synopsis of CMDHD activities for CY 2005 & 2006:
HIV/AIDS Partner Counseling & Referral Services (PCRS)
During the 2005 CY, a total of 76 HIV-infected index clients were referred to
CMDHD for PCRS, and in 2006, a total of 81 clients were referred. In 2006, only
1 index client declined PCRS, compared to 4 in 2005.
Partner data for the 2005 CY indicates that 49 at-risk sex and needle-sharing
partners were investigated by CMDHD. Of this, a total of 13 partners identified
with an unknown status, and 1 partner tested newly positive. In 2006 CY, the
number of partners investigated increased to a total 78. Of this, a total of 31
partners identified with an unknown status, and 2 partners tested newly
positive.
Syphilis Surveillance & Investigation
An overview of the CY 2005 syphilis data indicated CMDHD performed a total
of 49 surveillance investigations. Of those, 3 cases were identified as new
cases of syphilis, requiring follow up investigations. Five sexual contacts were
initiated from these 3 cases and 4 were examined. In 2006, CMDHD investigated
143 syphilis reactors. A total of 6 syphilis cases were identified and
investigated, resulting in 9 contacts being investigated. From the 9 contacts, 5
were examined, one contact was unable to be located. Subsequently, 4 contacts
were not infected, and required no prophylaxis treatment.
Overall, Central Michigan District Health Department staff continues to provide
disease management services for the low morbidity jurisdictions in an effective
manner.
Syphilis in Detroit
In 2006, after years of steady decreases, Detroit experienced an increase in
primary and secondary syphilis cases. The total number in Detroit was 64 cases,
17 cases of primary and 47 cases of secondary syphilis, representing a 16%
increase from December 2005 figures (n=54). This increase is a result of
targeted outreach to the high-risk populations, and improving patient’s access
to care. Additionally, partnerships with community programs have been successful
in providing onsite services to high-risk populations. These collaborations have
brought STD education and care services to populations who rarely seek medical
services and, more importantly, may not otherwise have had access. The rapport
with community-based organizations helped reduce the stigma attached to
syphilis, help participants recognize the symptoms of syphilis and other STDs,
and provided opportunities for high-risk populations to access service.
The STD program, along with organizations throughout the City, will continue to
target interventions to individuals most at risk. Additional emphasis will be
placed on pregnant females to continue to reduce the number of congenital
syphilis cases. Syphilis is relatively difficult to transmit. People are
infectious for a short period of time, the incubation period is long, giving
public health authorities and community partners a window of opportunity to
provide treatment and prevent further infection. Michigan is at the lowest rate
since 1997; it is important that the same level of effort continue even when
numbers are low.
CDC Recommendations
Since 1993, oral fluoroquinolones (ciprofloxiacin, ofloxacin, and
levofloxacin) have been recommended for the treatment of gonorrhea and are
actively used by the medical community in Detroit. On April 12th, the Centers
for Disease Control (CDC) made a major announcement concerning the treatment of
gonorrhea. They recommended that fluoroquinolones no longer be used for the
treatment of gonorrhea. This recommendation was based on analysis of new data
from CDC’s Gonococcal Isolate Surveillance Project (GISP), a sentinel
surveillance system that monitors trends of antimicrobial susceptibilities of
gonorrhea in the U.S. The data on which this recommendation is based show that
in the first half of 2006, rates of fluoroquinolone resistant (QRNG) reached
6.7% among heterosexual males. This represents an 11-fold increase from the 0.6%
rate in 2001.
Unfortunately, recommended options for the treatment of gonorrhea are now
limited to a single class of antibiotics, cephlalosporins. Within this class,
ceftriaxone, available only as an injection, is the preferred treatment for all
types of gonorrhea, We have been left with few oral options. Cefixime is an
effective oral cephlalosporin that is not available in the U.S. at this time.
Cefpodoxime is another oral alternative which is FDA approved and has been used
in California, but it is not currently recommended by the CDC because it does
not meet the minimum efficacy criteria of 95% cure rates. Finally, azithromycin,
the recommended treatment for chlaymdia which also works well in treating
gonorrhea when prescribed in a higher dose is expensive and causes
gastrointestinal distress for many.
HDRMH Documents - Health Disparities
HDRMH is in the process of finalizing two major documents. The Color
Me Health Compendium of Public Health Administration Programs. This document
will highlight the Department’s commitment to reducing racial and ethnic
disparities and bring value to agencies whose programs receive the “Color Me
Healthy” designation. It will be shared with policy makers, lay leaders and
potential funders, and, the Michigan Health Disparities Profile. The purpose of
this document is to highlight the health of minority populations and document
the disparities that exist within the state of Michigan.
HDRMH Demonstration Projects
The 2½ year funding period for the HDRMH demonstration projects will be
coming to a close September 30, 2007. HDRMH goals for FY 07-08 include
leveraging resources to initiate new and innovative programs such as:
1. Providing dental sealants for minority children in collaboration with the
Bureau of Family and Maternal Child Health.
2. Promoting breast and cervical cancer screening among minority women that are
on Medicaid.
HDRMH will also continue collaboration on interventions that focus on the
reduction of sudden infant death related to sleep position and sleep
environment, and continue programming to increase the practice of self
management of hypertension among African American adults over age 50.
Check UP! or Check Out!
CUCO has moved forward into the second phase of the project. CUCO is targeting
1400 African American male Molina HMO members residing in the City of Detroit,
who haven’t had a preventive health check-up within the last year. The
strategies focus on increasing their awareness of the importance of receiving a
preventive health check up.
One barrier to seeking preventive health checkups identified in the initial CUCO
focus groups was the absence of a personalized relationship between the
physician and male patient. Personalized mailers that contain a picture and
brief biography of the Molina member’s primary care physician, along with
information about calling the physician’s office to schedule a preventive health
checkup are currently in production. The mailers will serve as a foundation for
establishing an open line of communication between the physician and patient.
HAPIS - Michigan Dental Program (MDP)
The Michigan Dental Program (MDP), administered by the Michigan Department
of Community Health, Division of Health Wellness and Disease Control, is holding
an open enrollment which began on May 1, 2007 and ends on June 30, 2007. HIV+
persons in the state may get application and other eligibility information by
contacting their case manager or by calling the MDP office at 1-888-826-6565.
Information can also be found via the MDP website at:
http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2982-45691--,00.html
All completed applications must be faxed or mailed with a postmark of no later
than June 30, 2007. Applications received or postmarked later than June 30, 2007
will not be accepted.
HAPIS - Case Management Trainings
The Case Management Training held April 24–27 went extremely well. The next
training is August 28-31 at the Ingham County Health Department.
HIV Screening RFA
The Division of Health, Wellness and Disease Control, HIV/AIDS Prevention &
Intervention Section as released a Request for Applications (RFA) to support
planning for, and initial implementation of HIV screening in high HIV prevalence
health care settings. The Department is seeking to award approximately $400,000
to support HIV screening in emergency departments, urgent care centers,
community health clinics, primary care clinics and hospital outpatient
facilities operating in the counties of Berrien, Calhoun, Genesee, Ingham,
Jackson, Kalamazoo, Kent, Oakland, Washtenaw, and Wayne (including the City of
Detroit). Application deadline was May 21, 2007.
National HIV Test Day
The 11th annual National HIV Testing Day (NTD) will take place on Wednesday,
June 27, 2007. The theme for this year and last year is “Take the Test, Take
Control”, is meant to entice people who have not tested before to access their
HIV risk and if appropriate, get tested. Many exciting changes have taken place
to make this day a success including the offering this year of mini grants to
agencies who propose innovative strategies to make their event a success. Thirty
grant applications were submitted to HAPIS for this event, and decisions will be
made by mid-May. In addition to applications, HAPIS has received 12 plans of
action for NTD so far, even though the deadline submission is not until June 1.
The 6th annual NTD Kick Off Rally was held on April 11 at the Hampton Inn in
Okemos. Thirty-one individuals attended the rally on behalf of 15 agencies and
local health departments, and used their “brainstorming” abilities for new and
exciting ideas to share with one another. Considering we had snow that morning,
it was very well attended! Attendees reported extremely high satisfaction with
this event, particularly the ability to brainstorm ideas for their individual
target populations.
National Latino AIDS Awareness Day
The Latino AIDS Advisory Committee will begin planning for the 5th National
Latino AIDS Awareness Day (NLAAD) on Wednesday, May 16. NLAAD takes place on
October 15 of each year.
African American AIDS Advisory Council (A(4)C)
The African American Workgroup is now a standing committee of the Michigan
HIV/AIDS Council (MHAC). The Committee has been very busy since it became an
official committee on November 15, 2006. Activities undertaken by A4C to date
are:
• Conducted 2 legislative trainings for 22 participants.
• Held a town hall meeting, Resound the Alarm: HIV is Still Raging in Detroit,”
as the kick-off for the 3rd annual Black AIDS Awareness Campaign. The town hall
meeting was well attended with over 100 individuals in attendance.
• Facilitated the 3rd Annual Black AIDS Awareness Campaign. Activities occurred
in 29 Michigan cities with 26 agencies participating. Ten (10) new agencies
joined the Campaign this year.
• Participated with HIV/AIDS Alliance of Michigan (HAAM) in a Legislative
Briefing on April 26.
• Reviewed the HIV Prevention Plan and provided recommendation to the Needs
Assessment Committee of MHAC on priority populations.
The first of two community dialogues/lunch & learns will occur around National
Test Day and will focus on HIV and African American women.
Direct Observations of Counseling, Testing and Referral for Quality Assurance
Throughout March and April, the entire Community Partnerships Unit (CPU),
all of the Education, Training and Resource Development (ETRD) Unit, Bob Barrie,
and consultant Ellen Ives have been working very diligently to conduct chart
reviews and direct observations of counseling in community based agencies and
local health departments throughout Michigan. To date, we have observed
counseling and provided feedback for improvement to all funded CBOs, two local
health departments, and three designated non-funded agencies.
This has been a great learning experience for everyone. It has informed HAPIS
regarding the realities of our funded providers while giving us an opportunity
to give concrete feedback and strategize for improvement with our counseling
partners. Training and technical assistance is being developed to address areas
where patterns for improvement have been identified across agencies. Findings
from this process has produced both joy and concern but either way, knowing is
better! With the facts we can work toward improvement.
ETRDU - Training Unit
Upcoming Capacity Development Trainings (See
Trainings)
The Program Review Panel
The material submission and review process of the Program Review Panel (PRP)
has recently been revised. The new revisions include an appeal process. If the
Program Review Panel disapproved an item, the submitting agency has a right to
appeal the decision. The revised Frequently Asked Questions outlines the appeal
process.
HIV prevention funded agencies submitting curricula must first submit the item
to their contract monitor for a technical review before submitting to the PRP
chair. Following this technical review, the submitting agency is responsible for
submitting the curriculum to the PRP Chair. All other materials must be
submitted to the PRP chair directly.
For more information, please contact Christina Bolden, PRP Chairperson at
517-241-5929 or boldenc@michigan.gov .
New Web-based Training Tool
The Training unit has been developing a new tool in providing training to
the people we serve. A web-based version of day one of the Module 1: HIV/AIDS
Basic Knowledge Training is nearing completion. The creation of this resource
was born out of a collaboration between the Child and Adolescent Health Center
Program (AHC), who contracted with a consultant to develop an HIV training for
their staff and requested the training unit’s help in development.
Rachel Mroz has taken the lead on the development of this project and has been
working diligently over the past 3 weeks with AJ Boggs & Company (an
Okemos-based eSolutions company). This training is set to “go live” on May 18th.
This course will provide another training option for participants who value
spending less time in training and more time in the service of their clients.
Participants choosing this option must complete the web course and an exam at
the end with at least 80%. They are then required to attend and successfully
complete the second portion of the training in a face-to-face class to receive a
certificate of completion.
For more information, please contact Rachel Mroz at (313) 456-2626 or
mrozr@michigan.gov .
Counselor Certification Status Verification
Letters will be sent out to funded CBOs and local health departments
addressing the counselor certification status of staff and volunteers at these
organizations. A recent review of the counselor certification database revealed
that there were several staff at CBOs and LHDs whose certification had lapsed
yet they are still conducting counseling and testing.
Staff with lapsed certification must cease counseling and testing and will have
to either provide proof of current certification status or be recertified by
taking the Module training series again.
Update of certification must happen every two years after certification to
remain current. For details about certification update options, please refer to
page 6 in the training calendar.
For more information, please contact Rhonda Bantsimba at (313) 456-3322 or
bantsimbar@michigan.gov .
Now Providing Social Work Continuing Education Credits
The National Association of Social Workers – Michigan Chapter, has recently
approved the Training unit as a provider of continuing education credits (CECs)
for social workers for 12 months. Social workers will now be able to receive
CECs for Modules 1, 2 & 3 (both for CBOs and LHDs).
For more information, please contact Rhonda Bantsimba at (313) 456-3322 or
bantsimbar@michigan.gov.
Training Location Changes
All Lansing-area trainings have been relocated. Classes will no longer be
held at the Okemos Comfort Inn/Holiday Inn. If you are planning to attend an
upcoming training, take special care to be clear about where the training is
located.
For more information, please contact Julie Babb at (517) 241-5903 or
babbj@michigan.gov .
Departure and New Beginning
Rachel Mroz, who joined ETRDU in November 2006, will be leaving us at the
end of June. Rachel has been presented with an opportunity that she simply
couldn’t refuse.
We are very grateful for the time that we have had with Rachel and the training
team is very sad to see her go. She has been a valuable asset to the unit with
her quick learning ability, genuine curiosity and willingness to dive right in
and get to work. She has been a bright spot for us after an overwhelmingly busy
time.
Please join us in wishing Rachel well on her new path.
See April News
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