Columbus County, North Carolina



Columbus County Health Department

STD Clinic Overview

Columbus County Health Department (CCHD) management and staff view the Sexually Transmitted Disease (STD) Program as being an organized system for prevention of disease/morbidity, and premature death. This includes but not limited to STD related infertility, adverse pregnancy outcomes, cancers, and HIV transmission. This task will be accomplished by the following: organized community efforts utilizing the 10 Essential Public Health Functions (Intense focus on Assessment and Assurance), North Carolina Disease Surveillance System, N.C. STD Assessment, Prevention and Treatment Protocol, and guidance from our state Public Health Communicable Disease Branch and Center for Disease Control (CDC) for identification and treatment of STDs.

Understanding the Effect of Socio-Economic Factors

Columbus County Health Department understands that socio-economic factors are determinates which contribute to health care outcomes. The Columbus County STD Comparison report for years 2015 and 2016 shows a decrease in AIDS and HIV categories. There has been a rise in the reported cases of Gonorrhea, Chlamydia and a slight decrease Syphilis. Target populations include racial and ethnic minorities, adolescents, men who are have sex with men (MSM), clients who have multiple sex partners. 2010 Census shows our county grew from 54,212 to 58,098. 65% are Caucasian, 30.4 are African American, 3.3 are American Indian, and 3.5 are Hispanic and/or Latino. Columbus County is a largely rural county and identified as a Tier 1 County which means we are one of the most economically distressed counties in the state. An estimated 24.3 % of our residents live below the poverty level per Access NC January 2017. Columbus County ranks 3rd on the poverty scale per the NC Watch Report.

STD Clinic Staff and Supervision

The Adult Health clinical staff consists of certified STD ERRN’s, trained, and certified in Physical/STD Assessment as mandated by policy and job description. The CCHD Medical Director is available as needed for complex or complicated cases. Generally the ERRN’s follow the CCHD Medical Director’s signed standing orders for testing and treatment. Nurse(s) are to attend annual STD updates and are encouraged to take additional educational courses such as cultural diversity, customer service, Public Health Law, etc.

Clinic Procedures

The clinic is a walk in clinic, with a first come first serve basis which provides testing and treatment for many types of STD’s. All clients requesting testing for STDs will be seen within 24 hrs or one working day of their request. The clinic is generally open every day but may vary slightly depending on staff availability, meetings, training, and/or clinician’s discretion.

Additional services include but are not limited to include: prevention of STD’s through vaccination, safe sex education, outreach immunization service within the county and city school systems, diagnosis of STD/HIV through physical exams, laboratory testing, confidential counseling, and education regarding STDs and HIV, dispensing of free condoms on request, referral, and follow up services such as social work etc.

STD ERRN(s) will not evaluate a patient under the age of 13 and will refer him or her to the Nurse Practitioner or M.D. A client under the age of 13 diagnosed with an STD will be referred to a Child Protective Services as follow up. Persons seeking immediate care after a sexual assault will be referred to the local emergency department for proper care and gathering of evidence.

STD Clinic Services Provided

The CCHD STD clinic provides STD exams and Treatment in accordance with the

• 10A NCAC 41A .0101 REPORTABLE DISEASES AND CONDITIONS

• 10A NCAC 41A .0201 CONTROL MEASURES - GENERAL

• 10A NCAC 41A .0201 CONTROL MEASURES - GENERAL

• 10A NCAC 41A .0202 CONTROL MEASURES – HIV

• G. S. 90-21.5.  Minor's consent sufficient for certain medical health services

Community Partners and Collaboration

CCHD Adult Health staff collaborates with the New Hanover Regional Medical Center Infectious Disease Program to provide a satellite clinic twice a month to monitor and treat those diagnosed with HIV. All individuals with a reactive HIV PCR will be referred to the N.C. SLPH to a Disease Intervention Specialist (DIS) for follow up investigation within 72 hours.

CCHD has a signed agreement with the Dream Center (Community Based Non-Profit Agency) to assist them with:

1. HIV/AIDS/STD screening and treatment including laboratory services when needed

2. Tuberculosis screening.

3. HIV early intervention and prevention and client case management.

4. Use of relevant HIV/AIDS/STD standing orders, policies, and procedures

5. Use of CCHD confidentiality Policy

6. Staff member to serve on a Program Review Panel, as needed.

7. Provide training on health care issues as classroom space allows.

8. Place orders for DREAM Center at cost for the medical supplies.

CCHD Health Educator provides pregnancy prevention education to high schools which include STD prevention.

Staff attends health fairs with the college, the local hospital, as well as various

other venues providing literature and answering questions.

Utilize our electronic messaging sign at times throughout the year promoting safe sex

and use of condoms.

Last but not least, CCHD provides free condoms.

Quality Assurance

NC Communicable

Disease Branch |2012 Cases

(rate) |2013 Cases

(rate) |2014 Cases

(rate) |2015 Cases

(rate) |2016 Cases

(rate) |2016 N.C.

Average Rate | |HIV Tab.3 |7 |6 |8 |8 |2 |Table 27 | |(rate) |(14.5) |(10.4) |(16.6) |(16.6) |(4.2) |16.4 | |AIDS Tab. 6 |8 |7 |4 |5 |1 |Table 6 | |(rate) |(16.5) |(14.5) |(8.3) |(10.4) |(2.1) | 7.0 | |Gonorrhea |82 |70 |87 |94 |99 |Table 46 | |(rate) Tab 11 |(142.2) |(122.5) |(152.9) |(165.1) | (175.2) |194.4 | |Chlamydia |247 |226 |232 |285 |313 |Table 49 | |(rate) Tab. 12 |(428.9) |(392.1) |(407.2) |(500.6) |(553.9) |572.4 | |Syphilis (Primary

And Secondary) |

0 |

0 |

0 |

6 |

1 |

Table 45 | |(rate) Tab. 9 |0 |0 |0 |(10.5) |(1.8) |10.7 | |Syphilis (Primary Secondary, Early Latent |2

|1

|1

|4

|2 |

Table 45

| |(rate) Tab. 9 |(3.5) |(1.7) |(1.8) |(7.0) |(3.5) |8.0 | |Hepatitis B Tab 13 |1 |0.0 |1 | |2 |Tab 13 | | |(1.7) |0.0 |(1.8) |0.0 |(3.5) |1.5 | |Hepatitis C Tab 14 |0.0 |0.0 |1 |1 |1 |Tab 53 | | |0 |0 |(1.8) |(1.0) |(1.8) |1.8 | |Quarterly Audits are done in all clinical areas including STD clinic per audit policy utilizing the state audit tool. If there are compliance issues the staff involved are requested to complete a corrective action plan stating how they will make improvements and follow up chart reviews as needed.

N.C. 2012 HIV/STD Surveillance Report 2016

Communicable Disease Branch Columbus Count (Rate per 100,000- Population)



As seen in the table above Columbus County AIDS rate has decreased at a rate of 4.2 in 2015 and 2016 with 2 new cases each year. This is below the state rate of 16.4. The primary, secondary Syphilis cases decreased from 6 new cases in 2015 to 2 new cases in 2016. In 2016 are rate =1.8 which is below the state rate of 10.7. Early Latent Syphilis increased to 4 new case in 2015 (rate 7.0) and decreased to new 2 cases in 2016 (3.5). Columbus County below the state average of 8.0. There is obvious improvement in all other areas and are below the state average. Gonorrhea and Chlamydia have shown a steady increase in 2015 and 2016 and remains slightly lower than the state rate.

Highlights

HIV

• As of December 31, 2016, the number of people diagnosed with HIV who reside in North Carolina (including those initially diagnosed in another state) was 34,187.

• In 2016, 1,399 new diagnoses of HIV were reported among the adult and adolescent (over 13 years old) population, at a rate of 16.4 per 100,000 population. This is a slight increase from 2015, where 1,334 persons were newly diagnosed with HIV, at a rate of 15.9 per 100,000 population.

• Most counties have a declining AIDS rate (Stage 3).

• There were two perinatal (mother-to-child) HIV transmissions in 2016.

• People between 20 and 29 years old had the highest rates of newly diagnosed HIV in 2016, comprising 42.8% of the newly diagnosed population.

• Among race/ethnicity and gender groups, Black/African Americans represented 62.1% of all adult/adolescent infections, with a rate of 47.2 per 100,000 adult/adolescent population. The highest rate (81.0 per 100,000) was among adult/adolescent Black/African American men.

• For adults and adolescents newly diagnosed with HIV in 2016, men who have sex with men (MSM) was the principal risk factor indicated in 65.6% of all cases; heterosexual transmission risk in 28.8%; injection drug use (IDU) in 3.1%, and MSM/IDU in 2.7%.

SYPHILIS

• The number of early syphilis (primary, secondary, and early latent) cases diagnosed in North Carolina in 2016 was 1,894, with a rate of 18.7 per 100,000 population. This number is similar to the cases in 2015, when 1,881 early syphilis cases were diagnosed (18.7 per 100,000 population).

• A total of 16 infants were reported with probable congenital syphilis and two confirmed/stillbirths, for a total of 18 congenital syphilis cases in 2016. This is an increase, from the 11 probable congenital syphilis cases reported in 2015.

• The highest rates of newly diagnosed early syphilis occurred in people between 20 to 24 years old (50.4 per 100,000 population) and 25 to 29 years old (66.0 per 100,000 population). These cases comprised 43% of the total early syphilis cases in 2016.

• Black/African American men had the highest rates of early syphilis (92.4 per 100,000 population) and comprised 51.2% of total early syphilis cases in 2016.

GONORRHEA

• The reported number of gonorrhea cases in 2016 was 19,724 at a rate of 194.4 per 100,000 population, an increase from 17,049 cases in 2015 (rate of 169.9 per 100,000 population).

• North Carolina State Laboratory of Public Health testing data for gonorrhea showed that the positivity rate among women attending family planning clinics (a stable population which receives regular screening) has remained steady over the past five years. Therefore, increases in gonorrhea diagnoses among women may be due to increases in testing rather than true increases in disease.

• In contrast, gonorrhea diagnoses among men increased 20.2% from 2015 to 2016; this may in part be due to increased screening among men.

• Among women reported with gonorrhea, the highest rates occurred in 20 to 24-year-olds, followed by 15 to 19-year-olds (1,017.5 and 708.5 per 100,000 population, respectively). The 15 to 29-year-olds comprised 39.2% of the total reported gonorrhea cases in 2016.

• In 2016, Black/African American men and women had the highest gonorrhea rates (382.4 and 501.7 per 100,000 population, respectively) and comprised 50.0% of total gonorrhea cases.

CHLAMYDIA

• The number of chlamydia cases diagnosed in North Carolina in 2016 was 58,078 at a rate of 572.4 per 100,000 population, compared to 54,384 cases in 2015 (rate of 541.9 per 100,000 population).

• North Carolina State Laboratory of Public Health testing data for chlamydia showed that the positivity rate among women attending family planning clinics (a stable population which receives regular screening) has remained steady over the past five years. As with gonorrhea, increases in chlamydia diagnoses among women may be due to increases in testing rather than true increases in disease.

• Among women reported with chlamydia, the highest rates occurred in 20 to 24-year-olds, followed by 15 to 19-year-olds (4,832.6 and 3,901.6 per 100,000 population, respectively). Overall, the 15 to 24-year-olds comprised 67.3% of the total chlamydia cases in 2016.

• In 2016, Black/African American men and women had the highest chlamydia rates (574.9 and 1,196.2 per 100,000 population, respectively) and comprised 35.0% of the total chlamydia cases.

Hepatitis B

• The number of acute hepatitis B cases diagnosed in North Carolina in 2016 was 151 at a rate of 1.5 per 100,000 population, compared to 140 cases in 2015 (1.4 per 100,000 population).

• The highest rates of newly diagnosed acute hepatitis B occurred among the 35 to 44-year-old age group. This age group comprised 33.8% of the total acute hepatitis B cases.

• In 2016, White/Caucasian men and women had the highest acute hepatitis B rates (1.8 and 1.0 per 100,000 population, respectively) and comprised 60.9% of the total acute hepatitis B cases.

• In 2016, the exposure most frequently reported by people with acute hepatitis B was heterosexual contact, followed by injection drug use.

Hepatitis C

• The number of acute hepatitis C cases diagnosed in North Carolina in 2016 was 185 at a rate of 1.8 per 100,000 population, compared to 116 cases in 2015 (1.2 per 100,000 population).

• The highest rates of newly diagnosed acute hepatitis C occurred among the 20 to 39-year-old age group. This age group comprised 67.6% of the total acute hepatitis C cases.

• In 2016, White/Caucasian men and women had the highest acute hepatitis c rates (2.5 and 2.0 per 100,000 population, respectively) and comprised 79.5% of the total acute hepatitis C cases.

• In 2016, the most frequently reported risk factor by people with acute hepatitis C was injection drug use, followed by heterosexual contact.

Key Points from 2016 North Carolina HIV/STD Surveillance Report:

▪ As of December 31, 2016, the number of people diagnosed with HIV who reside in North Carolina (including those initially diagnosed in another state) was 34,187.

▪ In 2016, 1,399 new diagnoses of HIV were reported among the adult and adolescent (over 13 years old) population, at a rate of 16.4 per 100,000 population. This is a slight increase from 2015, where 1,334 persons were newly diagnosed with HIV, at a rate of 15.9 per 100,000 population. 

▪ There were two infants with perinatal (mother-to-child) transmission of HIV in 2016.

▪ The number of early syphilis (primary, secondary, and early latent) cases diagnosed in North Carolina in 2016 was 1,894, with a rate of 18.7 per 100,000 population. This number is similar to the cases in 2015, when 1,881 early syphilis cases were diagnosed (18.7 per 100,000 population). 

▪ A total of 16 infants were reported with probable congenital syphilis and two confirmed/stillbirths, for a total of 18 congenital syphilis cases in 2016. This is an increase, from the 11 probable congenital syphilis cases reported in 2015. 

▪ The reported number of gonorrhea cases in 2016 was 19,724 at a rate of 194.4 per 100,000 population, an increase from 17,049 cases in 2015 (rate of 169.9 per 100,000 population). Among women reported with gonorrhea, the highest rates occurred in 20 to 24-year-olds, followed by 15 to 19-year-olds (1,017.5 and 708.5 per 100,000 population, respectively). The 15 to 29-year-olds comprised 39.2% of the total reported gonorrhea cases in 2016. 

▪ The number of chlamydia cases diagnosed in North Carolina in 2016 was 58,078 at a rate of 572.4 per 100,000 population, compared to 54,384 cases in 2015 (rate of 541.9 per 100,000 population). Among women reported with chlamydia, the highest rates occurred in 20 to 24-year-olds, followed by 15 to 19-year-olds (4,832.6 and 3,901.6 per 100,000 population, respectively).

▪ The number of acute hepatitis B cases diagnosed in North Carolina in 2016 was 151 at a rate of 1.5 per 100,000 population, compared to 140 cases in 2015 (1.4 per 100,000 population). The highest rates of newly diagnosed acute hepatitis B occurred among the 35 to 44-year-old age group. This age group comprised 33.8% of the total acute hepatitis B cases.

The number of acute hepatitis C cases diagnosed in North Carolina in 2016 was 185 at a rate of 1.8 per 100,000 population, compared to 116 cases in 2015 (1.2 per 100,000 population).  The highest rates of newly diagnosed acute hepatitis C occurred among the 20 to 39-year-old age group. This age group comprised 67.6% of the total acute hepatitis C cases.

References:

N.C. HIV/STD Surveillance Report for year 2016

Communicable Disease Branch

Update 9/20/2017

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