Subject: CDC NCHSTP Daily News Update Date: Wed Dec 31 17:30:04 PST 2002 (000 lines) From: National AIDS Info Clearinghouse Copyright 2002 Information, Inc., Bethesda, MD CDC HIV/STD/TB Prevention News Update Tuesday, December 31, 2002 The CDC National Center for HIV, STD and TB Prevention provides the following information as a public service only. Providing synopses of key scientific articles and lay media reports on HIV/AIDS, other sexually transmitted diseases and tuberculosis does not constitute CDC endorsement. This daily update also includes information from CDC and other government agencies, such as background on Morbidity and Mortality Weekly Report (MMWR) articles, fact sheets, press releases and announcements. Reproduction of this text is encouraged; however, copies may not be sold, and the CDC HIV/STD/TB Prevention News Update should be cited as the source of the information. Contact the sources of the articles abstracted below for full texts of the articles. HEADLINES NATIONAL NEWS "FDA Inspection Finds Safety Lapses in Nation's Blood Supply" "As Rates Decline, TB Doctors Worry About Being a 'Victim of Success'" INTERNATIONAL NEWS "Chlamydia Eyed for Hit List" MEDICAL NEWS "Effect of a Clinical Practice Improvement Intervention on Chlamydial Screening Among Adolescent Girls" LOCAL AND COMMUNITY NEWS "St. Mary's/Duluth Clinic Doctor Has Tuberculosis" "Help for Residents with HIV" EDITORIALS AND COMMENTARY "In Africa, AIDS Has a Woman's Face" NEWS BRIEFS "Lee Urges United States to Fight Global AIDS Scourge" "Orphans to Reach Peak in Three Years" "Fighting AIDS" "AIDS Foundation Closed Because of Money Problems Burglarized" ************************************************************ NATIONAL NEWS ************************************************************ "FDA Inspection Finds Safety Lapses in Nation's Blood Supply" USA Today (12.31.02)::Rita Rubin The American Red Cross failed to investigate 134 cases of patients diagnosed with hepatitis after receiving blood it distributed, according to a 45-page report released Dec. 20 by the Food and Drug Administration. After a months-long investigation, the FDA found more than 200 violations of its laws and regulations. "The 134 cases of suspected post transfusion hepatitis... emphasize the dangerously cavalier attitude of previous ARC statements of assurance about the safety of the blood supply," Public Citizen's Health Research Group Director Sidney Wolfe said Monday in a letter to Sen. Edward Kennedy (D-Mass.), the ranking minority member of the Senate Health, Education, Labor and Pension Committee. "The FDA and the Red Cross agree that the nation's blood supply today is safer than it has ever been in our nation's history," Red Cross official Ramesh Thandani said in a Dec. 20 statement. "However, the Red Cross understands more work needs to be done to further strengthen our processes and procedures, and we are fully committed to working collaboratively with the FDA to enhance our systems." The suspected post-transfusion hepatitis cases occurred between Jan. 1, 2000 and June 30, 2002. The FDA said that by not investigating these cases, the Red Cross violated a 1993 consent degree ordering it to clean up its blood division. Unless a member region requests otherwise, the Red Cross does not investigate hepatitis cases when more than 10 blood donors are involved. In January 2001, the Northern Ohio Region asked the Red Cross to allow it to investigate the case of a patient who tested positive for hepatitis after receiving blood from 36 donors. The Ohio region's investigation revealed that one of the donors had been involved in a previous case of suspected post-transfusion hepatitis. Even when fewer donors are involved and an investigation is conducted, the Red Cross does not dig deeply enough, the FDA report said. In a statement after the inspection report was released, FDA Commissioner Mark McClellan said, "I am troubled by the apparent lapses in blood safety practices." "As Rates Decline, TB Doctors Worry About Being a 'Victim of Success'" Associated Press (12.30.02)::Daniel Yee Tuberculosis cases are declining in Georgia, falling 17 percent between 2000 and 2001, according to a report released earlier this month by Georgia's Division of Public Health. There were 575 cases in 2001 and 696 cases in 2000. Despite the decrease, health groups worry that the state's TB programs will deteriorate as state budgets tighten. Georgia health officials have weathered shrinking budgets for TB control over the last two years. Last year, the budget was cut by 5 percent; this fiscal year, there was a 2.5 percent cut, said Dr. Rose-Marie Sales, chief of the public health division's TB epidemiology section. Health officials fear a repeat of the past. Both the incidence of TB and the funding to fight it declined in the 1970s - then rates across the country shot up in the mid-1980s. It took until the early 1990s for state and federal officials to rebuild - and re-fund - TB programs to drive the disease's rates down again, said Wanda Walton of CDC. Earlier this year, CDC reported the nation's 15,991 TB cases in 2001 represented the ninth consecutive year of decline for the disease. Georgia's TB case rate of 6.9 cases per 100,000 people - versus 5.6 cases per 100,000 people nationally - is the seventh highest in the nation and still cause for worry. TB cases increased by 26 percent in 2001 among Georgia's homeless, ending five previous years of decline. Atlanta's Grady Memorial Hospital, which diagnoses 90 percent of Fulton County's TB cases, spent $1.5 million in 2001 to treat indigent TB patients, Sales said. Black people made up 61 percent of Georgia's TB cases, although they represent 29 percent of its population. Some poor Fulton County neighborhoods have TB rates approaching 100 cases per 100,000 people. One-quarter of Georgia's TB cases were from Fulton, state officials said. ************************************************************ INTERNATIONAL NEWS ************************************************************ "Chlamydia Eyed for Hit List" New Zealand Herald (12.26.02)::Bridget Carter As part of a major review of New Zealand's Health Act, health officials hope to reclassify chlamydia, one of the country's most common STDs, as a notifiable infection. If they succeed, people diagnosed with chlamydia would, by law, have to identify recent partners who would be contacted, and doctors would have to report every case of the disease to the medical officer of health. Health clinics currently trace chlamydia contacts only with the patient's informed consent. Dr. Doug Lush, the Ministry of Health's senior adviser on communicable diseases, said chlamydia cases are rising. Making the infection notifiable would provide detailed information to help the ministry launch appropriate education and control programs. The Institute of Environmental Science and Research reported that New Zealand's chlamydia rates are five times higher than the rates in Britain, Canada and Australia. Cases jumped from 2,870 in 2000 to 3,238 in 2001. Northland has launched a pilot program involving general practitioners to determine the costs of such an effort. Dr. Jonathan Jarman, Northland's medical officer of health, said, "The disease is running away on us." He noted that making it notifiable would allow nurses to get in early and "hit it hard." But Dr. Phil Shoemack, the Bay of Plenty's medical officer of health, expressed reservations about making chlamydia notifiable. He said people might avoid treatment, especially if they were having a relationship "on the side." Dr. Tricia Briscoe, chair of the general practitioners council of the Medical Association, said she supports the reclassification only if more funding accompanies it, because it would mean more work for GPs. ************************************************************ MEDICAL NEWS ************************************************************ "Effect of a Clinical Practice Improvement Intervention on Chlamydial Screening Among Adolescent Girls" Journal of the American Medical Association (12.11.02) Vol. 288: P. 2846-2852::Mary-Ann B. Shafer, MD; Kathleen P. Tebb, PhD; Robert H. Pantell, MD; Charles J. Wibbelsman, MD; John M. Neuhaus, PhD; Ann C. Tipton, MD; Sharon Brown Kunin, MS; Timothy H. Ko, DrPH, MPH; David M. Schweppe, MPH; David A. Bergman, MD Chlamydia trachomatis is the most commonly reported bacterial STD in the United States. Three million to four million cases occur annually, disproportionately among adolescent girls. The disease is asymptomatic in more than 75 percent of cases, and an untreated infection may lead to severe reproductive morbidity. Chlamydia trachomatis infections cost the US health care system $3 billion to $4 billion each year. Although broad-based Chlamydia trachomatis screening programs have been shown to be effective, only 20 percent of sexually active young women ages 15-25 who go to HMOs are screened. Barriers to screening include adolescent embarrassment about discussing reproductive health, lack of confidentiality, or fear of a pelvic examination. Health care organizations may not provide a setting conducive to confidential care, and health care practitioners may feel uncomfortable discussing sexuality with their adolescent patients. Until recently, Chlamydia trachomatis endocervical sampling was the standard diagnostic test, requiring a pelvic examination. The advent of urine-based Chlamydia trachomatis nucleic acid amplification tests means that Chlamydia trachomatis can be diagnosed without a pelvic exam. Such testing has been documented to be cost-effective, acceptable to adolescents, and accurate. The current study developed a clinical practice improvement intervention to increase Chlamydia trachomatis screening for eligible adolescent girls during routine checkups at Kaiser Permanente of Northern California pediatric clinics. Between April 2000 and March 2002, ten KP clinics participated in the study. Adolescents up to age 18 are seen for primary care in this HMO's pediatric clinics. In a given year, about 48,600 of the 97,000 enrolled girls ages 14-18 made at least one clinic visit. A third of them had a checkup. The clinics were randomly assigned: five to use the experimental intervention, five to serve as controls. At the experimental clinics, the research team engaged HMO leadership by showing the gap between best practice and current practice; assembled an onsite team to champion the project; identified barriers and developed solutions through monthly meetings of the research team facilitator and the adolescent care team; and monitored performance progress through site-specific performance indicators and a customized information infrastructure. Since practitioners were inconsistent in asking about and recording patients' sexual activity, the researchers developed an anonymous exit poll in which adolescents self- reported their sexual activity. They also initiated a universal urine-sample collection at clinic check-in, to ensure confidentiality about screening. The clinics served an ethnically diverse population with a median age of 15. Sixteen percent were black, 17 percent Asian, 16 percent Latina, 38 percent white, 11 percent multiethnic, and 2 percent other. Over the study period, 478 (47 percent) of 1,017 eligible adolescent girls were screened for Chlamydia trachomatis in the experimental clinics. Of the 1,194 eligible girls at the control clinics, 203 (17 percent) were screened. Thus, the intervention significantly increased Chlamydia trachomatis screening rates among adolescent girls coming in for routine checkups at Kaiser Permanente pediatric clinics. Testing revealed a 5.8 percent infection rate at the experimental clinics, versus 7.6 percent at the control clinics. "In developing our intervention," the authors wrote, "we recognized that to implement changes in screening practices successfully, it was necessary to couple the C trachomatis screening guidelines and advanced C trachomatis testing capabilities with a multifaceted, systems-level intervention that addressed the needs of the health care professional and the patient, and targeted barriers at all levels of clinical practice." They concluded that the next steps for improving screening practices are to train HMO personnel to implement the intervention in all clinic settings, to evaluate cost- effectiveness using a number of different scenarios, and to apply the intervention method and clinic team approach to other clinical problems in other settings to "improve clinical outcomes on an ad hoc or continuous basis." ************************************************************ LOCAL AND COMMUNITY NEWS ************************************************************ "St. Mary's/Duluth Clinic Doctor Has Tuberculosis" Duluth News Tribune (12.28.02)::Melanie Evans A St. Mary's/Duluth Clinic doctor diagnosed with tuberculosis may have exposed patients and health care workers to the disease, Minnesota health officials said Friday. The doctor's name was not released. Patients hospitalized at two hospitals in Duluth, Minn. - St. Mary's and Miller-Dwan - between Nov. 1 and Dec. 3 may have had contact with the ill doctor, said Beth Johnson, an SMDC spokesperson. On Dec. 4, the hospital notified Minnesota's Health Department of the contagious patient. He had not returned to practice by Friday, Johnson said. As many as 90 patients came into contact with the TB- infected doctor shortly before or after the physician's symptoms, which included a phlegmy cough, emerged in early November. However, only 20 patients - those with the frequent, close and lengthy contact needed to spread the bacteria - will be asked to be tested for recent infection, said St. Louis County epidemiologist Larry Sundberg. It is not yet certain how many SMDC employees had close enough contact to be considered at risk for an infection, Johnson said. If tests turn up positive, doctors may prescribe a nine-month course of antibiotics to kill the bacteria. Meanwhile, the doctor's illness prompted the health system to move a yearly TB screening from March to February. An estimated 2,500 SMDC employees who work in downtown Duluth undergo the skin test each year, Johnson said, and perhaps two or three test positive for a new infection. This is the second case of active TB in St. Louis County for 2002. In 2001, there were four contagious infections, with Minnesota reporting 239 cases. "Help for Residents with HIV" Boston Globe (12.26.02)::John Laidler Two Gloucester-based nonprofit groups, Action Inc. and North Shore AIDS Health Project, have joined forces to provide affordable housing and other services to low-income Essex County, Mass., residents with HIV/AIDS. The project, funded in part by a US Department of Housing and Urban Development $1.3 million grant to Action Inc., will provide 40 HIV/AIDS patients with services including job placement and training. Of the 40, 20 patients will receive assistance with low-cost housing. "This is a tremendous grant to get," said Chanda Millett Shin, Action's planning director. The project is among 14 new HUD grantees nationwide; the programs were chosen for their innovative nature or potential for replication. Action, an anti-poverty agency, must raise $1.3 million in matching funds. William Rochford, Action's executive director, said the agency's work with area homeless spawned the idea for the project. Many homeless people Action serves have HIV/AIDS, he explained, and since new therapies have increased such people's life spans, Action saw the need to provide more housing for them. Action plans to purchase an Essex County building for conversion to 10 apartments and to rent 10 additional apartments around the county. The apartments will be rented at low cost to clients, with part of the project funding subsidizing the rents. Action hopes to have the 10 apartments available by May and the 10-unit building open within a year. North Shore AIDS Health Project will serve as case managers for the program. Susan Oleksiw, director of the NSAHP, said the program would be a valuable resource, helping low-income HIV/AIDS patients live productive lives. ************************************************************ EDITORIALS AND COMMENTARY ************************************************************ "In Africa, AIDS Has a Woman's Face" New York Times (12.29.02)::Kofi A. Annan "A combination of famine and AIDS is threatening the backbone of Africa - the women who keep African societies going and whose work makes up the economic foundation of rural communities. ... "In famines before the AIDS crisis, women proved more resilient than men. ...Because droughts happened once a decade or so, women who had experienced previous droughts were able to pass on survival techniques to younger women. ... "But today, as AIDS is eroding the health of Africa's women, it is eroding the skills, experience and networks that keep their families and communities going. Even before falling ill, a woman will often have to care for a sick husband, thereby reducing the time she can devote to planning, harvesting and marketing crops. When her husband dies, she is often deprived of credit, distribution networks or land rights. When she dies, the household will risk collapsing completely.... "Because this crisis is different from past famines, we must look beyond relief measures of the past. Merely shipping food is not enough. Our effort will have to combine food assistance and new approaches to farming with treatment and prevention of HIV and AIDS. It will require creating early-warning and analysis systems that monitor both HIV infection rates and famine indicators. It will require new agricultural techniques, appropriate to a depleted work force. It will require a renewed effort to wipe out HIV-related stigma and silence. "It will require innovative, large-scale ways to care for orphans, with specific measures that enable children in AIDS- affected communities to stay in school. Education and prevention are still the most powerful weapons against the spread of HIV. Above all, this new international effort must put women at the center of our strategy to fight AIDS. "Experience suggests that there is reason to hope. The recent United Nations report shows HIV infection rates in Uganda continue to decline. In South Africa, infection rates for women under 20 have started to decrease. In Zambia, HIV rates show signs of dropping among women in urban areas and younger women in rural areas. In Ethiopia, infection levels have fallen among young women in the center of Addis Ababa. "We can and must build on those successes and replicate them elsewhere. For that, we need leadership, partnership and imagination from the international community and African governments. If we want to save Africa from two catastrophes, we would do well to focus on saving Africa's women." The author is secretary-general of the UN. ************************************************************ NEWS BRIEFS ************************************************************ "Lee Urges United States to Fight Global AIDS Scourge" Oakland Tribune (12.30.02)::Lisa Friedman Rep. Barbara Lee (D-Calif.) is leading a charge for a "major new US initiative" to fight the global HIV/AIDS epidemic. In a letter to President Bush last week, Lee and 31 other members of the Congressional Black Caucus called for $2.5 billion toward global AIDS programs in 2004. In early 2002, the Bush administration made a much-heralded push for the $500 million AIDS program aimed at fighting the deadly pandemic. But at the last minute, the White House pulled support from its own proposal, and GOP lawmakers instead offered a scaled-back $200 million plan. Congressional inaction, however, has prevented that money from coming through. In the meantime, Bush pledged support for domestic and international disease initiatives as he proclaimed World AIDS Day. "My administration remains strongly committed to supporting research that treats those living with HIV/AIDS, prevents the spread of this disease, and that can develop a cure," Bush said. "Orphans to Reach Peak in Three Years" Nation (Thailand) (12.28.02) Thailand's national committee on HIV/AIDS said last week that the problem of AIDS orphans is expected to peak in the next three years. Thailand had the highest number of AIDS orphans in Asia in 2001 - approximately 289,000 - and that number is forecast to continue rising, reaching 380,000 in 2005, said committee Chair Deputy Minister Chaturon Chaisang. A study conducted by the Public Health Ministry and Chulalongkorn University found that 60 percent of men ages 15-25 and 40 percent of women ages 15-25 had had unsafe sex. Seventy-two percent of respondents said they were aware that condom use was the best form of protection - but up to 45 percent of males and 19 percent of females said they never thought of carrying condoms with them. "Fighting AIDS" Indianapolis Star (12.26.02) The Indiana AIDS Fund has awarded $117,000 in grants to five Indianapolis social service organizations. Damien Center received $44,000 for prevention programming for women of color. Concord Center Association received $10,000 for a program to facilitate risk-reduction behaviors by high-risk clients. The Indiana Youth Group was awarded $10,000 for its Cyber Project, which coordinates HIV prevention activities for rural Indiana youths through Internet dialogues. Pathway to Recovery was given $8,000 for prevention, intervention and education programs targeting homeless adults, and $25,000 for its Treatment Plus Health Program mobile van. Shalom Health Care Center received $20,000 to support an HIV prevention program for Hispanic and black youths in western Marion County. "AIDS Foundation Closed Because of Money Problems Burglarized" Associated Press (12.31.02) The Coastal Bend AIDS Foundation, which was forced to stop serving its 400-plus clients in Corpus Christi, Texas, because of a funding shortfall, has been burglarized. CBAF was forced to close after it could no longer pay the bills and care for clients - problems stemming from an ongoing dispute over a $300,000 contract with Bexar County Housing and Human Services, CBAF's main funding agency. Staffers said they noticed Monday morning that several donated items, such as a guitar worth $3,000 and a CD player, were missing. However, the foundation also received some good news Monday: Bexar County has sent a $78,000 check. Though the money is not enough for the foundation to reopen, it will allow staffers to provide insurance deductibles for about 20 clients and partial rental assistance for about another 100 clients, board Director Laurie Lee said. The foundation continues to operate its testing and education services, since they are funded from a different state source. ************************************************************ ANNOUNCEMENT: Prevention News Update will not be published Jan. 1. Regular publication will resume Jan. 2. ************************************************************