Community Embedded Disease Intervention

Specialist (CEDIS): The Los Angeles Experience

Ellen T. Rudy, PhD,Ellen T. Rudy, PhD,11 Johnny Cross, Johnny Cross,22 Frank Ramirez,Frank Ramirez,11, Robert K. Bolan,MD,, Robert K. Bolan,MD,22 Peter R. Kerndt, MD, MPHPeter R. Kerndt, MD, MPH11

11Los Angeles County Dept. of Public Health Sexually Los Angeles County Dept. of Public Health Sexually Transmitted Disease Program (STDP) and the Transmitted Disease Program (STDP) and the 2 2 LA Gay & LA Gay & Lesbian Center (LAGLC) Lesbian Center (LAGLC)

P&S SYPHILIS IN LAC

54

164

97

320

249

502

0

100

200

300

400

500

600

Ix within 7days

Ix within14 days

Ix within30 days

Jan-Dec '07

Jan-Dec '09

EPIDEMIOLOGY OF SYPHILIS IN LAC

• In 2008 62% (914 out of 1481) of Early Syphilis cases in LAC among MSM

• 14% of ES cases dx out of LAGLC– 55% of these cases also HIV co-infected

• Partner Services recognized as key prevention strategy – MMWR Reports, 2008: 57 (RR-09)

TIME TO INTERVIEW

• Lost to follow-up: 4% (CEDIS) vs 28% (Trad)

• 20-fold increase in interview w/in 7 days

149

108

5

188177

115

020406080

100120140160180200

Disease Total PatientsInterviewed

Interview w/in7days

2007 Traditional 2009 CEDIS

PARTNERS NAMED

61

340

0

50

100

150

200

250

300

350

2007 Traditional 2009 CEDIS

Partner Index:• 2007 (0.56)• 2009 (1.91)• 3-fold increase

PARTNERS PREVENTIVELY TREATED

10

11214

54

020406080

100120140160180

2007 Traditional 2009 CEDIS

Epi-treat Brought to Treatment

Preventive Index:

•2007 (0.22)

•2009 (0.93)

•4-fold increase

LAGLC EARLY LATENT CASES INCREASED 123% IN 2009

101

94

101

87

39

48

0 50 100 150 200

2009

2008

2007

Primary/Secondary Early Latent

SUMMARY OF BENEFITS OF SUMMARY OF BENEFITS OF CEDIS PROGRAMCEDIS PROGRAM

• Notification is by an employee of the Notification is by an employee of the trusted CBOtrusted CBO

• Reduced the time to interview of index Reduced the time to interview of index case and lost to follow-upcase and lost to follow-up

• Significant number of partners are being Significant number of partners are being treated for syphilis treated for syphilis – interrupting the chain of transmissioninterrupting the chain of transmission

• Reduced burden of cases at STDP

BENEFITS SEEN FROM CEDIS PROGRAM

• 25 fold improvement in time to interview within 7 days and 4-fold decrease in lost to follow-up

• 50% increase in the partners index and 4-fold improvement in partners preventatively treated index

• Reduced burden of cases at STDP

CHANGING SOCIAL NORMS

Thanks…Thanks…

• To the diligent staff at LAGLCTo the diligent staff at LAGLC

• To our collaborators at LAC STD ProgramTo our collaborators at LAC STD ProgramContact Information:Contact Information:Johnny CrossJohnny Cross

jcross@lagaycenter.orgjcross@lagaycenter.org