Howard County Health Department

State: MD Type: Promising Practice Year: 2019

The Howard County Health Department (HCHD) is the local health department for Howard County Maryland.  Howard County is located in central Maryland.  Howard County has a population of approximately 321,113 residents which are 51% female, 49% male, 62% 19-64 years of age,  25% 18 years and younger, and 13% 65 years and over.  The racial/ethnic demographics are approximately 57% White, 20% Black, 19% Asian, 4% Two or More Races, 0.4% American Indian and Alaska Native, 0.1% Native Hawaiian and Other Pacific Islander and 7% Hispanic.  The median household income is $115,576.  Approximately 6% of persons live in poverty.

Nationally, the rate of sexually transmitted infections (STIs) has increased and disproportionately effects adolescents and young adults ages 15-24.  This trend has occurred in Maryland and Howard County.  In Howard County the numbers of cases of both chlamydia and gonorrhea have nearly doubled in teens ages 15 and up.  In response this growing public health issue, HCHD formed a community partnership with Howard County Public School System (HCPSS), and Maryland Department of Health (MDH) with the goal of launching an awareness campaign to inform high school students about prevention of STIs, risks of STIs and offer free, confidential screening tests and access to treatment.   The overall initiative falls within our Teen STI Communication Plan. The initiative utilizes I Want the Kit (IWTK), funded by the MDH and test kits provided by Hopkins University.  IWTK provides self-collection STI testing kits that include swabs to test for chlamydia and gonorrhea.

Through the initiative information about the health risks of STIs and how to access free, confidential testing is posted in all high school counseling and nurses' office, school restrooms and locker rooms. Students log into the IWTK website to request a free STI testing kit.  The STI testing kits are either mailed to high school nurse's office or to the student's home.   Students requesting the test kit and receiving test results remain confidential.  Test results are shared with the student, MDH and HCHD as part of state communicable disease reporting laws.

The outcomes of the practice are to implement free, confidential school-based STI testing in HCPSS high schools and have 200 test kits mailed and submitted for STI screening.  As of December 12, 2018, 44 kits have been mailed.  The initiative is planned for September 25, 2018 through June 30, 2019.

The factors that have led to the success of this initiative included support of partner agency leadership, multiagency partnership, scheduling regular partner meetings to provide project updates and gain input and oversight of project, commitment to address growing public health concern of STIs in adolescents and utilization of data and surveillance to provide the evidence for the need for the initiative and tracking results.

The public health impacts of the practice are policy change on the part of HCPSS to allow STI testing in schools which have led to increased access and availability of STI testing and increased self-efficacy for teens through behavior change, requesting STI test kits and self-testing.

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According to the Maryland Department of Health, chlamydia, a sexually transmitted infection (STI), has increased 300% over the past decade among teens 15 – 19 years of age. The issue of increasing STIs in Howard County youth is alarming and must be addressed.  Youth are disproportionately affected by STIs.

The target audience for our initiative is Howard County teens ages 15-19 years of age. 

Our current proposed initiative is innovative in that it brings STI testing into schools through the use of a self-collection method, IWTK.  Through IWTK, teens can order free, confidential testing kits online that are delivered to school or to their home.  These tests reduce the barriers of transportation to a clinic, cost and stigma associated with testing.  Students that test positive can either receive treatment from their healthcare provider, Howard County Health Department or other local free public health clinics.  In addition, for those students unable to come to the Health Department, community health nurses will arrange a date and time to go out to the student's school to provide STI treatment.

The current practice of STI screening and treatment of youth is evidence based as outlined in the following guidelines USPSTF and CDC.

Howard County Health Department (HCHD) convened a group of stakeholders and partners, including Howard County Public School System (HCPSS), Maryland Department of Health (MDH) and community members to develop a Teen STI Communication Plan to address the health disparities of STIs in Howard County Youth.  The plan will provide information to target audience and key stakeholders about the burden of the problem and steps to mitigate its impact.  

The communication plan covers who will receive the communications, how the communications will be delivered, what information will be communicated, who communicates, and activities required to implement the plan.

The goals of the communication plan are to increase awareness of STIs, provide STI prevention resources, and provide access to screening and treatment to reduce the rate of STI infection in Howard County within three years. One of the main focuses of the plan is to provide free, confidential STI screening in schools. 

In order to implement the stragies of the Teen STI Communication Plan, our community workgroup met to plan our objectives, key messages, communication plan and key stakeholders/partners.  We then developed action oriented and attainable activities to address our goals.  The time period to implement activities was schduled over a  12 month period.  Our first activity was to convene focus groups of teens and parents to determine how to best inform the development and implementation of activities, i.e. STI screening, communication of STI prevention, screening and treatment and increase community awareness of public health issue.  The Health Department scheduled the meetings and communicated with partners about each step in the process.

Funding for the initative has been provided in-kind from the HCHD and MDH.  MDH provided approximately $26,000 for implementation of project activities.  Funding was used to create educational material to launch STI screening in schools, parent and provider education and funding for STI screening.

Evaluation of the Teen STI Communication Plan will focus on short term outcomes of increasing the number of teens screened and treated for STIs in schools and survey knowledge awareness and acceptance of school based STI screening.   Data on  number of students screened will be tracked by our partner, Johns Hopkins University, that provides I Want the Kit, self-collected STI testing kits.   Knowledge, awareness and acceptance of school based STI screening will be conducted via an online survey.  

Throughout the process, the workgroup will meeet regulary to review our plan and make any adjustments needed.  

The Howard County Health Department plans to continue our Teen STI Communication Plan project in 2019.  The sustainablity of the program is likely because students are utilizing IWTK for testing in schools and homes.  The local school system has supported efforts by approving the testing in schools and has created information for parents on its website.  Our State partner, Maryland Department of Health is committed to addressing the public health issue of STIs in youth. 

Our plans for sustainability will include reviewing this year's data and survey results.  This information will inform how many additioanl tests or less will be needed in subsequent years and how to best communicate with youth about the availability of STI screening in schools.  

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