1) Chlamydia rates in Minnesota have been rising, reaching 319 cases per 100,000 people in 2011. Traditional strategies of screening and treating infected individuals have not been able to substantially reduce the rates. 2) In response, the Minnesota Chlamydia Partnership was formed to take a more comprehensive, community-based approach to addressing the epidemic. They developed a statewide Chlamydia Strategy focusing on five strategic areas. 3) Health insurance plans in Minnesota have initiated a three-year program to improve Chlamydia screening rates among providers. They are working with local public health and communities to implement the Minnesota Chlamydia Strategy.

1. Minnesota’s Chlamydia
Partnership and Health Plans
Work Together
National Chlamydia Coalition Annual Meeting
February 20, 2013
Candy Hadsall, STD Nurse Specialist
Minnesota Department of Health

2. Chlamydia in Minnesota
Rate per 100,000 by Year of Diagnosis, 2001-2011
319 per 100,000
168 per 100,000
Data Source: Minnesota
STD Surveillance System
STDs in Minnesota: Annual
Review

3. STDs in Minnesota:
Number of Cases Reported in 2011
• Total of 19,547 STD cases reported to MDH:
– 16,898 Chlamydia cases
• 11,888 ages 15-24 yrs
– 2,283 Gonorrhea cases
• 1,392 ages 15-24 yrs
– 366 Syphilis cases (all stages)
– 0 Chancroid cases
• HIV = 292 new infections

4. Traditional Strategies for
Controlling Chlamydia: Disease
Intervention Model
√ Screen young women; treat positives
√ Identify and treat partners
√ Retest patients

5. Why Was Change Needed?
• CT rates continue to rise = epidemic; “highest
numbers ever” released every year
• MDH has dwindling federal resources, no state
funding
• Problem so large and resources limited =
MDH unable to do alone; needs help from
interested stakeholders and communities to
impact epidemic

6. Rate of Funding 1999-2009
300
275
250
Rate of Chlamydia and Gonorrhea
225
200
175
150
125
100
75
50
25
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year

7. What Was Needed?
• Disease intervention model very important but
unable to substantially impact rates
• Needed additional approaches, new strategies
• Investigated strategic planning and community
coalitions funded by CDC in other PH areas –
could work in STDs?

8. Responses to CT Epidemic in MN
• Identified 10 arenas needing actions, later
collapsed to 5
• Formed MN Chlamydia Partnership
• Summit on Chlamydia – August 2010 (NCC
grant)
• Volunteer workgroups met through early 2011:
– formulated actions in each of 5 strategic arenas
– submitted ideas, goals, objectives for strategy
to MDH

9. Minnesota Chlamydia
Partnership
Purpose:
• Raise public and professional awareness
• Support communities in taking action

10. Partners
• City, county, state public health
• U of M Prevention Resource Center
• Clinics funded by MIPP (PP, teen clinic)
• YWCA youth program director
• School-based clinics in St. Paul
• Health Plan Consortium
• Need to recruit: faith communities, youth,
business

11. The Minnesota Chlamydia
Strategy:
Action Plan to Reduce and
Prevent
Chlamydia in Minnesota

12. What is the Chlamydia Strategy?
• Comprehensive document includes MCP’s
recommendations and overview of CT trends
• Is living document/process:
http://www.health.state.mn.us/mcp
• Intended to be used as a tool for communities
to develop and implement their own plans for
tackling the CT epidemic

13. 2012 Chlamydia: Special Report
• “User friendly” version of the Minnesota Chlamydia Strategy
• Outlines community roles and what each can to do prevent
spread of CT
– Communities of faith not included- too varied
– MDH willing to assist any interested faith community
• Provides information and suggestions for communities
wishing to implement their own strategies for tackling the CT
epidemic

15. MCP Unique Approaches
• Chlamydia = more than a medical issue
• Top down approach often not successful - Need to
energize stakeholders and empower communities to
design and implement plan, raise/contribute resources
• Broader focus = sexual health and sexual rights (in
line with CDC, WHO)
http://www2.ohchr.org/english/issues/development/do
cs/rights_reproductive_health.pdf

16. Chlamydia:
More than a Medical Issue
Reasons why people have unprotected sex, even
when aware of consequences = multiple, varied,
complex

17. Determinants of Sexual Health
Socioeconomic, political, and cultural context
e.g. Policy, gender norms, faith, culture, ethnicity, norms and values
Distal social environment
e.g. Neighborhood, community, school, work, faith group
Health Care
Proximal social and sexual networks
e.g. Sexual partner(s), family, peers, teachers
Individual characteristics
e.g. Biology, social skills, cognitive ability,
knowledge, attitudes, confidence,
competence
Sexual Health and Wellbeing
Characteristics Outcomes
Physical Emotional
Cognitive Reproduction
Behavioral Disease (avoidance)
Emotional Violence (avoidance)
Social
Conception Adulthood
Source: Amended from Zubrick et al (2008), Solar & Irwin (2007), Scottish Executive (2003)

18. What is Community Empowerment?
 Basic tenets:
 People identify their own problems
 People determine their own solutions to the
problems
 People undertake the implementation of their
solutions
 Aim is to empower people = we cannot do something
for another person; that person must do it for
themselves.
 Leaders support them in this process.

20. Efforts Needed to Curb Chlamydia
Epidemic
• Changes in policies at all levels – national, state, local
and organizational
• Increased adequate and sustained funding
• Improved screening and treatment by providers
• Improved access to clinical services for STDs
• Must address issues of sexism, racism, ageism
inherent in epidemic

21. Community Efforts
• Increase awareness outside medical community
• Support from all levels of communities
• Educate teens, young adults, parents/caregivers,
teachers, providers
• Support for individual behavior change; starts with
changes in community norms
• Local, national advocacy for adolescent females
(similar to HIV model)

22. Demonstration Project
Kandiyohi County Public Health
Coalition for Healthy Adolescent
Sexuality

23. Purpose of Project
• Replicate model used to create MCP and CT
Strategy
• Demonstrate how to implement project to
address CT in conservative rural community in
MN
• Make materials available to other interested
communities

24. Health Plans
• Health plan consortium approached MCP in
November 2012
– Medica, Health Partners, Blue Cross/Blue Shield,
Ucare, Stratis Health
– Attended MCP meeting, presented ideas
• Program Improvement Plan – 3 year project
– Purpose: improve CT screening rates by providers in
govt. funded programs
– Barriers discovered: providers lack of knowledge
about CT, belief systems, confidence in skills re:
talking to youth/parents

25. Health Plans (cont.)
• Program Improvement Plan components
– Provider training – online; periodic
– Provider toolkit (MCP mbrs provide fdbk, out in March)
– Targeted outreach to low performing clinics using MN
Community Measurements data
• Support implementation of MN CT Strategy
– Work with LPH, schools
– Attend health fairs
– Attend conferences jointly – table; co-present
– Help MCP develop communication materials to be used in
communities

26. Health Plans (cont.)
• Sustainability Plan
– Continue with provider/clinic QA monitoring and
interventions
– Collaborate with MCP on statewide efforts to
implement Strategy
– Other new ideas……

29. Current &
Future MCP Projects
• MDH continues to participate and lead MCP
– Identify community organization that will eventually assume MCP
• Continue to support Kandiyohi PH project
• Community coalition in Minneapolis – to implement Strategy
in African American community
• Look for ways to advocate for health of young women
• Collaboration with health plans
– Quality improvement w providers; support Strategy implementation
with new ideas
• Support other communities wanting to implement Strategy
• Communicate with national organizations about Strategy

30. Candy Hadsall
Minnesota Department
of Health
651-201-4015
candy.hadsall@state.mn.us