Sexually Transmitted Diseases  >  Program Guidelines  >  Surveillance and Data Management

Program Operations Guidelines for STD Prevention
Surveillance and Data Management

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Appendix S-B

EXAMPLE REACTOR SURVEILLANCE FOLLOW-UP GRID

Patient Type	Qual. Or MHA/FTA Only	1:1	1:2	1:4	1:8	1:16	1:64	+DF
Prenatal	P	P	P	P	P	P	P	P
0-19	P	P	P	P	P	P	P	P
20-29	F-P M-Q	F-P M-Q	F-P M-Q	P	P	P	P	P
30-39	F-P M-AC	F-P M-AC	F-P M-Q	F-P M-Q	P	P	P	P
40-49	AC	AC	AC	Q	Q	P	P	P
50-59	AC	AC	AC	AC	Q	P	P	P
60+	AC	AC	AC	AC	AC	Q	Q	P
Age Unk	F-P M-Q	Q	Q	Q	P	P	P	P

Codes:

"F" FEMALE

"M" MALE

"P" PRIORITY: If no record is found, initiate Field Record (2936), and assign to the field.

"Q" QUERY LETTER: If no record is found, initiate query letter to provider. Initiate 2936 to the field if no response to letter after 14 days.

"AC" ADMINISTRATIVE CLOSURE: May be closed on basis of age, titer or negative treponemal test. No action required.

"DF" DARKFIELD

The above is an example reactor grid. Each program area should individualize this grid based on local disease profiles and priorities.

General Instructions:

1. All incoming reactors should be date-stamped and prioritized. This will assure that priority (1) reactors get handled first.
2. Update Laboratory Log/Cards as to number of reactors received. Such a system enables the program to track laboratory activity and reporting habits.
3. Record search all reactors against "open" and "closed" investigative files. The medical records of those patients reported from the STD clinic should also be pulled and reviewed.
   • If a prior reactor(s) is found, serologies must be carefully reviewed to determine whether additional follow-up is indicated—i.e., does the current serology represent a two fold or greater increase in titer?
   • Update any records to reflect the current results. At a minimum, this should include the date and result(s).
   • When a record search identifies an "open" 2936, it should be pulled, updated to reflect the new information, and immediately brought to the attention of the assigned worker.
4. Initiate and assign 2936 for each priority (1) reactor that is not closed by record search.
5. Initiate query letters. It is recommended that a 2936 also be initiated at this time and filed by date. It can be used to document any information received from the health care provider or initiated to the field after 14 days.
6. Document and close any "administrative closures."

Example Format for the Evaluation of the Reactor Grid

MALES

Age	No. reactive serologies	No. (%) completed investigations	No. (%) untreated syphilis	No. (%) previously treated spills	No. (%) not found to be syphilis
30-39%
Titer
1:1
1:2
1:4
1:8
1:16
1:32
1:64
1:128

Regular table cells	= Not routinely investigated
Shaded table cells	= Routinely investigated

Evaluation of the Reactor Grid

To evaluate a reactor grid, a program must first explicitly decide what outcome it hopes to achieve through using a reactor grid to evaluate reports of positive serologic tests for syphilis (STS). Two different goals have, from time to time, been proposed as appropriate outcomes for the follow-up of positive STS.

Goal A: The purpose of the reactor grid is to identify untreated syphilis infections of any stage. The STD prevention program may assist medical providers in determining who needs to be treated, regardless of diagnosis or stage but should assist if it is an untreated infectious case or a pregnant female.

Goal B: The purpose of the reactor grid is to identify early syphilis infections so that the STD prevention program can intervene in disease transmission through treatment of the infected person and persons exposed to disease or testing those associated with the chain of infection. Medical providers are responsible for their patients, and the health department's interest is in new infections.

The purpose of evaluating a reactor grid is to maximize the number of syphilis infections identified with the most efficient use of available resources. Evaluation of the grid is accomplished by evaluating each sex category, age group, and titer category routinely initiated and by calculating what proportion of investigations result in identifying persons with early syphilis. The program must decide whether the current reactor grid is sensitive in identifying persons with syphilis and how it might be manipulated to identify persons with syphilis in a more sensitive manner. This is accomplished by "opening up" the grid to evaluate the lower titer categories not routinely initiated and by determining what proportion of investigations result in identifying persons with infectious syphilis in these titer categories. This requires that the program investigate reactors that would normally not be initiated. The program must then decide whether the returns (additional cases identified) justify the expenditure of resources.

• Evaluation of the current reactor grid

Select each sex, age, and titer category of the reactor grid that results in the routine initiation of an investigation. For each category, calculate what proportion of investigations result in identifying persons with syphilis.

• Evaluation of additional grid parameters

Expand the current grid to include the next lowest titer category for each sex and age grouping. Field records (FRs) are initiated on the resulting laboratory slips that cannot be closed by record search. For example, if the current cut-off is males aged 30-39, with titers of 1:16 and higher, then males aged 30-39 with titers of 1:8 would be investigated to identify those with syphilis. Depending on the productivity of this group, the program may want to evaluate what proportion of investigations of males aged 30-39, with titers of 1:4, 1:2, and 1:1 result in identifying persons with syphilis.

• Efficient Use of Available Resources

To support the final design of the grid, the program should review each category of the reactor grid to determine the number of syphilis infections identified and the availability of resources for investigation. Special attention should be given to women of childbearing age. Programs are encouraged to investigate women with lower titer categories and a low yield of cases rather than run the risk that pregnant women with syphilis may go untreated.

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