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Program Operations Guidelines for STD Prevention
Areas of Special Emphasis

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Appendix SE-1

DSTD PROJECT AREA CORRECTIONAL HEALTH CARE ASSESSMENT

1. Project Area

2a. Person completing assessment from health department
Telephone

2b. Person assisting assessment completion from the facility
Telephone

3. Health Department FTE working on correctional health issues
Telephone

4. Date completed

5. Name and Address of Facility.  Please specify type of facility (county, city, etc.)

6. Chief Medical Director
Telephone

7. Number of correctional health staff having attended CDC/state sponsored STD Prevention/Training Center Courses in 1996/1997.

_____ Comprehensive (2 weeks)

_____ Intensive (1 week)

_____ Part-Time Intensive (3 days)

_____ Advanced (1 week)

_____ Laboratory Methods (1-3 days)

_____ other (specify) ____________

8. What key person(s) at this facility represents correctional health care issues on the local HIV prevention community planning group? (If none or unknown, please state.)

9. Are health care services for inmates privatized?

Yes _____ No _____ Unknown _____

If yes, please specify the health services company having the service delivery contract.

10. Is the facility accredited by the National Commission on Correctional Health Care (NCCHC)?

Yes _____ No _____ Unknown _____

11. Are all arrestees offered STD testing and are all women arrestees offered pregnancy testing? Please check only those STDs for which inmates are routinely offered testing. If information is unknown, please write "unknown" in the space provided.

	Males	Females
chlamydia
gonorrhea
syphilis
hepatitis B
pregnancy	-

12. Of the total number of arrestees, what percentage (%) receive STD testing within the specified time frames. The total for both males and females should add up to 100%.

	Males	Females
<24 hours
24-48 hours
3-7 days
8-14 days
>14 days
not tested
unknown
Total

13. If STD testing is not offered to all arrestees and pregnancy testing is not offered to all women arrestees, under what conditions are arrestees tested for the following STDs and pregnancy? Check all that apply.

Males	Symptoms	Request	Court Order	Not Tested	Unknown
chlamydia
gonorrhea
syphilis
hepatitis B

Females	Symptoms	Request	Court Order	Not Tested	Unknown
chlamydia
gonorrhea
syphilis
hepatitis B
pregnancy

14. What percentage (%) of all arrestees are tested for the following STDs and pregnancy? If information is unknown, please write "unknown" in the space provided.

	Males	Females
chlamydia
gonorrhea
syphilis
hepatitis B
pregnancy	-

15. Is a written protocol followed for STD screening?

Yes _____ No _____ Unknown

If yes, please specify:

_____ CDC Chlamydia Screening Guidelines

_____ Internal document

_____ Health department document

_____ other (specify)

16. Is a STAT RPR protocol routinely used to screen for syphilis?

Yes _____ No _____ Unknown _____

If no, what are the obstacles for implementing STAT RPR testing at intake?

Lack of:

_____ space

_____ money

_____ trained medical staff

_____ equipment

_____ time during intake medical exam

_____ unknown

_____ Other

17. Are chlamydia and gonorrhea screened using LCR or PCR testing?

Yes _____ No _____ Unknown _____

If no, what are the obstacles for implementing LCR or PCR testing for chlamydia and gonorrhea at intake?

Lack of:

_____ space

_____ money

_____ trained medical staff

_____ equipment

_____ time during intake medical exam

_____ unknown

_____ Other

18. Is a STAT pregnancy test protocol routinely used?

Yes _____ No _____ Unknown _____

If no, what are the obstacles for implementing STAT pregnancy testing for all women of child-bearing age?

Lack of:

_____ space

_____ money

_____ trained medical staff

_____ equipment

_____ time during intake medical exam

_____ unknown

_____ Other

19. Does this facility routinely offer HIV counseling and testing for inmates with diseases characterized by ulcers (e.g. syphilis, chancroid, genital herpes)?

Yes _____ No _____ Unknown _____

20. Are pap smears routinely offered to women inmates?

Yes _____ No _____ Unknown _____

22. Check the average turnaround time for laboratory results. Check only one response for each condition.

chlamydia ____<24 hours ____24-48 hours ____3-7 days ____>1 week

____no testing avail ____unknown

syphilis ____<24 hours ____24-48 hours ____3-7 days ____>1 week

____no testing avail ____unknown

gonorrhea ____<24 hours ____24-48 hours ____3-7 days ____>1 week

____no testing avail ____unknown

pregnancy ____<24 hours ____24-48 hours ____3-7 days ____>1 week

____no testing avail ____unknown

23. Specify the site(s) where laboratory STD diagnostic testing takes place.

	On-Site	Off-Site (state public health lab)	Off-Site (other)	Unknown
chlamydia
gonorrhea
syphilis
pregnancy

24. Specify the site(s) where STD treatment is conducted.

	On-Site	Off-Site	Unknown
chlamydia
gonorrhea
syphilis

25. Are inmates treated presumptively on-site for STD infection if symptomatic?

Yes _____ No _____ Unknown _____

26. Is a written protocol followed for STD treatment?

Yes _____ No _____ Unknown _____

If yes, please specify:

_____CDC/STD Treatment Guidelines

_____Internal document

_____Health department document

_____Other (specify)

27. If inmates are treated off-site for STD infection, are jail cases differentiated from other cases when morbidity

is reported from this off-site facility?

Yes _____ No _____ Unknown _____ Not Applicable_____

In the last two sections of this document, data will be requested to supplement and strengthen the information already given. For questions 28-39 use data from the last full month it is available. Please report all data from the same month/year. If information is unknown, please write "unknown" in the space provided.

28. Month/Year of data being reported in this section ____________

Males Females Total

	Males	Females	Total
29. Average # of admissions per day
30. Average census per day
31. Average length of stay (days):
32. Average percent of arrestees released: <24 hours
24-48 hours
3-7 days
8-14 days
>14 days
33. Average percentage of female arrestees charged with: prostitution
drugs offenses

For questions 34-39 please provide data from the last full month it is available. The month/year of data reported in this section should be the same as  the month/year in the previous section. If any of the information requested in this section is unknown, please write "unknown in the space provided.

34. Month/Year of data being reported in this section ___________

	Males	Females	Total
35. Number of chlamydia tests done
a. Type of test(s) used. Check all that apply. Culture
Gen-Probe
PCR
LCR
EIA
DFA
Unknown
Other (list)
b. # of positive tests
c. of those testing positive, provide the # of untreated inmates leaving facility requiring field follow-up
d. of those requiring field follow-up, provide the # closed with C disposition (brought to treatment)
e. of those requiring field follow-up, provide the # closed with E disposition (previously treated)
f. total number of cases of chlamydia in the county
36. Number of gonorrhea tests done
a. Type of test(s) used. Check all that apply. Culture
Gen-Probe
PCR
LCR
Gram Stain
Unknown
Other (list)
b. # of positive tests
c. of those testing positive, provide the # of untreated inmates leaving facility requiring field follow-up
d. of those requiring field follow-up, provide the # closed with C disposition (brought to treatment)
e. of those requiring field follow-up, provide the # closed with E disposition (previously treated)
f. total number of cases of gonorrhea in the county
37. Number of serological tests for syphilis done
a. Type of test(s) used. Check all that apply. RPR
VDRL
FTA
TPPA
Unknown
Other (list)
b. # of positive tests
c. of those testing positive, provide the # of inmates tested, diagnosed, and treated for early syphilis while incarcerated
d. of those testing positive, provide the # of inmates leaving facility requiring field follow-up
e. of those requiring field follow-up, provide the # closed with C disposition (brought to treatment for early syphilis)
f. of those requiring field follow-up, provide the # closed with E disposition (previously treated for early syphilis)
g. of those requiring field follow-up, provide the # closed with F disposition (not infected)
h. total number of cases of early syphilis in the county
38. Number of HIV tests done
a. # of positive tests
39. Number of pregnancy tests done
a. # of positive tests

 40. What type of technical assistance would STD program managers like from the Division of STD Prevention at the CDC? Check all that apply.

_____site visit assessment

_____protocols of currently established and effective models of STD screening and treatment in jail settings

_____CDC STD guidelines for treatment and screening

_____consultation/mini-assessments

_____training (specify)

_____other (specify)

41. What percent (%) of the current resources at the state-level STD Prevention Office is directed toward STD prevention activities in correctional health care facilities?

Additional comments:

 

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