Grant-Health Dept for elimination of Syphilis 10-19-1999 - 9e

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7 ^: remaining cases. Consistent with these similarities between the syphilis and HIV epidemics in North Carolina, the five-county target azea accounted for 21 % of the state's 1997 HIV cases, with Guilford, Forsyth and Durham Counties ranking 3rd, 4th and 6th, respectively, among the ' ' 100 counties. _..--- - Outbreaks of syphilis continue to occur in some localities within North Carolina, despite the noted decline in overall morbidity. •Several counties in central North Carolina-Forsyth, Guilford, Alamance, and Orange--recently experienced or are currently experiencing outbreaks of syphilis. Forsyth County, the farthest west of the group, reported increasing numbers of syphilis cases in the latter part of 1993, with the outbreak peaking in 1995. Shortly thereafrter, syphilis morbidity began to increase in Guilford County, immediately east of Forsyth County. Rates in Guilford County appear to have peaked in late 1997, though rates remain well above baseline levels. In late 1997 and early 1995, small clusters of early syphilis cases began to appear in areas of Alamance and Orange Counties--the next counties to the east--where syphilis had previously been uncommon. East of Orange County lies Durham County, an area that has traditionally had high levels of STDs but recently has had modest primary and secondary syphilis rates (1 I.2 cases/100,000 in 1997). However, very recent data show that primary and secondary syphilis.is increasing in. Durbam County, v~~ith more cases in May, 1998 than in the previous four months combined. '~- In response to the high syphilis morbidity in Guilford County, the North Carolina HIVISTD Prevention and Caze Section worked with Guilford County during August 1997 to implement a Rapid Intervention Outreach Team (R.I.O.T.) effort. The North Carolina RI.O.T. was onainaIly developed in 1993 as an outbreak response team. The primary fiznction of the R_I.O.T. is to coordinate efforts among local health deparim.ents, community-based organizations and the state HTV/STD Prevention and Care Section to rapidly increase outreach education, screening, diagnostic services, treatment, and partner notification activities in areas that have documented exceptionally high early syphilis morbidity-. During a R,I.O.T. effort, outreach workers from community-based organizations and disease intervention specialists (DIS) from around the state go into an area of high. morbidity to work together as prevention partners. This enables the local community to offer one-on-one street and community outreach, community-based risk reduction education, HIV/STD counseling, testing, and referral during non-traditional hours to people who are infected, exposed or have questions about HTV/AIDS and STDs. Amore detailed description of R_I.O.T. can be found in North Carolina's 1996 and 1997 Sexually T~r~~tted Dzsease (STD) Accelerated Prevention Campaign C~:ntinuarion applications. _ _ During the Gruilford County RI.O.T., a statewide network of community based organizations and DIS participated in door to-door outreach, counseling, screening and health fairs. The door- to-door outreach allowed outreach workers, local health department staff, and DIS from across the state to work together as partners in prevention, sharing techniques. for engaging at-risk individuals in conversations about HIV/STDs. The RI.O.T. resulted in distribution of 1998 . packets of syphilis risk reduction information and on-the-spot syphilis counseling and testing to 104 individuals, of wham 13 (12.~%} were positive. 2