Targeting Gonorrhea Counseling and Sex Partner Services to African Americans Using ZIP Codes and Fee-for-Service Reimbursement

Background:African Americans accounted for 76% (6,971/9,152) of reported cases of gonorrhea in Illinois excluding Chicago in 2008 and had a case rate 37 times greater than among whites per 100,000 population (859 vs. 23).

Objectives: To determine if providing targeted patient counseling and partner referral services (PCRS) for gonorrhea in selected ZIP codes and reimbursing local health departments (LHDs) for PCRS services result in the identification and treatment of previously untreated cases and a reduction in gonorrhea incidence among African Americans.

Methods: Beginning in February 2009, six LHDs received fee-for-service reimbursement to provide PCRS to at least 75 percent of reported gonorrhea cases residing in from 1 to 6 ZIP codes per LHD jurisdiction that accounted for at least 83 percent of total reported cases per jurisdiction in 2007.

Results: From 2/1/2009 to 7/31/2009, 75% (350/470) cases of reported gonorrhea in target ZIP codes received PCRS. African Americans accounted for 80% (376/470) of reported cases and 81% (285/350) of cases receiving PCRS. Cases were counseled predominantly in-person at a health department clinic (48%) or by phone (46%) compared to in the field (6%). Counseled cases identified 467 sex partners during the counseling period (60 days) of which 32% (151/467) were examined. Fifty-eight percent (88/151) of examined sex partners were infected and newly brought to treatment resulting in 0.25 sex partners newly brought to treatment per case counseled (range: 0.09 to 0.68 at the six LHDs) .

Conclusions: Providing targeted gonorrhea PCRS is an effective strategy to identify and treat infected sex partners thus breaking the chain of transmission.

Implications for Programs, Policy, and/or Research: Providing PCRS for gonorrhea should result in reduced health disparities among African Americans.