Improvement of Treatment for Gonorrhea Cases in New York State during a Performance Incentive

Background:  From November 2014 through May 2015, 57 local health departments (LHDs) in NYS excluding New York City (NYS) were offered a performance incentive (PI) to increase the percentage of gonorrhea (GC) cases treated per 2012 CDC STD Treatment Guidelines. The PI goal was to delay cephalosporin-resistant GC transmission by achieving adequate treatment of a minimum of 90%. LHDs worked with medical providers to promote adherence to guidelines.

Methods:    Adequate treatment was defined as dual therapy with recommended antibiotics within two days of each other or monotherapy with Azithromycin 2 grams. Surveillance data from the NYS Communicable Disease Electronic Surveillance System was used for analysis. Monthly cumulative reports were generated which compared LHD performance. LHD-specific line-listed data on GC cases were securely posted for LHD review. LHDs acted to improve treatment where possible and documented reasons for nonadherence to guidelines. To improve performance, NYS Department of Health (NYSDOH) staff routinely educated LHDs on proper data collection and treatment guidelines.

Results:   During the Pre-PI (November 2013 – May 2014), GC treatment was adequate in 82.6% (2781/3369) of cases, inadequate in 13.7% (463/3369), and missing for 3.7% (125/3369). During the PI, 92.1% (4251/4616) of cases received adequate treatment, 5.7% (263/4616) inadequate, and 2.2% (102/4616) were missing data. During the PI, the most common reasons for inadequate or missing treatment were patient lost to follow-up (60.1%), treatment unchanged and physician educated (15.5%), and patient refusal (14.1%).

Conclusions:   During the PI, public health intervention by LHDs significantly improved adherence to federally-recommended GC treatment with 92% of cases receiving adequate treatment. Routine data feedback alerted LHDs to cases requiring follow-up and promoted surveillance data completeness. Given GC treatment revisions issued in the 2015 STD Treatment Guidelines, NYSDOH is continuing the GC PI to sustain high rates of treatment adherence and mitigate the threat of cephalosporin-resistant GC in NYS.