Jurisdictions are leaning into targeted STI prevention and treatment strategies by focusing on the needs and interests of local communities and delivering partnerships invested in meeting people where they are.
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The California Department of Public Health is taking a proactive approach to addressing prenatal care equity by offering services through a new open access prenatal care clinic in San Joaquin County. Opened in January 2022, the Pregnancy Connections clinic offers prenatal care to pregnant people at increased risk for contracting syphilis—a strategy directly aimed at preventing and reducing congenital syphilis cases community-wide. Through a process created with input from potentially eligible patients, Pregnancy Connections also provides comprehensive prenatal care to help minimize or eliminate barriers to prenatal care entry and retention. This includes offering substance use treatment, transportation for appointments, and also providing access to a dedicated case manager who connects patients to resources such as hotel stays during a syphilis treatment series—all contributing to the overall goal of providing prenatal care that is logistically, economically, and culturally accessible. Pregnancy Connections is funded with a small congenital syphilis special project award supported by an increase in CDC STI funding.
The Sexually Transmitted Disease and Viral Hepatitis Section of the Division of Disease Control and Health Protection of Florida’s Department of Health, and frequent partner Florida A&M University, have joined forces again to create a data modernization project for electronic processing of chlamydia and gonorrhea test results. The new system, launched during the summer/fall of 2022, uses informatics to analyze sexually transmitted infection (STI) test results for Florida residents from labs all across the country —rapidly determining new and repeat infections, potential outbreaks, and prioritization of cases for field investigation. This kind of data modernization, a CDC priority, has the potential to save thousands of work hours a year. The new project, funded in part through a CDC-supported grant provided by the National Association of County and City Health Officials, is also training our future public health leaders: Florida A&M public health students are evaluating the overall process to confirm efficiency and to identify possible enhancements. The collaborators hope to incorporate analysis for other STIs, such as syphilis and HIV, in the future.
The Atlanta Harm Reduction Coalition (AHRC), now in its 28th year of operation, began as a program focused on addressing high rates of HIV in people who inject drugs. Today, it has evolved into a complete, one-stop shop for community outreach and sexually transmitted infection (STI) prevention and treatment. This approach aligns with CDC’s focus on adopting new and innovative ways of delivering prevention and care services that better reach people where they are to optimize health and improve quality of life. To implement its one-stop shop philosophy, AHRC has partnered with local health departments to increase STI prevention and treatment delivery for people in need. In the past year, they administered almost 1,000 tests for gonorrhea (treating 206 cases) and almost 400 for syphilis (treating more than 20 cases). They also distributed over 60,000 condoms in that time. AHRC also provides telehealth services, including direct access to STI test results and other health care needs. Lack of access to stable health care and other public services can put people at risk for certain health conditions. To help mitigate this situation for its patients, AHRC provides a broad range of STI prevention and treatment options – including STI testing and treatment, women’s health services, and HIV linkage to care. AHRC also provides other forms of public assistance, including providing meals and shower facilities, as well. Funded in part through PS21-2102 and PS22-2203, AHRC currently has three locations throughout metro Atlanta. A revamped mobile health unit will also be available soon, and a fourth site is on track to open in late spring of 2023.
A pilot program at the Louisiana Department of Public Health (LDH) offers communication flexibility to disease intervention specialists (DIS) facing a rise in sexually transmitted infection cases statewide. The new process, launched in April 2022, uses a partner services video application for virtual patient interviews in lieu of in-person or phone interviews. LDH added the virtual option to deliver the comfort level and personal touch of a direct, face-to-face interview, while also offering the convenience and accessibility of signing on from anywhere. Once the patient chooses the video interview option during initial contact, the DIS sends a secure link accessible via computer or smartphone to a virtual meeting room (no software or app download required). The initial phase of the project has focused on virtual interviews for syphilis cases in two public health regions of Louisiana with high case volumes but limited DIS capacity for field interviews. Results are encouraging: out of 117 patient interviews, DIS collected the names of 43 partners, among whom 12 were new syphilis infections, nine were preventively treated, and 11 were previously treated. LDH plans to expand the virtual interview option into all public health regions of the state in the near future. The project is funded in part through a CDC-supported grant provided by the National Association of County and City Health Officials.
The HIV, STD, and Hepatitis Section of New Mexico’s Department of Health (NMDOH) created a strategy for recruitment and retention of its Disease Intervention Specialist (DIS) workforce by developing a career pathway that rewards their hard work, dedication and specialized skills and expertise related to infectious disease. There are now three distinct types of DIS with increasing responsibilities who are grouped into three different state government pay bands. In addition to the long-standing Health Educator-Basic (DIS), there are now also Health Educator-Operational (lead DIS who mentor others), and Health Educator-Advanced (DIS with the highest level of interview skills adept at handling the most complex cases including congenital/maternal syphilis, HIV linkage to care, and Hepatitis C virus navigation to treatment). This means that DIS who develop expertise can stay in the field while progressing through state government jobs, with the potential to also be front-line DIS Supervisors and Disease Prevention Program Managers.
The Office of Sexual Health and Epidemiology (OSHE) in New York State’s Department of Health is using the power and accuracy of modeling to predict outbreak trends for common STIs (gonorrhea, syphilis, and chlamydia). Modeling, along with monthly heat maps that display observed increases, helped OSHE successfully predict STI upticks throughout the state in 2020 and 2021, and social determinants of health maps developed from the technology are helping disease intervention specialists (DIS) at public health departments around the state address local issues affecting the rise in STIs. Now that they are pivoting away from COVID-19 prevention, tracking, and treatment efforts, DIS are using these tools to directly focus on driving STI rates back down.
Test easy, rest easy. The North Dakota Health & Human Service (NDHHS) HIV, STI, TB & Viral Hepatitis Unit implemented an at-home sexually transmitted infection (STI) sample collection program in January 2022 to help North Dakotans know their STI status easily and privately, for free. The program seeks to reach the 30 percent of state residents who live more than 20 miles away from a clinic that provides comprehensive sexual health care. It also aims to bring awareness of, and access to, HIV pre-exposure prophylaxis (PrEP), and ultimately reduce the number of STIs in the state. Individuals complete a sexual health evaluation to determine which of five different STI kits is best for them. After a medical provider reviews the evaluation, a kit is shipped to the requested address. Next, the individual visits their online portal to activate the kit, proceeds with self-collection, places the completed kit in a postage-prepaid box, and drops it off at the nearest collection box. Test results arrive in about six days, and if treatment or confirmatory testing is needed, North Dakota Disease Intervention Specialists connect the person to services. The program provides educational materials to all test recipients and offers an introduction to HIV PrEP services. If interested in beginning HIV PrEP, North Dakotans from all corners of the state can meet with a NDHHS-partnered medical provider via a telehealth platform.
A pilot program launched in November 2022 in Pennsylvania by the Allegheny County Health Department, the University of Pittsburgh School of Pharmacy, Hilltop Pharmacy, and Color Health is reshaping and expanding the scope of sexually transmitted infection (STI) prevention and treatment, offering more flexibility and convenience to patients. Thanks to this new partnership, community members can self-test for chlamydia and gonorrhea, receive results electronically, and stop by a local pharmacy for treatment. To initiate the process, a person requests a self-test online from Color Health and following a positive result, heads to the participating pharmacy. After a pharmacist conducts a brief intake and captures the patient’s vital signs, they provide on-the-spot treatment for the diagnosed STI—a process that takes only about 20 minutes from start to finish. This innovative on-demand service also includes access to a “tell your partner” text notification service and referral to a local primary care provider for follow up. The collaborators see the potential for successful replication across other jurisdictions for a number of reasons: it’s a simple, convenient process that would increase access to STI health care for many, including those without a permanent address (who can request their test be mailed to a participating pharmacy); those with privacy concerns who might not want test supplies mailed to their home address; those who want to avoid the stigma that may be associated with STI clinics; and those who live in communities without a public health department. The partners are exploring opportunities to phase in syphilis and HIV testing in the future.
The Rhode Island Department of Health (RIDOH) offers innovative STI testing and prevention options that emphasize convenience, ease, and privacy. In 2018, RIDOH became the first state health department in the nation to launch a sexual health app. Operated in collaboration with the state’s family planning program, the RIghtTime App (https://www.righttimeapp.com) provides information on everything from locations of STI treatment centers, to guidance on accessing free condoms by mail, and partner notification tools—and is available in an alternative web-based version (https://apps.apptology.com/m/ridoh/). RIDOH also offers its “Testing 1-2-3” website, which gives asymptomatic people access to STI testing without having to see a doctor; they simply fill out a form online, choose a nearby lab, and the automated program generates a physician’s test order. And teaming up with overdose prevention partners, RIDOH delivers free harm reduction resources including condoms to those 18+ via harm reduction vending machines located across the state. Learn more.
The Office of Communicable Disease of the Division of Population Health in Utah’s Department of Health and Human Services (UDHHS) works closely with the Utah Navajo Health Systems and Uintah and Ouray tribes to provide training and conduct STD/HIV case investigations. And since 2020, UDHHS has partnered with Comunidades Unidas, a local Latinx community organization, to build bridges of trusted communication for education in sexual health best practices. This includes encouraging women to seek self-empowerment in personal relationships and offering guidance to help increase comfort when discussing sexual health topics regarded by most as private or taboo. Active plans are in the works to launch similar partnerships with local Tribal partners: UDHHS aims to promote and help sustain improved community sexual health by placing DIS directly into Tribal communities for the first time in the state’s history.
A new partnership between the Richmond and Henrico Health Districts (RHHD) of the Virginia Department of Health and Bremo Pharmacy is using a unique provider model to create additional access to sexually transmitted infection (STI) health care and prevention—helping ease patient demand and decreasing wait times for services. The partnership, which grew out of a previous collaboration focused on COVID-19 vaccinations, pivoted in early-2023 to providing STI treatment and prevention services directly through the pharmacy, options that would usually be fulfilled at traditional RHHD health department sites. Services offered include STI screening and testing, expedited partner therapy, and second- and third-dose benzathine penicillin G injectable treatment for syphilis infection. Most clients are usually in and out in about five minutes. With increased accessibility a priority, the program serves underinsured and uninsured patients, offers transportation to those who need it, and provides help from Spanish-speaking staff. Since February 2023, the partnership has completed over 70 successful referrals for STI treatment. And leaning into the ongoing role of building community trust, the program recently added Hope Pharmacy—a local, minority-owned business serving the surrounding predominantly African American community—as a new partner.