Ending the HIV Epidemic in the U.S. (EHE): Scaling Up HIV Prevention Services in STD Specialty Clinics
Through the Ending the HIV Epidemic (EHE) initiative, the Department of Health and Human Services (HHS) has set an ambitious goal of reducing all new HIV infections in the U.S. by 90% by 2030. To support this goal, HHS has provided multiple funding opportunities to jurisdictions, including continued investments in STD specialty clinics.
In January 2020, CDC announced the Notice of Funding Opportunity (NOFO): PS20-2010: Integrated HIV Programs for Health Departments to Support Ending the HIV Epidemic in the United States (EHE) to support the development and implementation of programs tailored to ending the HIV epidemic in America.
Component C of this NOFO focuses on implementing strategies and activities that scale up HIV prevention services to reach populations that access care in STD clinics. This funding aims to strengthen the infrastructure of STD clinics, which serve a high volume of people from racial, ethnic, sexual and gender minority groups. STD clinics play a vital role in the EHE initiative because:
- They serve populations who are not engaged in HIV prevention programs, or primary healthcare system for their STD and HIV prevention care;
- They serve as an important healthcare setting for patients who may not otherwise have access to healthcare services;
- STDs are associated with a higher risk of acquiring HIV and indicate increased risk of HIV acquisition in future and potential need for pre-exposure prophylaxis (PrEP).
PS20-2010 Component C Strategies
With Component C funding, recipients focus on implementing five strategies to scale up HIV prevention services to reach populations that receive and seek care in STD clinics.
- Assess or re-assess clinic infrastructure to document HIV prevention services, identify gaps, and assess service quality.
- Implement evidence-based approaches to scale up HIV prevention capacity in STD clinics, including self-collected STD testing, express visits, HIV testing and viral load assessment.
- Expand the capacity of STD clinics to offer PrEP, post-exposure prophylaxis (PEP), and strengthen clinic and laboratory capacity for recommended follow-up visits for people on PrEP.
- Optimize linkage to, retention in, and re-engagement with HIV medical care.
- Facilitate partnerships with other community HIV clinical providers, health departments, and community-based organizations providing HIV prevention services and collaborating in the implementation of EHE.
In August 2020, a new investment from the Minority HIV/AIDS Fund (MHAF) aimed to specifically address under-resourced STD clinics. This investment leverages the current CDC-funded National Network of Sexually Transmitted Diseases Clinical Prevention Training Centers (NNPTC) to bolster training and technical assistance efforts so STD specialty clinics can better provide HIV prevention services. Activities include providing onsite or distance-based (web or phone) consultations, guidance to conduct clinic assessments, in-person site visits, and resources.
PS20-2010 Component C Recipients
Recipients of Supplemental MHAF Award for NNPTC
The Prince George’s County Health Department (PGCHD) in Maryland recently restructured their HIV PrEP program leading to a twofold increase in their ability to engage with diverse populations. A key contributor to the increased engagement was the launch of a new team dedicated to providing PrEP services. The team is comprised of one PrEP manager and two PrEP counselors who provide PrEP education, assessments, follow up and referrals, and work closely with an onsite HIV/STI physician. Through collaboration with Disease Intervention Specialists and health department staff conducting outreach activities, the team has seen a notable increase in young LGBTQ+ people accessing PrEP services. Most recently, PGCHD implemented a broader-reaching social media campaign for all county residents, including women and heterosexual men who may not be represented in other PrEP advertising. PGCHD plans to continue expanding PrEP services by adding a nurse and community health workers to their team, and by strengthening partnerships with the county’s domestic violence program, CBOs working with priority populations, and community providers.
Open Health Care Clinic is increasing its use of technology through the implementation of digital check-in and self-scheduling solutions. This strategic move is geared towards optimizing patient interactions, curbing wait times, and boosting the clinic’s efficiency. A notable advantage of the new system is that patients can conveniently check in up to a week prior to appointments and proactively update their records, expediting the overall process. The digital check-in system also bolsters patient privacy by minimizing the need for personal information exchanges with front desk staff. To address diverse patient preferences, the clinic also offers conventional check-in alternatives. Open Health Care Clinic’s dedication to elevating the patient experience is fostering a more streamlined, person-centered healthcare system.
The Jefferson County Department of Health in Birmingham, Alabama, has increased clinic capacity at all three of its sexual health clinics by implementing an express STI service model, known as Fast Track. The clinic uses a set of pre-appointment questions to triage patients requesting services. Once triaged, patients without symptoms can easily schedule a Fast Track visit for HIV/STI testing. During the visit, a Disease Intervention Specialist provides specimen collection instructions, patient education, risk-reduction counseling, and referral for HIV PrEP, if needed. Fast Track allows patients to receive timely notification of their test results, and visits have steadily increased since the program’s introduction in late-2019. From 2020 to 2022, the Fast Track Program increased its patient volume from 888 to 1863 visits, with plans to further expand Fast Track services through the implementation of online self-scheduling. As of July 2023, clinics have completed 1252 visits since the start of the year. With Fast Track in place, providers can dedicate more of their appointment time to patients with symptoms suggestive of an STI, and patients with or without symptoms can more easily receive the timely STI and HIV testing services they need.
The Neighborhood Union Health Center of Fulton County Board of Health in Atlanta, Georgia, has launched express clinic services for oral HIV PrEP. To remain on PrEP, CDC guidance recommends that clients follow up with their providers every three months and complete lab tests before the client’s next PrEP refill. Depending on the timing of the follow-up visit, repeat lab tests may include HIV, bacterial STIs (syphilis, gonorrhea, chlamydia), triglyceride and cholesterol levels, and tests to assess kidney function. Prior to launching the program, all appointments were in-person and at least an hour long, limiting the number of clients that could be seen each day for PrEP appointments or other sexual health services. With the Neighborhood Union Express Clinic in place, clients only need to meet with a provider once per year, and this can be in-person or via telehealth. Since the program’s launch, a typical PrEP follow-up visit for repeat testing only takes 10-15 minutes. Once results are received, the client is seen by a provider if there are any concerns. Providing express services for oral HIV PrEP has increased Neighborhood Union’s capacity to offer convenient, client-centered PrEP care.
The Orange County Department of Health in Orange County, California, launched a rapid antiretroviral therapy (rART) program at the local 17th Street Testing, Treatment and Care Clinic. Since the program’s launch in 2020, the clinic has linked over 247 clients newly diagnosed with HIV to rART and reengaged 65 clients into HIV medical care. For clients previously lost to follow-up, the program has designed workflows that incorporate community partnerships, HIV-related data and reporting, and review of patient medical records to improve reengagement outcomes. The clinic also utilizes public health investigators and case managers to reengage clients into care. They are trained to be socially, culturally, and linguistically competent with an understanding of the social determinants of health that affect a client’s ability to take their HIV treatment regimen as prescribed. The program is able to link clients to longer-term HIV medical care and support services based on each client’s needs and service eligibility (e.g., insurance status, income level, existing provider relationships, etc.). Since the launch of the program, 76 percent of clients the clinic has reengaged into HIV care have achieved viral suppression.
In August 2023, the HIV, STD, and Hepatitis Branch of Public Health Services in the County of San Diego Health and Human Services Agency implemented a doxycycline as sexually transmitted infection (STI) post-exposure prophylaxis (doxy as STI PEP) program in their regional clinics. Having a bacterial STI, like primary or secondary syphilis, can increase someone’s risk of getting or transmitting HIV. For that reason, doxy as STI PEP is part of a syndemic approach to reduce new HIV infections and STI/HIV-related illness in the region among populations disproportionately affected by STIs and HIV. Eligible clients who are interested in doxy as STI PEP receive a 14-tablet (7-dose) starter pack and are a written prescription for additional medication. The doxy as STI PEP program has generated considerable interest among eligible clients. In the first 17 days of program implementation, 23 clients started doxy as STI PEP.
The Bell Flower Clinic of the Marion County Public Health Department in Indianapolis, Indiana, has successfully increased patient engagement thanks to a recent communication campaign focused on PrEP awareness in gay and bisexual men. Since the campaign launched in early November 2022, referrals, visits, and PrEP prescriptions at the clinic have more than doubled. The secret to the campaign’s success was including eye-catching, sex-positive messages on popular dating apps, posters, and bus wraps displayed around the city. Another key component of the campaign was gathering community member feedback to ensure that the messaging resonated with and reached the intended audiences. In the future, the Bell Flower Clinic plans to build upon the momentum of the campaign by expanding its work with lessons learned from its recent success.
- Infographic – Reversing the Rise in STIs: Integrating Services to Address the Syndemic of STIs, HIV, Substance Use, and Viral Hepatitis (April 2023)
- CDC’s Ending the HIV Epidemic website
- America’s HIV Epidemic Analysis Dashboard (AHEAD)
- Funding Opportunity Announcement PS20-2010: Integrated HIV Programs for Health Departments to Support Ending the HIV Epidemic in the United States