Clinics and health department programs that provide integrated STD and HIV prevention services reduced the incidence of HIV transmission in populations at high risk; however, delivery of certain specific services at the local level warrant improvement, according to a recent MMWR.
“Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV care matching, or integrating staff members,” Kendra M. Cuffe, MPH, from the division of STD prevention at CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, and colleagues wrote. “Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate.”
To examine how extensively state and local health department STD programs provided HIV services, CDC researchers assessed data from a sample of 311 local health departments and 56 state health departments across the U.S. from December 2013 to January 2014.
They analyzed the extent of HIV field testing, linkage to care and follow-up for persons who tested positive for HIV during partner services, program visits to HIV care providers and surveillance activities related to HIV. Using regression models, researchers compared provision of HIV services by health department type (state verses local). They determined whether jurisdiction size was associated with type of HIV service offered using chi-square analyses.
The results showed that among programs that provided HIV field testing services, all provided linkages to HIV care, using mostly health department staff members to provide this linkage rather than referral. The majority of STD programs in state and local health departments provided follow-up for newly diagnosed HIV cases that were linked to care. CDC researchers observed that most state health departments reported visiting HIV care providers, matching STD case report data with HIV data to study syndemics and/or overlaps, targeting prevention activities to persons at high risk and publishing surveillance data on the health department annually.
Cuffe and colleagues found that although many public STD programs in state and local health departments reported that they provided multiple HIV services, the programs varied at the state and local levels in the provision of these services.
Overall, a significantly higher percentage of state health departments conducted visits to HIV care providers (94.1%) when compared with local health departments (46.7%). Additionally, a higher percentage of state health departments (73.1%) than local health departments (16.1%) matched STD case report data with HIV data to analyze syndemics and overlaps. The investigators observed that a larger number of the surveyed state health departments reported targeting prevention activities to populations at high risk compared with local health departments (92.3% verses 58.4%). Among local health departments, smaller jurisdiction sizes were less likely to offer HIV field testing for STD contacts and to perform site visits to HIV care providers.
“Despite encouraging progress, areas where improvements in provision of HIV services by STD programs might be beneficial were also identified,” Cuffe and colleagues wrote. “Data collected through STD programs often illuminate important opportunities for enhancing STD and HIV surveillance data and helping inform future decisions affecting STD and HIV prevention programs.” – by Savannah Demko
Disclosures: Cuffe is an employee of CDC.