Field Services–Facilitated Treatment and Prevention: Challenges and Opportunities

Abstract

Assisted partner services (APS) is a longstanding public health strategy to reduce transmission of sexually transmitted infection (STI) and human immunodeficiency virus in the United States. However, with rapidly increasing rates of STI, innovations to APS are needed to allow health departments to conserve limited public health resources while improving the effectiveness of APS. Disease Intervention Specialists (DIS), public health staff who conduct APS, have a wealth of experience in identifying, locating, and interviewing index patients and their sexual partners, but are currently limited in the services that they are able to provide in the field. Although several state and local health departments are working to expand the role of DIS to incorporate less traditional APS activities, such programs are uncommon. We discuss several services that DIS could conceivably provide in the field, such as STI testing, treatment, and vaccination, and identify critical issues to be addressed to implement these changes in DIS activities on a larger scale. Broadening the scope of DIS activities may result in multiple benefits to health departments, including more effectively delivering STI testing and treatment to hard-to-reach populations, imparting more responsibility to DIS, thereby potentially increasing job satisfaction, and building a workforce that is better prepared for public health crises. Effective approaches to address variable state level regulations governing DIS scope of practice are needed.

Vital Signs: Missed Opportunities for Preventing Congenital Syphilis — United States, 2022

“…This outcome has been achieved at some medical facilities and health organizations through implementation of rapid syphilis point-of-care testing ( 10 ), which the World Health Organization recommends during pregnancy in settings where a delay in diagnosis can lead to loss to follow-up ( 11 ). Innovations in treatment and close follow-up (e.g., field-delivered treatment and disease intervention specialists trained to prevent and control infectious diseases providing linkage to care) can help facilitate adequate treatment ( 12 – 14 ).…”

Creating a Sexually Transmitted Infection Disease Intervention Workforce for the 21st Century

“…43 However, the extent of the DIS role in this area will be determined by local and state regulations and licensing restrictions. 43 A field services home-based program in New York that seems to be promising included a telehealth visit with a nurse practitioner as well as self-collected STI testing, field delivery of STI and HIV treatment and PrEP, and expedited clinic visits for follow-up HIV testing. 44 Finally, newer developments in testing technology may have a significant impact on disease intervention including advancements in rapid tests, point-of-care tests, and self-collection of specimens.…”

“…Disease intervention specialists can often conduct field-based specimen collection, testing, and treatment depending on the jurisdiction, and the increased use of telehealth during COVID-19 has the potential to significantly expand the DIS role into longer-term therapy 43 . However, the extent of the DIS role in this area will be determined by local and state regulations and licensing restrictions 43 .…”

“…Disease intervention specialists can often conduct field-based specimen collection, testing, and treatment depending on the jurisdiction, and the increased use of telehealth during COVID-19 has the potential to significantly expand the DIS role into longer-term therapy 43 . However, the extent of the DIS role in this area will be determined by local and state regulations and licensing restrictions 43 . A field services home-based program in New York that seems to be promising included a telehealth visit with a nurse practitioner as well as self-collected STI testing, field delivery of STI and HIV treatment and PrEP, and expedited clinic visits for follow-up HIV testing 44 .…”