Modernizing Field Services for Human Immunodeficiency Virus and Sexually Transmitted Infections in the United States

Abstract

Public health field services for sexually transmitted infections (STIs) have not adequately evolved to address the expanding scale of the STI problem, its concentration among men who have sex with men, the emergence of new communication technologies and the availability of antiretroviral therapy as a cornerstone of HIV prevention. Field services need to modernize. Modernization should seek to expand field services objectives beyond sex partner STI testing and treatment to include: HIV testing of persons with bacterial STI and their partners, including efforts to promote frequent HIV/STI testing; increased condom access; linkage and relinkage to HIV care and promotion of viral suppression; PrEP promotion; linkage to long acting contraception; and referral for health insurance. Field services programs cannot advance these new objectives while simultaneously doing all of the work they have traditionally done. Modernization will require a willingness to reconsider some longstanding aspects of field services work, including the centrality of face-to-face interviews and field investigations. Health departments seeking to modernize will need to carefully assess their ongoing activities and reorganize to align the use of field services resources with program priorities. In some instances, this may require reorganization to allow staff greater specialization and closer integration with surveillance activities. Adapting programs will require new staff training, improvements in data management systems, and a greater investment in monitoring and evaluation. While modernization is likely to evolve over many years, the time to start is now.

Historical and Current Trends in the Epidemiology of Early Syphilis in San Francisco, 1955 to 2016

“…Furthermore, DIS who provide PS are tasked also with critical high-impact HIV prevention work, including PS and linkage to care for HIV-positive cases and PrEP for HIVnegative STD cases. 16 The proliferation of ways to meet sex partners reflected in the sharp increase in the proportion of partners who cannot be identified for screening and treatment illustrates the limitations of PS to ensure secondary prevention. With more diagnoses occurring outside the STD clinic setting, more robust and innovative approaches for PS are needed for it to have an impactful role in a multipronged syphilis prevention strategy.…”

“…[38][39][40][41][42] Increasingly expanding yet interconnected sexual networks demand that traditional PS evolve to meet the current challenges in syphilis control. 16 Community engagement and qualitative research are needed to help elucidate novel strategies for partner elicitation and notification. 43 Improved data-sharing across local health jurisdictions, as well as a more regional approach to STD prevention, is necessary given the growing radius of sexual networks.…”

“…Meeting partners through the Internet in the 2000s, and more recently, geosocial networking applications (apps) have led to an increase in partners for whom there is no retrievable locating information and fewer common physical spaces, such as bathhouses, where people meet (and can relocate) partners. [13][14][15] Outdated technology and tools for disease investigation, 9,16 increasingly interconnected sexual networks, 17 and declining rates of condom use 18 are also likely contributing to ongoing increases in syphilis morbidity in MSM. 19,20 As the syphilis epidemic continues to expand locally and nationally, we examined data maintained for syphilis surveillance and PS in SF to inform prevention strategies.…”

A Comparison of Syphilis Partner Notification Outcomes by Reported Use of Internet-based Apps to Meet Sex Partners in North Carolina, 2013–2016

“…Our findings demonstrate the expanded benefit that IPNS could provide in reaching populations who routinely utilize internet-based platforms to communicate. Unfortunately, like many jurisdictions (17), and due to legal concerns in NC regarding the use of government-owned electronic devices to access websites and apps used by patients to meet sex partners, state-employed DIS staff cannot directly perform IPNS. Restricting IPNS activities to one contracted employee has also limited our ability to assess the value IPNS could have if it were an integrated part of all DIS investigations.…”

Syphilis Control in the Postelimination Era: Implications of a New Syphilis Control Initiative for Sexually Transmitted Disease/Human Immunodeficiency Virus Programs

“…For example, public health programs might elect to conduct very intensive investigations of syphilis cases among heterosexuals – where numbers of cases are often low and the risk of congenital syphilis may be high – but less intensive investigations among HIV-infected MSM who are virally suppressed. We recently addressed issues related to field services modernization in detail 38 .…”