The United States is experiencing unprecedented levels of drug overdose and STIs. These epidemics are closely intertwined, and situated within a broader syndemic of HIV, STIs, viral hepatitis, and overdose. Recognizing these intersections and taking a syndemic approach to these public health challenges can be essential to addressing them efficiently and effectively. Integrating services is an important component of a syndemic approach, as it allows local health departments (LHDs) and their partners to maximize their reach and provide more holistic care to clients. For example, data show that rates of substance use are higher among STI clinic clients. By offering substance use disorder (SUD) and/or harm reduction services in STI clinics, LHDs can address multiple public health challenges simultaneously, and enable clients to do the same.
To address this need, NACCHO and the Centers for Disease Control and Prevention (CDC) partnered on the Addressing High-Risk Substance Use through STI Clinics: Strengthening Connections to Treatment and Behavioral Health Services project, which aimed to strengthen connections to SUD treatment and behavioral health services for individuals engaged in high-risk substance use (HRSU) seeking STI clinical services. For the purposes of this project, HRSU was defined as forms of substance use (particularly the use of illicit drugs and non-medical use of prescription drugs) that pose higher risk for negative health outcomes, such as dependence, SUD, overdose, HIV, and viral hepatitis. Through this project, NACCHO worked with three public health organizations to implement and evaluate Screening, Brief Intervention, and Referral to Treatment (SBIRT) for HRSU in STI clinics. SBIRT leverages behavioral interventions such as motivational interviewing, an evidence-based, collaborative, goal-oriented style of communication framed in the patients’ language of change—in this case, to help clients presenting at STI clinics engaged in HRSU set goals related to their substance use and health. SBIRT may facilitate early identification and intervention for those engaged in substance use who seek services in STI clinics. Considering the syndemics of HRSU and STIs, SBIRT in STI clinics presents a unique opportunity to reach persons engaged in HRSU and connect them with potentially life-saving treatment and care. To learn more about this project and to explore the implementation of SBIRT for HRSU at your organization, check out the resources below:
Final Project Report: This report characterizes the project, providing in-depth detail on the demonstration sites’ SBIRT models and workflows and synthesizing lessons learned.
Toolkit: This toolkit is designed to help LHDs, and other public health organizations, implement SBIRT for HRSU in STI clinical settings, based on the findings of this project.
Staff Training PowerPoint: This PowerPoint is designed to be adapted by LHDs and other STI clinics to use in training their staff on the SBIRT for HRSU intervention.
As this project demonstrated, SBIRT for HRSU can be a useful tool for identifying STI clinic patients engaged in HRSU and connecting them to SUD treatment. However, LHDs and other public health organizations should consider whether this intervention is the most appropriate and feasible approach for their community and organization before initiating implementation. To support this, the Final Project Report includes helpful information about the factors that facilitated or hindered implementation, the challenges that grantees faced, and the benefits they experienced. The Toolkit includes a Feasibility Assessment Checklist to help organizations determine if they have the necessary resources, infrastructure, and partnerships and details Implementation Logistics to consider before getting started. Depending on community need and organizational capacity, LHDs and other STI clinics may also consider offering educational materials with information about local SUD treatment and harm reduction services; incorporating connections to harm reduction services into the SBIRT intervention; and/or co-locating STI, harm reduction, and/or SUD treatment services.
Contact Kat Kelley, Lead Analyst – Syndemics – HIV, STI, Hepatitis, and Harm Reduction at [email protected] with any questions.
