The United States is experiencing a syndemic of sexually transmitted infections (STIs), HIV, viral hepatitis, and overdose. Substance use is a leading risk factor for STIs, particularly congenital syphilis, and people who use drugs often face significant barriers to accessing STI services.

Addressing these overlapping epidemics through a coordinated syndemic approach can improve efficiency and impact. A key component of this approach is service integration, which enables providers to deliver holistic care and address multiple health needs in a single visit.

Between 2023 and 2024, NACCHO funded 10 organizations across the country to evaluate models of STI/HR integration. The resulting report offers concrete insights and recommendations for local health departments, community-based substance use programs, and their partners.

The report highlights wide variation in integration models, shaped by local resources, community needs, and service delivery settings. Common challenges include siloed or restrictive funding, limited staffing and physical space, and difficulties navigating fragmented data systems. Despite these hurdles, all participating sites emphasized the value of offering integrated services—not only to reach new populations but as a step toward building trust, reducing barriers, and expanding access to critical care.

Key lessons learned include:

• The importance of partnerships.
• The role of community based substance use programs as a gateway to STI prevention and care.
• The need for further investment in staffing, space, and systems.

The report includes actionable insights, offering practical examples of integration in the field and recommendations to inform service delivery, partnership development, and funding advocacy. It also identifies opportunities for additional research and underscores the need for continued evaluation of STI and substance use trends.

To learn more, check out NACCHO’s project report, an accompanying webinar, and an article in the Journal of Public Health Management and Practice synthesizing findings from the project:

• Project Report
• Webinar recording
• Journal of Public Health Management Article