NACCHO releases report from the “Sexually Transmitted Infection Research Agenda” meeting.

In May 2022, the National Association of County and City Health Officials (NACCHO) convened a group of national experts to develop a national research agenda for sexually transmitted infection (STI) prevention and treatment for the next five years.

The research agenda meeting was constructed to focus expert attention in eight different areas of Interest: Pathogenesis and Diagnostics; Biomedical Prevention and Clinical Management; Data Science and Surveillance; Epidemiology; Health Economics and Services; Policy; Social, Behavioral, and Computational Science; and Transmission Dynamics.

Participants were instructed to identify broad “answerable” research questions and not be limited by the specific technicalities of designing or implementing research projects to answer such questions. They were also requested to consider STI research questions in the broader context of the social determinants that drive the STI epidemics, as well as from a health equity lens. Participants identified cross-cutting considerations and areas for future research both within the areas of interest and across them.

NACCHO hopes this document will be used by all kinds of funders and research academic institutions to approach research funding and design.

ABOUT THE PROJECT

NACCHO, with funding from the Centers for Disease Control and Prevention’s (CDC’s) Division of STD Prevention, initiated a project in October 2018 to support the use of CDC’s Recommendations for Providing Quality STD Clinical Services, published in January 2020. The Recommendations augment CDC’s Sexually Transmitted Infection Treatment Guidelines and are intended to be used as a tool to guide sexually transmitted disease clinical practice standards. This project facilitates implementation of the Recommendations by development of the STD QCS Planning Toolkit which includes an assessment tool as well as decision making and prioritization guidance and tools. Healthcare settings can use the tools to critically assess existing STD care service offerings in their facilities and identify opportunities to build, maintain, or enhance the delivery of those services.

The toolkit consists of three key components that walk healthcare settings through the process of critically assessing their services and determining whether additional services can or should be made available to address service gaps. These components include:

• Assessing clinical services available by facility
• Decision-making for building or enhancing STD clinical service delivery
• Implementing next steps for the provision of quality STD clinical services

To use the assessment tool, you will need to register with NACCHO so that we can follow up as part of toolkit evaluation.

PROJECT RESOURCES

• Planning Toolkit
  
• Assessment Tool

ABOUT THE PROJECT

In partnership with CDC’s Division of STD Prevention (DSTDP), NACCHO is supporting a diverse set of local jurisdictions/health departments across the U.S. to implement and evaluate a program strategy to improve congenital syphilis prevention and control efforts in their areas. The objective is to help galvanize local efforts to address rising rates of congenital syphilis and syphilis among pregnant individuals and individuals of child-bearing capacity. Specifically, innovations or improvements focus on one or more of the following areas: of congenital syphilis prevention:

• Improving support for pregnant individuals who have syphilis
• Improving support for pregnant individuals who do not have syphilis
• Improving support for individuals with syphilis who could become pregnant but are not currently pregnant

The project will evaluate feasibility of innovations, barriers and facilitators to successful implementation, and the extent to which the innovation or improvement reached its intended targets and outcomes.

PROJECT RESOURCES

• One-pager: Local Innovations in Congenital Syphilis Prevention

RECENT UPDATES

Funding Announcement for Congenital Syphilis Intervention and Evaluation - Applications Now Closed

In partnership with the CDC’s Division of STD Prevention, NACCHO will provide up to four local health departments with up to $25,000 each to implement and/or evaluate a program strategy that will improve congenital syphilis in their area. The objective is to help galvanize local efforts to address rising rates of congenital syphilis. Specifically, it will fund the implementation and evaluation of scalable interventions that focus on one or more of the following areas of congenital syphilis prevention:

1. Linkage to prenatal care
2. Syphilis and/or pregnancy screening in non-STD care/clinic settings
3. Telehealth/medicine for individuals with syphilis who are pregnant

If your jurisdiction is already implementing an intervention that falls under one of these areas, it is permissible to apply just for evaluation of the intervention.

Visit NACCHO's website to learn more. The deadline to apply was January 27th, 2020.

ABOUT THE PROJECT

With funding from the CDC’s Division of STD Prevention (DSTDP), NACCHO leads the STI Express Initiative, which is designed to increase the evidence base for express STI clinical visits and support clinics in quality improvement efforts to strengthen, scale-up, and evaluate STI express models. We define STI express services as triage-based STI testing without a full clinical examination. Express services, also known as “fast-tracking,” are often associated with technology and automation and can reduce visit time, decrease time to treatment, and free up provider time; empower use of staffing models that utilize top of license strategies; enable self-collection of swabs; and increase opportunities to implement in diverse settings.

The STI Express Initiative has a number of components, including a Community of Practice with clinics that currently implement or are interested in implementing express STI visits, in-depth assessments with three sites to strengthen operational plans for STI express models, and a Data Collaborative through seven STI clinical sites will evaluate their express models across common variables; data from this project is forthcoming.

PROJECT RESOURCES

With funding from the CDC’s Division of STD Prevention (DSTDP), NACCHO and Cardea Services engaged seven sites in a multi-jurisdiction data collaborative to understand the impact of express STI services on patient characteristics and satisfaction; clinic capacity and time; STI testing and treatment outcomes; and cost. The final report, “Evaluating Sexually Transmitted Infection Express Services: Findings from a Multi-Site Data Collaborative,” shows that express STI services increase clinic capacity, reduce time to treatment, and reduce visit time, therefore making them an important tool for increasing access and testing while maximizing available resources. The accompanying clinic guide “Implementing Express STI Services: Considerations and Lessons Learned” details multiple factors and real-life lessons learned that clinics should consider when designing and implementing an express STI model.

NACCHO additionally engaged Cardea to conduct in-depth assessments of three jurisdictions considering or planning to establish STI express services. NACCHO and Cardea visited Jackson, MS; Providence, RI; and San Francisco, CA to develop a better understanding of the role that STI express services can play in each jurisdiction and to explore clinical operations and resource requirements related to express visits. As a result of the in-depth assessments, Cardea developed a report with recommendations and considerations for each site, and for express models more generally. The executive summary is now available.

To learn more, visit our homepage for the STI Express Initiative, where you can access our issue brief, view conference posters from the STD Prevention 2020 conference regarding satisfaction and characteristics of express vs non-express patients, and watch our recent presentation from the 2020 Ryan White Conference. For questions or support, please contact Samantha Ritter, Director of Maternal, Adolescent, and Child Health, at sritter@naccho.org.

In partnership with CDC’s Division of STD Prevention (DSTDP), NACCHO is supporting three local health departments (LHDs) to strengthen partnerships with substance use disorder (SUD) treatment and other behavioral health (BH) providers and implement screening, brief intervention, and referral to treatment for high-risk substance use (HRSU) in STI clinics. The goals of this project are to assess the syndemic of STIs and HRSU and identify models for connecting STI clinic patients to SUD treatment and other BH services. For additional information, contact Kat Kelley, Senior Program Analyst, HIV, STI, & Viral Hepatitis (kkelley@naccho.org).

NACCHO is working with the CDC Division of STD Prevention, the National Coalition of STD Directors, and the Public Health Accreditation Board to develop a national certification program for disease intervention specialists (DIS). The effort aims to strengthen and formalize the role of DIS, expand the recognition of DIS and the profession, ensure adequate training, and improve service provision and health outcomes. Learn more about this project here and by reading the article titled “Strengthening Public Health at Its Core: A Focus on Disease Intervention Specialist” in the Winter 2015 NACCHO Exchange.

During and beyond COVID-19, local health departments (LHDs) continue to work to find solutions so that all people have access to HIV/STI testing. Self-testing is one strategy for individuals who are unable or prefer not to visit traditional testing facilities.

Learn about local health departments implementing non clinic-based self-collected testing for HIV/STIs and access provider- and client-facing resources at our self-testing webpage below.

WEBINAR - STI Testing: New Point-of-Care Advances

On December 9, 2021, NACCHO, the National Coalition of STD Directors (NCSD), and the National Association of State and Territorial AIDS Directors (NASTAD) hosted a webinar on a new point-of-care technology for testing of sexually transmitted infections (STIs) and the impact of its use for health departments.

Historically, STI testing has required that samples be sent to a lab for testing while the patient awaits results and possible treatment. A fast diagnosis and appropriate treatment are essential in preventing the spread of STIs. A point-of-care test allows for faster diagnosis and eliminates the 4–7-day turnaround. A reliable, low-cost, point-of-care test which allows clinicians and healthcare workers to diagnose and provide accurate treatment in one visit could help reduce burden on the patient and help improve health outcomes including by helping to reduce the threat of antibiotic resistance from empirical treatment. By streamlining the process of providing accurate treatment and counseling at once, providers can save time and money, reduce patient anxiety, and minimize the loss of patients to follow-up care (treatment).

In August, Visby Medical received FDA clearance and a CLIA waiver for its point-of-care PCR test for the detection of chlamydia, gonorrhea, and trichomonas with a vaginal swab. Results are available within 30 minutes and can be shared within a single patient visit. This is the first point-of-care test that has received this approval.

The webinar covered:

1. Rising Rates of STIs
2. Traditional STI Testing Methods and Challenges
3. Benefits Presented by Point-of-Care Testing
4. Impact on Health Department Services and Care with Point-of-Care Testing
5. Q&A

Speakers:

• Rebekah Horowitz, National Association of County and City Health Officials (NACCHO)
• Gary Schoolnik, Chief Medical Officer, Visby Medical and Profession of Medicine at Stanford University
• Jennifer Mahn, National Coalition for STD Directors (NCSD)

Supplementary Material:

Webinar Slides

Audio Transcript

WEBINAR- 340B Basics and Beyond

Would your health department benefit from understanding and utilizing the 340B Drug Pricing Program? NACCHO and the National Coalition of STD Directors (NCSD) explored the basics and beyond of 340B. Learn how the 340B Drug Pricing Program can support health department operations—saving money, generating revenue, and expanding sexual health services.

Learning objectives:

• Increase functional knowledge of HRSA’s 340B Drug Pricing Program including eligibility, patient definition criteria, and models of implementation
• Understand the roles of state and local health departments, partnerships, and the registration process
• Operationalize the 340B Drug Pricing Program in STD (and HIV and viral hepatitis) control efforts

Supplementary Material:

Webinar Slides

Audio Transcript

STD 340B Revenue Clarification