Local health departments (LHDs) are on the frontlines of sexually transmitted infection (STI) prevention, testing, and treatment. LHDs offer a multitude of services, including free or low-cost STI/HIV testing and treatment, partner services, and access to condoms, among other things. Additionally, sexual health education, community outreach, and STI/HIV screening events are often organized through LHDs. Health departments also serve as an important resource for healthcare providers by providing education and technical assistance on testing and treatment recommendations. Through the below projects, NACCHO continues to support LHDs in building capacity to address STI rates in their communities.
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.
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.
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:
- Linkage to prenatal care
- Syphilis and/or pregnancy screening in non-STD care/clinic settings
- 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.
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 firstname.lastname@example.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 (email@example.com).
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.
Stories from the Field provides a means for local health departments to share their experiences and demonstrate the value of public health.
NACCHO’s Model Practices Program nationally honors and recognizes outstanding local public health practice and shares the outstanding practices through the Model Practices Database. By submitting a practice, LHDs contribute to the overall improvement of public health through effective evidence-based practice methods.
Model Practices are awarded to local health departments across the country for implementing programs that demonstrate exemplary and replicable outcomes in response to an identified public health need. Promising Practices are exciting approaches and strategies to local public health issues that are on track to becoming Model Practices. Each awarded practice was reviewed by a committee of peers, made up of other local health department professionals, and selected from a competitive collection of applications.
View the drop-downs below to access select STI-related Model Practice and Promising Practice award winners from the last two years. To view all Model Practice awardees from previous years, visit our searchable database.
|Application Title||Award Status||Year Awarded||Health Department Name||Keywords|
|MCHD-Grindr Partnership to Alert Grindr Users to Syphilis Outbreak||Model Practice||2020||Monongalia County Health Department||STI prevention, partnerships, promotion, outreach, MSM, social media, dating app, syphilis outbreak, sexual health|
|Public Health Detailing as a Strategy to Address Congenital Syphilis||Model Practice||2020||Los Angeles County Department of Public Health (CA)||STI prevention, partnerships, public health detailing, provider engagement, congenital syphilis, reproductive health, pregnancy, perinatal screening|
|Increasing Access to PrEP in a Sexual Health Clinic||Model Practice||2020||Jefferson County Department of Health (AL)||PrEP, STI, HCV testing, HCV treatment, HIV prevention|
|Be Well Maryland Mobile Wellness "Wellmobile"||Model Practice||2020||Anne Arundel County Department of Health (MD)||Harm reduction, mobile services, MAT, naloxone, HIV prevention, STI prevention, syringe exchange|
|Healthcare on the Spot: Integrated Mobile Treatment||Promising Practice||2020||Baltimore City Health Department (MD)||Harm reduction, mobile services, MAT, naloxone, HIV prevention, STI prevention, syringe exchange|
|The Ask: Partnering to Connect At-Risk Teens with Sexual Health Resources||Promising Practice||2019||DuPage County Health Department (IL)||Sexual health, adolescent health, education, HIV prevention, STI prevention, community engagement, coalition|
|Community Collaboration to Enhance STD Testing at a Juvenile Assessment Center||Promising Practice||2019||Pinellas County Health Department (FL)||STI prevention, adolescent health, corrections facility, chlamydia, gonorrhea, STI testing, partnerships, linkage to care|
NACCHO's policy statements and communications to Congress and the administration related to STIs are found below. The organization's Board of Directors determines positions on public health issues. Learn how local health departments have used NACCHO's policy statements to influence local, state and federal policy.
NACCHO members participate actively in the organization's policy development process through workgroups. The HIV, STI, and Viral Hepatitis Workgroup contributes to the development and revision of all STI-related policy statements. Learn more about this workgroup and apply to join here.
STI-related policy statements
Health equity policy statements
- Health and Disability
- Health Equity and Social Justice
- Immigrant Health
- LGBTQ Health
- Mass Incarceration and Structural Racism
- Police Violence and Racism
- Women's Health
Letters to Congress and the Administration
- Letter to HHS Commenting on the Sexually Transmitted Infections National Strategic Plan for the United States (2021 - 2025) (10/1/20)
- Joint Letter to Congress Supporting Increased Funding for Division of STD Prevention (DSTDP) (11/16/19)
View more policy statements and letters to Congress and the administration on NACCHO's Policy and Advocacy page.
Stay up to date on the latest HIV, STI, and viral hepatitis tools, news, and resources on our blog, The Essential Elements of Local Public Health! Click through the arrows below to see recent our recent posts or visit the blog to view all posts related to HIV, STI, and viral hepatitis.
Find all the latest webinars from the HSH team here.
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:
- Rising Rates of STIs
- Traditional STI Testing Methods and Challenges
- Benefits Presented by Point-of-Care Testing
- Impact on Health Department Services and Care with Point-of-Care Testing
- 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)
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.
- 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
New Funding Opportunities for Partnering with Pharmacies and Retail Health Clinics
NACCHO, with support from the Centers of Disease Control and Prevention (CDC) Division of STD Prevention (DSTDP), is pleased to announce two new funding opportunities for health departments to partner with other healthcare entities to expand STI and HIV services, treatment, and care in their communities.
Leveraging Pharmacies for STI Services and Care
This funding is to explore the provision of expanded STI patient care via pharmacy settings.
- Two-to-five health department-pharmacy partnerships will be funded up to $75,000 (per site) to develop, design, and implement a collaborative partnership with local health departments to expand STI services and care.
- Findings will be shared broadly with STD programs and pharmacies across the country.
- Applications are due on May 27, 2022. For additional information or to access the RFA, visit here.
- For more information, view the slides or recording of the informational webinar on the RFA that took place on April 14th.
Leveraging Retail Health Clinics for STI/HIV Services and Care for Underserved Minorities
This funding is to support integration of sexual health services for underserved and under-diagnosed racial/ethnic and sexual minorities, including young people, across RHCs, health department, primary care, and other healthcare settings. This funding is being provided as part of the Minority HIV/AIDS Fund (MHAF) funding to the Division of STD Prevention (DSTDP).
- This funding is only available to partnerships in Ending the HIV Epidemic (EHE) priority jurisdictions.
- Three health departments-retail health clinic(s) teams will be funded up to $300,000 (per site) to develop, design, and implement a collaborative partnership to expand STI/HIV services and care.
- Applications are due on May 31, 2022. For additional information or to access the RFA, visit here.
- For more information, view the slides or recording of the informational webinar on the RFA that took place on April 19th.
If you are interested in applying for either of these opportunities but have questions, there will be informational webinars in April which are noted in the respective RFAs. Additionally, if you are interested in applying and need support with developing a partnership with a pharmacy or retail health clinic or have other questions, please contact Rebekah Horowitz.
Funding local health departments to explore the provision of expanded STI patient care via pharmacy settings. Applications due May 27.
NACCHO Releases National Scan of Congenital Syphilis Prevention and Control Efforts
Over the last year, NACCHO has collected information on congenital syphilis prevention and control interventions/activities across the United States. This effort focused on gathering information on any interventions/activities across the entire spectrum of prevention of syphilis among persons with childbearing capacity and congenital syphilis, as well as information on your syphilis screening/testing efforts of persons with childbearing capacity at your local jail(s). A compendium of the collected responses has been developed to increase peer-to-peer collaboration and improve congenital syphilis prevention efforts.
In addition to looking at what other jurisdictions have tried regarding congenital syphilis prevention, you can enter information on your local interventions/activities, regardless of whether the intervention/activity has been evaluated.
For more information, and if you have questions, contact Shalesha Majors, Program Analyst, HIV, STI, & Viral Hepatitis, at firstname.lastname@example.org.
RFA: Pharyngeal Gonorrhea Test of Cure (TOC) Project
In partnership with the Centers for Disease Control and Prevention (CDC), NACCHO is pleased to announce a Request for Applications (RFA) to galvanize local efforts to assess test of cure (TOC) for pharyngeal gonorrhea as a strategy to identify and prevent the spread of antimicrobial-resistant gonorrhea.
NACCHO will fund up to 4 local health departments (LHDs) up to $100,000 each to implement pharyngeal gonorrhea TOC. This implementation will provide essential information about the feasibility of implementing TOC for all pharyngeal gonorrhea cases in clinical practice. Findings will be shared broadly with STD programs across the country.
RFA: Local Innovations in Congenital Syphilis Prevention
In partnership with the CDC’s Division of STD Prevention, NACCHO's Local Innovations in Congenital Syphilis Prevention project will provide at least five local health departments with up to $25,000 each to implement and 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. To learn more about the project, view the recording and presentation slides from our informational webinar, held December 17, 2020. Applications are now closed.
For questions about NACCHO's work regarding STI prevention, detection, and response, contact our STI specialists below.
Community Health Program
Senior Program Analyst, HIV, STI & Viral Hepatitis