The National Institutes of Health (NIH) has issued a Request for Applications (RFA) for research on effective strategies for expanding the provision of HIV pre-exposure prophylaxis (PrEP) for people at increased risk of HIV by leveraging existing sexually transmitted infection (STI) programs.
Research supported by this initiative should be based on point of care HIV testing for all persons seeking STI services, followed by linkage to available antiretroviral therapy (ART) or PrEP, in addition to STI testing, treatment, and prevention services at designated STI clinical settings. HIV testing, PrEP, and ART should be linked with STI services in settings where they are needed and not currently co-located. Interventions should be included to (i) overcome stigma and discrimination, (ii) provide individualized services to optimize PrEP and ART uptake and retention, (iii) ensure ongoing access to ART, PrEP, and other prevention services, (iv) and provide quality STI services that meet current CDC recommendations (Recommendations for Providing Quality STD Clinical Services).
Having a sexually transmitted infection (STI) can increase the chances of getting or transmitting HIV, because having an STI may make HIV transmission easier. Additionally, the same behaviors and circumstances that place people at risk for STIs also can place them at risk for HIV.
STD clinics are important healthcare settings for people who may not otherwise have access to healthcare services, including those who are uninsured or seek confidential services. They serve people who are not engaged in HIV prevention programs or the primary healthcare system for STD and HIV prevention and care.3 For example, in 2018, an analysis of CDC-funded HIV tests found STD clinics provided more than one-third of all HIV tests conducted among healthcare settings and identified approximately 20% of all people newly diagnosed with HIV in these settings.
This reflection piece details the many challenges and opportunities COVID-19 has brought to the HIV/STD prevention field, particularly in the southern United States, and showcases the innovative approaches sexual health providers implemented to further prevent service disruption.
While the COVID-19 pandemic is still ongoing, this document looks at what the sexual health workforce has been through, and continue to go through, navigating ending an HIV epidemic while in a global pandemic.
The recently released STI National Strategic Plan (STI Plan) and HIV National Strategic Plan were developed concurrently with the Viral Hepatitis National Strategic Plan and each calls for a more integrated approach to addressing the syndemic of HIV, STIs, viral hepatitis, and substance use and mental health disorders. Together, these three plans aim to enhance coordination of the activities of federal agencies and diverse community stakeholders to reduce morbidity and mortality, stigma, discrimination, health inequities, and disparities; improve outcomes; and fortify the public health and health care infrastructure to support prevention, diagnosis, care, and treatment across these infectious diseases. As federal agencies begin work to develop implementation plans for each of these five-year plans, we will explore opportunities to enhance integration of prevention, care, and treatment of STIs, HIV, viral hepatitis, and behavioral health issues by leveraging capacity and infrastructure across the domains and breaking down operational and funding silos.
Such silos result in missed opportunities every day to test people for multiple infections and to scale up services in settings where people at risk receive other services. These missed opportunities translate directly into lost time and resources and may result in harm to people who remain undiagnosed, untreated, and at risk of severe outcomes or of transmitting HIV, an STI, or viral hepatitis to others. A reciprocal, integrated approach in our responses to infectious diseases and substance use and mental health disorders that puts patients first through a status-neutral and no-wrong-door approach will maximize their ability to access services that meet their health needs.
For example, HIV testing, prevention, and care programs can identify opportunities to screen for other STIs, viral hepatitis, and behavioral health issues and provide treatment and/or linkage to appropriate services. Current CDC PrEP guidelines recommend STI screening as part of PrEP care and the HHS HIV Treatment Guidelines provide information on screening, treatment, and prevention of herpes and syphilis.
Similarly, STD clinic patients represent a population at increased risk for HIV; so STD specialty clinics play a vital role in reaching people at risk for HIV who are not engaged in HIV prevention programs or other health care services, including those who are uninsured and those who seek confidential services. In addition, STD specialty clinics serve a high proportion of racial and ethnic minorities, gay and bisexual men, and transgender people so are ideally positioned to reach these populations disproportionately affected by HIV who could benefit from PrEP or PEP or reach people with HIV who are either unaware of their status or are not virally suppressed and could benefit from linkage to or reengagement in care.
Sexually transmitted infections (STIs) impose billions of dollars in medical costs in the U.S., but STI prevention and control is chronically underfunded, stigmatized, and siloed from efforts to promote overall health and well-being, says a new report from the National Academies of Sciences, Engineering, and Medicine. The report calls for modernizing national STI surveillance and monitoring systems, bolstering the STI workforce, developing and scaling up structural and behavioral interventions, and accelerating the development of vaccines, diagnostics, and therapeutics. Taking these strategic actions would also better position the U.S. to respond to COVID-19, HIV/AIDS, and future infectious disease outbreaks, the report says.
Despite the economic burden and alarming increase of STI rates over the last 20 years, the Centers for Disease Control and Prevention’s STI funding has remained flat. Although HIV is an ongoing and highly significant concern, the mandate of the committee that wrote the report was to focus its recommendations on STIs other than HIV, due to increasing rates of chlamydia, gonorrhea, and syphilis. However, the report discusses the interplay between HIV and other STIs, and ways HIV and STI services can collaborate or integrate their prevention, care, and research efforts.
Pennsylvania state health officials are reporting increased amounts of sexually transmitted infections, in particular syphilis, prompting officials to encourage the public to take steps to decrease their risk.
Pregnant women should be screened at first and third trimester because of the sharp increase in the number of babies born with the disease in the United States. Nationally, cases of congenital syphilis increased by 185 percent between 2014 and 2018. In 2019, five congenital syphilis cases were reported in the state of Pennsylvania, following seven cases reported in 2018. These reported cases of congenital syphilis in the state represented the highest number of cases in more than 25 years.Early syphilis in Pennsylvania is currently at the highest rate in more than 20 years. Over the last five years, early syphilis reported in women of child-bearing age (women aged 15 to 44) increased 114 percent, from 78 cases in 2015 to 167 cases in 2019.
“Sexually transmitted diseases are serious diseases that impact many Pennsylvanians each year,” Acting Secretary Beam said. “It is essential that all residents are aware of the risks and dangers associated with STDs. Many of these diseases can be easily diagnosed and treated, which is why we encourage all residents to talk to their doctor about getting tested so we can further prevent diseases and keep our residents healthy.”
While the eyes of the nation are on the coronavirus pandemic, another threat to public health has been steadily growing in the United States. We’ve been battling rising rates of sexually transmitted infections (STI) for the last several years. In fact, 2020 marks the fifth consecutive year of increasing rates of gonorrhea, chlamydia and syphilis in the U.S., due in part to significant funding cuts to more than 50% of the nation’s public health STI programs. And now the COVID-19 pandemic has placed an even greater burden on our strained public health system and supply chains, shifting focus from one major public health issue to another.
We can’t risk losing one critical resource that will be essential to ending the STI epidemic — the availability of free and confidential STI testing for adolescents. Prior to the pandemic, national public health efforts were scaling up to improve STI and HIV testing, and quickly link youth to prevention services. Rapid identification and treatment of STIs not only has public health benefits in terms of lowering transmission, but when left untreated, STIs increase the risk of infertility, severe pelvic infection, chronic pelvic pain, ectopic pregnancy and HIV transmission.
While accounting for 25% of the population, adolescents and young adults comprise over 50% of STIs in the U.S. each year. Black, Latinx, and LGBT youth face the greatest burden of infections and risk of complications. Fortunately, significant advances have been made over the last several decades to improve rates of STI and HIV testing among adolescents and young adults. The American Academy of Pediatrics now recommends HIV screening by the age of 16-18 years for all youth regardless of their sexual activity.
Combined cases of syphilis, gonorrhea, and chlamydia reached an all-time high in the United States in 2018, reaching 2.4 million cases. This marked the fifth consecutive year of sharp increases in STDs. For more than a century, sexually transmitted disease (STD) clinics have provided critical prevention and care for these common infections. Today, data show that STD clinics serve a high volume of racial/ethnic minorities, gay and bisexual men, and transgender people, and that they have become a primary source of both STD and HIV prevention services for people without regular access to healthcare.
As a result, STD clinics will play a vital role in the nation’s ambitious federal initiative Ending the HIV Epidemic: A Plan for America (EHE). However, these clinics are vastly under-resourced. An FY2020 investment from the HHS Minority HIV/AIDS Fund (MHAF) aims to address that by bolstering training and technical assistance (T/TA) efforts so STD specialty clinics can better provide HIV prevention services.
Leveraging the infrastructure and expertise already in place through this dynamic collaborative, the HHS MHAF investment will allow the NNPTCs to provide effective T/TA to enhance and scale up HIV prevention services, like pre-exposure prophylaxis (or PrEP) and post-exposure prophylaxis (or PEP) provision, in STD specialty clinics. Activities could include, for example, providing onsite or distance-based (web or phone) consultations, guidance to conduct clinic assessments, in-person site visits, and resources. These efforts will strengthen the clinical, laboratory infrastructure, and health delivery systems of STD specialty clinics serving a high proportion of racial/ethnic and sexual minorities in EHE jurisdictions.
Bruce W. Furness, M.D., M.P.H., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues developed and evaluated a quality improvement initiative (Transforming Primary Care for LGBT People) to enhance the capacity of 10 federally qualified health centers (FQHCs; 123 clinical sites in nine states) to provide culturally affirming care.
The researchers found that FQHCs reported increases in culturally affirming practices, including collecting patient pronoun information (42.9 percent increase) and identifying LGBT patient liaisons (300.0 percent increase). Based on sexual orientation and gender identity (SOGI) from electronic health records among nine FQHCs, SOGI documentation increased from 13.5 to 50.8 percent of patients. Screening of LGBT patients increased from 22.3 to 34.6 percent for syphilis, from 25.3 to 44.1 percent for chlamydia and gonorrhea, and from 14.8 to 30.5 percent for HIV among the eight FQHCs reporting the number of LGBT patients.
“FQHCs participating in this initiative reported improved capacity to provide culturally affirming care and targeted screening for LGBT patients,” the authors write.
As clinics and health departments across the country have shuttered during the coronavirus pandemic, the nation’s roughly 2,200 disease detectives, the so-called “contact tracers” of infectious disease outbreaks, have been re-deployed to track where cases of COVID-19 — the disease caused by the novel coronavirus — are spreading, to try to stop those outbreaks in their tracks. It’s a necessary shift, but one that may have serious, long-term impacts for the country’s sexual health, and for President Trump’s year-and-a-half-old plan to “eliminate” HIV from the US by 2030.
[…] According to a recent NCSD survey of HIV and STD disease tracers around the country, 83% are forgoing their usual field visits as a result of this pandemic. Two-thirds of the country’s clinics (66%) have also reported decreases in health screenings and testing due to COVID-19.