Barriers, Facilitators, and Cost of Integrating HIV-Related Activities Into Sexually Transmitted Disease Partner Services in Jackson, Mississippi

Abstract

Background Many US health departments now integrate HIV-related outcomes (e.g., relinkage to HIV care and preexposure prophylaxis [PrEP]) into sexually transmitted disease (STD) partner services (PS) programs. We sought to determine the barriers, facilitators, and cost of integrating these activities into PS. Methods From 2016 to 2018, the Mississippi State Department of Health integrated 3 new activities into STD PS: HIV testing for partners of HIV-negative men who have sex with men with gonorrhea/chlamydia, relinkage to HIV care for STD PS recipients previously diagnosed with HIV, and PrEP referrals. We conducted direct observations and interviews with disease intervention specialists (DIS) in Jackson to assess barriers and facilitators to implementing these activities. We completed time and motion studies with 8 DIS and case tracking forms for 90 unique cases to estimate the incremental staff time and associated personnel cost of added services compared with a standard PS case. Results Disease intervention specialists were optimistic about integrating HIV-related activities but noted disparate data systems, nonsystematic documentation, and lack of training as barriers. The mean time for a standard STD PS case without HIV-related activities was 195 minutes (cost, $77.69/case). The cost to conduct PS for HIV-negative men who have sex with men with gonorrhea/chlamydia was 36% higher than a standard case. Integrating relinkage to care and PrEP referrals resulted in a 44% and 20% increase in cost, respectively. Conclusions Integrating HIV care relinkage and PrEP referrals into STD partner services was generally acceptable by DIS and added marginal cost per case. Coupling these cost metrics with an assessment of the effectiveness of these activities can inform prioritization of partner services activities.

Priorities in the implementation of partner services for HIV/STIs in high-income nations: a narrative review of evidence and recommendations

“…67 In general, the marginal cost of integrating these outcomes into the services provided to people who are already receiving PS is low. 68,69 Whether these non-traditional outcomes can justify the expansion of PS programs beyond their current scope will depend on the relative costeffectiveness of competing alternatives to achieve similar outcomes.…”

Measuring Success: Disease Intervention Specialists Performance Metrics and Outcome Assessments

“…Disease intervention specialist efforts have led to the diagnosis of HIV in 6% to 7% of syphilis patients and up to 3% of partners. 9,12,[26][27][28][29] Disease intervention specialist have been successful with referring syphilis patients and their partners for PrEP services in Seattle, San Francisco, Iowa, and Chicago, but there is wide variation in how these outcomes are documented and reported across populations and jurisdictions. 26,30-32s Because the provision of HIV services during syphilis investigations is already a prioritized activity, particularly for men who have sex with men (MSM), we need to have better and standardized measurement of this work.…”

“…Because people with a new syphilis diagnosis are at a higher risk of acquiring and/or transmitting HIV, 25 incorporating HIV services into syphilis investigations is an excellent use of resources. Disease intervention specialist efforts have led to the diagnosis of HIV in 6% to 7% of syphilis patients and up to 3% of partners 9,12,26–29 . Disease intervention specialist have been successful with referring syphilis patients and their partners for PrEP services in Seattle, San Francisco, Iowa, and Chicago, but there is wide variation in how these outcomes are documented and reported across populations and jurisdictions 26,30 .…”

A Demedicalized Model to Provide PrEP in a Sexual Health Clinic

“…Ideally, PrEP should be readily accessible to patients, affordable, and implemented without disrupting other SHC services or placing unsustainable new demands on clinician time. [9][10][11] We describe our experience implementing a demedicalized model of PrEP between 2014 and 2020 in the Public Health-Seattle & King County (PHSKC) SHC located in Seattle, WA.…”