Experts want CDC to hasten STD/HIV integration efforts
Recommendations include better guidance, models
As the Infectious Diseases Society of America prepares publication of guidelines for integrating HIV and STD prevention into HIV care settings, health officials are also pushing for better integration between STD and HIV prevention practices.
To that end, the Centers for Disease Control and Prevention’s Advisory Committee on HIV and STD Prevention created a working group that has developed several recommendations.
The working group’s overall conclusion is that programs need better leadership and models to help clinics get beyond institutional and cultural barriers that have made integration slow and uneven.
The recent syphilis outbreaks in men who have sex with men, many of whom are HIV-positive, has underscored the need for better coordination of prevention services.
Top-level personnel changes at the CDC’s Division of HIV Prevention and its Division of STD Prevention also make this an opportune time to make changes, say officials at the National Association of State and Territorial AIDS Directors (NASTAD).
This summer, NASTAD teamed up with the National Coalition of STD Directors to publish the report, "STD/HIV Prevention Integration." Among their recommendations is a call to federal agencies to "better articulate their goals and coordinate their efforts relating to funding for HIV prevention, STD prevention and treatment, HIV care and treatment, and substance abuse prevention and treatment."
Although integration has been pushed at the CDC for nearly five years, progress has been hindered by separate funding streams and fears of merging departments. Attitudes are changing, but more guidance is needed, the CDC work group noted.
"People are at the stage now that they know we should be doing more, but the question is what should we be doing and how much more, especially when we are challenged by funding sources and levels," says Gail Bolan, MD, director of California’s STD control program and a co-leader in the workgroup. "Also, many programs don’t know how to frame the issue. Are we talking about money, staff, messages, or planning? Integration means different things to different people."
After meeting over the past year, the workgroup came up with four recommendations for the CDC to consider:
1. The agency should hold a consultancy to discuss issues pertinent to the integration of HIV and STD prevention. Ideally, the meeting would be held jointly with the Health Resources and Services Administration, which oversees HIV care in the country. The meeting would address best practices and recommendations for removing barriers in both care and prevention.
A meeting report would provide programs and providers recommendations for integration of services for CDC and other funding agencies in making necessary structural changes.
As an alternative to the consultancy, the workgroup proposed a less comprehensive "briefing book" to provide background materials.
As part of the briefing, the CDC would interview STD and HIV program directors as well as the chairpersons of community planning groups to identify successes and failures with integration.
2. The CDC’s National Center for HIV, STD, and TB Prevention would designate a staff person in the Office of the Director to serve as point person to coordinate ongoing issues in integration. This position is seen as increasingly important as STDs and HIV re-emerge in men who have sex with men.
3. The CDC should review existing and planned HIV initiatives, guidelines, and program announcements to ensure integration issues are included.
4. Mechanisms should be established to support regular meetings between HIV and STD prevention program staff at the project level to enhance ongoing communication and planning.
While removing funding restraints is seen as critical to increasing integration, there was agreement that the programs need to remain separately funded.
"No one is interested in putting HIV and STD funding together. Everyone is clear about that," says Dorothy Mann, director of the Southeast Pennsylvania Family Planning Council in Philadelphia.
Opportunities for integration identified by the workgroup include: using STD data to target and evaluate HIV prevention activities; integrating STD and HIV prevention messages; and offering STD screening in HIV care settings and vice versa.
An example of the latter can be found in California, where syphilis elimination money is funding efforts at community-based HIV prevention programs to add STD screening and prevention messages, Bolan says. "At the same time, we hope to learn from them how we can do a better job of integrating HIV prevention and behavioral models, which is something STD programs have not embraced as quickly."
A critical issue raised by CDC advisors is the fact that some federal programs, such as Medicaid, don’t reimburse for STD or HIV screening.
"The real key to making things happen would require providers to get paid for risk screening," says Thomas Liberti, MD, chief of Florida’s Bureau of HIV Services.
As the Infectious Diseases Society of America prepares publication of guidelines for integrating HIV and STD prevention into HIV care settings, health officials are also pushing for better integration between STD and HIV prevention practices.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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