(P113) Addressing the Syndemic of STIs and Substance Use through Service Integration

Background

The United States is experiencing a syndemic of STIs and substance use, characterized by record high rates of overdoses and STIs. The epidemics of STIs and substance use are closely interrelated due to shared root causes including poverty, housing insecurity, poor healthcare access, and delays in seeking healthcare, exacerbated by stigma and discrimination from medical providers. Providers of STI services can effectively reach people who would benefit from harm reduction (HR) services and vice versa; HR providers are uniquely situated to build trust with populations that are medically underserved and may be wary of publicly funded health services.

Methods

The National Association of County & City Health Officials (NACCHO) has launched a project to identify best practices for addressing the syndemic of STIs and substance use. NACCHO has conducted an environmental scan of published and gray literature on STI/HR integration as well as a survey and focus groups with organizations providing integrated STI/HR services to understand models, facilitators, and barriers. In spring 2023, NACCHO will launch a pilot project through which it will support organizations in implementing, scaling up, or evaluating models for integrating or establishing linkages between STI and HR services.

Results

Of 233 local health departments (LHDs), syringe service programs (SSPs), and other organizations responding to NACCHO’s survey, 147 (63.1%) reported that they currently provided or funded integrated STI-HR services; 36 (15.4%) reported previously supporting or funding integrated services, and 21 (9.1%) were considering integration. The services most frequently provided in integrated models included naloxone distribution(n=117), HR counseling/education (n=115), and STI counseling/education (n=108). Medication-assisted treatment (n=38) and patient-collected STI testing (n=46) were least commonly provided in integrated models. Among organizations providing or funding integrated services, the most cited barriers to successful integration were restrictions on use of funds (66.4%) and insufficient funding quantity (60.7%), while the most cited facilitators to integration were the client community (80.3%) and partners (75%).

Conclusion

Policy and resource issues pose challenges to the implementation and scale-up of integrated STI and HR services by LHDs and other organizations. Strategic partnerships and shared case management represent opportunities for managing barriers to service integration.