(P32) Staff reductions and budget cuts to local health department STD programs in the United States before and during the COVID-19 pandemic

Background
In the United States, many public health sexually transmitted disease (STD) programs have experienced staff reductions or budget cuts in recent years. The scope of recent disruptions during COVID-19 along with any impacts on the provision of STD services has not been studied in a systematic way.

Methods
We surveyed 668 and 669 local health departments (LHD) before (2018) and during (2021) the COVID-19 pandemic, respectively. STD program managers for each LHD jurisdiction were asked to complete a web-based survey including questions about staff reductions and budget cuts during the previous calendar year. In both surveys, if a manager indicated that their STD program had net staff reductions, they were asked a follow-up question about which staff had been lost. In the 2018 survey, managers reporting budget cuts were asked a follow-up question about subsequent negative program impacts. Responses were weighted by US Census region, jurisdiction population size, and nonresponse to be representative of approximately 2500 LHD in each survey.

Results
A weighted 38.6% (95%CI=30.8-46.9) of STD program managers surveyed in 2021 indicated net staff reductions in calendar year 2020, a significant increase over 16.0% (95%CI=11.7-21.6) in calendar year 2017. Staff reductions by job category are reported in Table 1. In both surveys, LHD STD programs with net staff reductions were most likely to report decreases in clinical staff (78.6% and 77.3% in 2017 and 2020, respectively). Among LHD indicating net staff reductions in 2017, 16.5% (95%CI=7.7-32.0) reported decreases in disease intervention specialists (DIS). In 2020, during the height of the COVID-19 pandemic, that number increased significantly (38.0%, 95%CI=26.0-51.7). Budget cuts were reported by 24.1% (95%CI=18.3-31.0) of respondents in 2017 and 21.1% (95%CI=13.6-31.3) in 2020. Of those reporting budget cuts in 2017, 40.6% (95%CI=26.8-56.2) reported reductions in clinical services as a result and 16.8% (95%CI=8.6-30.2) reported reductions in partner services.

Conclusion

LHD STD programs report significantly more staff disruptions in 2020, at the height of the COVID-19 pandemic, than prior to the pandemic in 2017. These disruptions may impact the ability of LHD to meet the need for safety net STD services and partner services within their jurisdictions.