Doing More with Less: Modernizing Approaches to HIV and STI Services in Public Health

Population health systems can emerge stronger from the pandemic if, collectively, all of us who work in the Public Health space take some time for self-reflection. COVID-19 exposed strengths and weaknesses in the healthcare system — the workforce, technology, and community relationships had to adapt quickly to test and treat people at an unparalleled scale. 

At Color, we constantly evolve our work as we learn from the past and encourage our partners to do the same. The pandemic taught us a lot about the interconnectedness of Public Health services, and how precarious the balance can be across programs. For example, COVID-19 negatively impacted the testing and treatment of sexually transmitted infections (STIs), as providers reassigned resources to pandemic efforts. We need to understand how the pandemic disrupted HIV and STI services so that we can help our partners do this vital work more effectively and efficiently. 

COVID-19 reduced the HIV and STI workforce 

The impact of COVID-19 on the HIV and STI workforce was massive. A  2020 survey by the National Coalition of STD Directors reported that health departments redirected roughly 78% of the STI and HIV health workforce to pandemic-focused initiatives. In the same survey, 20% of STI directors said that their operations were “completely disrupted and unable to complete core functions.” 

Stay-at-home orders further complicated the delivery of HIV and STI services. Most healthcare clinics restricted in-person visits to patients with symptoms, yet many STIs can exist without noticeable symptoms. Routine healthcare visits also decreased during the pandemic, making early diagnoses and treatment of STIs extremely difficult. According to a study by the American Journal of Preventive Medicine, the disruptions caused by COVID-19 likely resulted in a combined total of more than 33,000 undiagnosed cases of chlamydia and gonorrhea from January 2019 to June 2020. 

Pre-pandemic STI rates had already been climbing. Recent CDC research suggests they have continued to rise in 2020. Given the redeployment of HIV/STI departments to COVID-19 efforts and the restricted access to care, HIV and STI services experienced a compounding burden on already strained resources. Before 2020, STI rates outpaced STI funding. Federal funding for STI prevention was lower in 2019 than in 2003, even though syphilis rates, for example, were four times higher. 

Remote care delivery for HIV and STI services is crucial

McKinsey & Company reports that telehealth utilization increased 38x between January 2020 and February 2021. Customers and providers are clearly more willing to use telehealth services. Plus, regulatory changes enabled expanded access. Remote care delivery models are a viable alternative, or supplement, to in-person care. 

Stigma and privacy concerns have historically deterred individuals from seeking HIV/STI care. Telehealth services paired with self-administered test kits can make these services more accessible and discrete. Virtual care removes some of the concerns HIV and STI patients may have about seeking in-person treatment, whether that be the fear of running into someone they know or being in an uncomfortable environment. 

The geographic distribution of those needing HIV/STI care also builds a solid case for continued investment in telehealth and mobile care beyond the pandemic. We are particularly impressed with folks like End Hep C SF, a San Francisco-based initiative to eliminate the hepatitis C virus (HCV). This organization pivoted to providing HCV treatment access through telehealth and mobile services during the pandemic. End Hep C SF partnered with DeliverCare UCSF and their mobile van service to remove transportation barriers to testing and treatment. This approach included administering treatment at shelter-in-place hotels. 

Community partnerships are foundational for success

While telehealth will continue to be a vital tool for improving access to HIV and STI services, technology is just part of the solution. 

Community partnerships can also help deliver HIV and STI services to those who need them. Local leaders play an increasingly crucial role in healthcare delivery by removing the geographical and technical barriers preventing many people from accessing essential services. In addition, health workers who are respected community members carry unique knowledge of how people within their community live and operate. This knowledge is tremendously valuable when determining how best to deliver HIV and STI services, whether remote, in-person, or hybrid. 

One example of a community partnership was that between Color Health and the Friendship Christian Center in Oakland and Third Baptist Church in San Francisco. In December 2021, Color and these two Northern California churches offered free HIV and STI testing services to their communities as an additional service at their existing COVID-19 vaccination sites. In just one week of this pilot program, we screened hundreds of people for HIV. Out of the attendees offered a free screening, nearly 40% opted to get tested. 

Color helps to extend the reach and effectiveness of public health programs

Our partners can use the same public health infrastructure we designed to test and treat COVID-19 for other infectious diseases. Remote health options and community partnerships were vital to the success of pandemic health initiatives. These hybrid care delivery models are now critical in engaging geographically distributed populations. They also help us reach under-resourced and over-burdened communities with limited access to essential healthcare. As we learned during the pandemic, removing barriers to care access is necessary to minimize the transmission of STIs. Without access to testing, people who don’t know their status are much more likely to transmit. As reported by the CDC, people unaware of their HIV status transmit roughly 40% of all HIV cases.

We’ve taken significant steps toward more equitable and accessible HIV/STI care. However, there is still much work to do and limited resources with which to work. In March of this year, Politico reported that funding for sexual health clinics that provide free testing and wellness services has dramatically decreased. 

In the face of rising STI rates and decreased funding, creative new approaches to delivering HIV/STI services are crucial. These novel approaches supplement and extend the reach and effectiveness of existing public health programs. The future depends on communities, public health organizations, and service providers like Color Health working together to improve access to HIV and STI services. In partnership, we can ensure that convenient, respectful, and affordable services are available to everyone, wherever they are.

If you’d like to learn more about working with Color to deliver HIV and STI services to your community, contact our team.