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Modernizing Field Services for Human Immunodeficiency Virus and Sexually Transmitted Infections in the United States

Golden, Matthew R. MD, MPH*†; Katz, David A. PhD*†; Dombrowski, Julia C. MD, MPH*†

doi: 10.1097/OLQ.0000000000000652

Public health field services for sexually transmitted infections (STIs) have not adequately evolved to address the expanding scale of the STI problem, its concentration among men who have sex with men, the emergence of new communication technologies and the availability of antiretroviral therapy as a cornerstone of human immunodeficiency virus (HIV) prevention. Field services need to modernize. Modernization should seek to expand field services objectives beyond sex partner STI testing and treatment to include: HIV testing of persons with bacterial STI and their partners, including efforts to promote frequent HIV/STI testing; increased condom access; linkage and relinkage to HIV care and promotion of viral suppression; preexposure prophylaxis promotion; linkage to long-acting contraception; and referral for health insurance. Field services programs cannot advance these new objectives while simultaneously doing all of the work they have traditionally done. Modernization will require a willingness to reconsider some longstanding aspects of field services work, including the centrality of face-to-face interviews and field investigations. Health departments seeking to modernize will need to carefully assess their ongoing activities and reorganize to align the use of field services resources with program priorities. In some instances, this may require reorganization to allow the staff greater specialization and closer integration with surveillance activities. Adapting programs will require new staff training, improvements in data management systems, and a greater investment in monitoring and evaluation. Although modernization is likely to evolve over many years, the time to start is now.

Changes in the epidemiology of human immunodeficiency virus/sexually transmitted infection and available prevention interventions make a compelling case for fundamental changes in the organization and objectives of human immunodeficiency virus/sexually transmitted infection public health field services in the United States. Supplemental digital content is available in the text.

From the *Center for AIDS and STD, University of Washington; and †Public Health-Seattle & King County, Seattle, WA

Sources of Funding and Conflicts of Interest: Research reported in this publication was supported in part by NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, NIDDK of the National Institutes of Health under award number AI027757, and by CDC H25PS004364 and CDC H25PS005108.

Correspondence: Matthew R. Golden, MD, MPH, Harborview Medical Center Box 359777 325 9th Ave Seattle, WA 98104. E-mail:

Received for publication January 31, 2017, and accepted May 6, 2017.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

© Copyright 2017 American Sexually Transmitted Diseases Association