Improving HIV/STD Partner Services: Assessment of Barriers and Facilitators of Three New Activities at the Mississippi State Department of Health

Abstract

Introduction: Mississippi has one of the most severe HIV epidemics in the United States. At the Mississippi State Department of Health (MSDH), the partner services program has not routinely integrated HIV-related activities into sexually transmitted disease (STD) partner services to identify undiagnosed HIV infection among sex partners of cases, nor has it routinely performed activities to identify previous HIV-positive individuals with an STD who are out of care. Additionally, the promotion of pre-exposure prophylaxis (PrEP) has not been integrated into Disease Intervention Specialist (DIS) case work. These new activities have the potential to substantially bend the curve of the HIV epidemic in Mississippi. The goal of this analysis was to identify: I) the time required to implement the three new HIV-related activities; and II) the barriers and facilitators of integrating the three new HIV-related activities into STD partner services. Together these two analyses were designed to determine the long-term feasibility of the integration of the new activities statewide. Methods: We used two methods to identify barriers and facilitators of integrating the three new HIV-related activities into STD partner services: staff interviews and a time and motion study of DIS. We also used two methods to estimate time spent on partner services activities: the time and motion study and individual case tracking. Results: The average amount of time actively working on a case for STD partner services without the new activities was about 3.25 hours. With the addition of three new HIV-related activities, the time varied from 3.75 hours to 4.5 hours per case. DIS noted that the activities were well integrated into their daily workload, but anecdotally stated it was an increase in the number of cases that they handle. DIS generally had a very positive perception of the new activities. However, DIS’ thoughts on effectiveness were mixed. Discussion: This analysis represents the first time that systematic collection of time spent on partner services activities has been completed for the partner services program at the MSDH. While gonorrhea and chlamydia cases are the target of the new activities, they are the lowest priority for DIS. This means that DIS are often following up on gonorrhea and chlamydia cases several days after the client has been tested and treated—reducing the likelihood that the DIS will be able to successfully contact the client for an interview. The results of this study can be used to conduct a costing study. Future investigations focused on the effectiveness of the new activities, costing, and the distribution of duration of tasks may provide a more accurate picture of time spent on tasks not only for the new activities, but also the existing STD partner services program.