Sexually Transmitted Infections Adopting a Sexual Health Paradigm (2021) / Chapter Skim
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11 Supporting and Expanding the Future STI Workforce
11 Supporting and Expanding the Future STI Workforce
Pages 547-580
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11 Supporting and Expanding the Future STI Workforce Chapter Contents Introduction Sexual Health and Ethics as an Organizing Framework for the STI Workforce Current STI Workforce in the United States • Refocusing and Improving Traditional Service Delivery Paradigms in Clinical STI Prevention and Care Leveraging Health Care Systems and Practitioners Not Traditionally Involved in STI Service Delivery • Diverse Actors in Sexual Education and Sexual Health Promotion • Pharmacists • Research Strengthening the National Public Health Workforce • Leveraging Nurses for Population Health • DIS for Population Health 547
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. SEXUAL HEALTH AND ETHICS AS AN ORGANIZING FRAMEWORK FOR THE STI WORKFORCE More than other issues of public health importance, STIs are subject to stigma, misconceptions, discrimination, and strongly held differences of opinion (Albright and Allen, 2018; Hilpert et al., 2010; Nsuami et al., 2010; ODPHP, 2020)
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Refocusing and Improving Traditional Service Delivery Paradigms in Clinical STI Prevention and Care The clinical STI workforce includes both primary care generalists, whose work broadly relates to basic management and prevention, but who traditionally do not perceive STI services as a key focus area, and specialists in sexual health and STIs. Given the importance and complexity of the workforce involved in STI management and prevention, the purpose of the following section is to highlight the clinical STI workforce
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This large workforce can carry out routine STI screening, initiate pharmaceutical treatment, and promote STI prevention, including offering evidence-based STI prevention counseling interventions recommended by the United States Preventive Services Task Force for all sexually active adolescents and for adults at increased risk for STIs (Krist et al., 2020)
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Insufficiently prioritizing prevention, testing, and management in primary settings represents a missed opportunity to leverage a large segment of the clinical health care workforce to address increasing STI prevalence nationally. Therefore, a shift in traditional paradigms of primary care delivery toward increased recognition of the important role of general practitioners in sexual health, STI prevention, and management is drastically needed.
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Integrating STI services into women-specialized care provides greater opportunity for screening and contributes to higher rates of STI testing for these patients (Bertakis et al., 2000; Kalmuss and Tatum, 2007; KFF, 2015)
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counties were estimated to have no STI clinic (defined as a publicly funded provider of STI services, including family planning clinics, community health centers, and schoolbased clinics) (Meyerson et al., 2019)
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For instance, in the STI workforce, the stereotype that Latino/a people, African American people, or men who have sex with men are more prone to sexual risk and less likely to adhere to medication results in delayed or lower likelihood of prescribing PrEP or antiretroviral treatment (Bean et al., 2013; Calabrese et al., 2014; Hall et al., 2015; Stone, 2005)
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STI workforce in response to alarming increases in STIs needs to include efforts for leveraging health care systems and practitioners not traditionally involved in STI service delivery for novel prevention and treatment strategies. In addition, dimensions of effective and comprehensive STI prevention and management outside of traditional clinical settings warrant consideration, given that populations disproportionately affected by STIs frequently face access barriers to traditional health care systems.
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, represents an additional segment of the workforce relevant to sexual education and sexual health promotion. Through targeted allocation of resources, these paraprofessionals can be leveraged to build a pipeline that expands the STI workforce beyond the practitioners traditionally involved in STI service delivery, as they can be trained to take on an important role in various services that are essential to prevent, identify, and manage STIs, such as general and STI-specific health literacy education and patient navigation to testing services (Han et al., 2018; Harmon-Darrow et al., 2020)
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The integral role of pharmacists within public health, however, has not yet been broadly recognized, and they are not traditionally regarded as a core segment of the STI workforce. Adding pharmacists as recognized STI service providers is one promising way to improve STI prevention and control (APhA, 2006; Chisholm-Burns et al., 2010; Gronowski et al., 2016; Wood and Gudka, 2018)
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The complete incorporation of pharmacists into health care delivery systems faces barriers, however, such as regulatory limitations on providing direct patient care (e.g., testing for and treating STIs)
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Research professionals in the STI workforce are most often employed in academia, the pharmaceutical industry, public health agencies, or specialty clinics. Existing biomedical and behavioral research on STI prevention and management does not correspond to the scale of innovation needed to address STIs as a national and international public health priority.
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Public health practitioners whose scope of work includes preventing and managing STIs are diverse and include public health officials, laboratory technicians, DIS, and providers of clinical STI prevention and treatment. Epidemiologists and other public health officials at local and state health departments oversee and coordinate STI programming, disseminate prevention messaging, and implement surveillance for reporting to the Centers for Disease Control and Prevention (CDC, n.d.)
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Federal-, state-, and local-level regulatory and programmatic support for a broader scope of nursing practice in STI prevention and control is particularly meaningful within the context of innovative service delivery models outside of traditional clinical settings. The Health Resources and Services Administration (HRSA)
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Thus, an expanded public health DIS workforce could potentially benefit STI prevention, and they would also function as core participants in community-based STI prevention collaboratives. In addition, due to the increasing growth in using technologies and digital data as tools for sexual health (see Chapter 6)
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To adequately address the challenges associated with increasing STI incidence and prevalence, mechanisms to attract and train clinical and nonclinical health professionals to STI specialty professions are warranted, including programs comparable to HRSA's NHSC Loan Repayment Program, which provides financial incentives for health care providers in selected disciplines to provide services in medically underserved communities (HRSA, n.d.)
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STI WORKFORCE EDUCATION AND DEVELOPMENT As outlined above, the STI workforce comprises many disciplines and also includes actors that have traditionally not been recognized as having an important role in STI prevention, such as community and faith leaders, parents, and educators. This section, however, focuses on professionals who directly interact with patients and clients as care or prevention providers and discusses existing and needed resources for STI workforce education and development.
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They also need to be aware of additional STI prevention resources, including STI specialty clinics and training programs. Given that including pharmacists as collaborative partners in the health care workforce is one promising way to improve STI prevention and control, expanding their scope of practice warrants consideration in training curricula.
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Such programs can develop a pipeline for STI experts who combine clinical and epidemiological STI expertise with programmatic and policy STI expertise by supporting applied experiences at sites such as CDC, STI programs at state and local health departments, and STI resource centers. Schools of Public Health Schools of public health are crucial to training the nonclinical STI workforce, particularly those who will be working in surveillance and epidemiology.
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Most health departments have developed strong collaborations with their regional STD Clinical PTC to coordinate and help deliver technical assistance and training. STI Resource Centers As described in Chapter 12, the committee envisions a community engagement process that involves an interdisciplinary collaboration of public and private stakeholders, including care providers and community leaders, to develop a comprehensive plan for STI prevention and control at the local and community levels.
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They have become much more selective in whom to offer hands-on, clinic-based training, focusing on those who are more likely to continue working in STI clinical programs and can be groomed to become local leaders in delivering quality STI clinical services and ongoing STI workforce development. The PTCs remain primary hubs of training resources and expertise that can be leveraged for the national plan on STI prevention and management.
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A silver lining is that current efforts to expand the DIS workforce in the context of the COVID-19 response may be sustained in anticipation of potential future waves of this infection or other infectious disease outbreaks. Other Training Resources While not categorically targeting STI clinical or DIS training, a number of training organizations support clinical providers who are strongly allied to STI prevention, including HIV care providers (supported by the AIDS Education and Training Centers, funded by HRSA)
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The existing U.S. STI workforce characterized in this chapter has notable strengths, which can be leveraged for the national response to the increasing STI incidence.
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and behavioral health specialists should formulate a minimum sexual health skill set (e.g., taking a sexual history and understanding the basics of STI prevention, being aware of guidelines for STI screening and treatment, and understand ing HIV prevention and care) to be reflected in formal training programs and yearly continuing medical education, continuing medical units, and continuing education requirements.
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and state and local health departments, in collaboration with STI/ HIV expert providers and the regional STI prevention training centers, should serve as a resource of clinical expertise for pri mary care providers and nonclinical health and social services professionals and paraprofessionals. This should be accom plished through consultation, technical assistance, and continu ing education (see also Recommendation 12-5)
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2020. Recommendations for providing quality sexually transmitted diseases clinical services, 2020.
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2015. 2015 sexually transmitted diseases treatment guidelines.
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2017. Interventions to increase male attendance and testing for sexually transmitted infections at publicly-funded family planning clinics.
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2020. Behavioral counseling interventions to prevent sexually transmitted infections: U.S.
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U.S. public sexually transmitted disease clinical services in an era of declining public health funding: 2013-14.
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2019. NIH awards will advance development of vaccines for sexually transmitted infections.
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2019. The national network of sexually transmitted disease clinical prevention training centers turns 40 -- a look back, a look ahead.
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2015. Sexually transmitted diseases treatment guidelines, 2015.
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