Community pharmacists and their colleagues in the public health space can work together to increase STI testing and treatment in at-risk groups.
Rates of sexually transmitted infections (STIs) in the United States are high—“far too high,” according to Melissa A. Habel, MPH, strategic partnerships and planning lead at the Division of STD Prevention at the CDC. In 2021, more than 2.5 million cases of chlamydia, gonorrhea, syphilis, and congenital syphilis were reported to the CDC. Although chlamydia rates have decreased, rates of gonorrhea, syphilis, and syphilis among newborns have increased since 2017.
“This endemic of HIV, STI, viral hepatitis, substance use, and mental health…highlight the overlapping risk factors, as well as associations with the social determinants of health,” said Habel.
During a presentation at the National Community Pharmacists Association (NCPA) 2023 Annual Convention and Expo, Habel and her co-presenters dove into the ways that pharmacists and public health professionals could work together to implement STI testing at the community level.
According to Habel, there are an estimated 30 million pharmacy visits each year—more than 10 times the annual number of patient contacts and all other primary care providers combined. As highly accessible locations to the communities they serve, “it may be seen as less stigmatizing when somebody goes [to a pharmacy] to receive sexual health care.”
On a national level, pharmacists are emphasized across the STI strategies, including the CDC’s National Strategic Plans for STIs and viral hepatitis. And in a report commissioned with the National Academy of Sciences, it is recommended that pharmacist expertise and access to the community can be leveraged to expand STI-related services.
The CDC Division of STD Prevention (DSTDP) is undertaking multiple pharmacy-focused products, Habel noted, with the goal of addressing sexual health in their communities, including STI and HIV pharmacy training modules and the implementation of quality clinical STI services in conjunction with local health departments.
There are 6 local health department-pharmacy partnerships currently being funded by the CDC DSTDP, located in Allegheny County, Pennsylvania; Chaffee County, Colorado; Detroit, Michigan; Henrico County, Virginia; and Linn County, Iowa.
In Richmond, Virginia, Tana N. Kaefer, PharmD, director of clinical services at Bremo Pharmacy, is responsible for overseeing the relationship between the Richmond City Health District (RCHD) and the pharmacy. Before the project began, she said, no STI testing was offered at the pharmacy—but their community pharmacy location did have 3 private clinic rooms that could facilitate private conversations with patients about STI test results.
“When I learned about this project…I knew the people to call [at the health department] and I said, ‘Hey, Bremo could be a partner for this.’”
“There were a lot of barriers that they thought were existing in the system, and as soon as I got on the call, I [was able to say], ‘That’s not a barrier; here’s what Bremo can do, this is what we can do at the pharmacy,’” Kaefer explained. Thanks to the COVID-19 pandemic, health departments are aware of what pharmacies can do in the vaccine space—but they may not be aware of what pharmacists can do when it comes to STIs.
“We have the rooms and confidentiality available at Bremo” to treat patients, Kaefer said, adding that the pharmacy team underwent cultural sensitivity training to help address patient questions and concerns in the most effective way possible.
Together, Bremo and the RCHD created a system for patients to engage in STI testing right in the community. The initial evaluation took place at RCHD, where patients underwent testing. When results came back, patients were given the option to go to Bremo Pharmacy for their treatment. Using a digital scheduling link, patients were able to schedule an appointment; these appointments would trigger an email alert at the pharmacy to let staff know that patients were coming—and to expect an electronic prescription from the nurse practitioner. And to ensure that all community members could access the program, Bremo offered appointments with both Spanish- and English-speaking technicians.
Between February and August 2023, a total of 69 patients were referred to Bremo. Next steps, Kaefer said, included strategic planning to develop a robust outreach program for high-risk communities, engaging a nurse practitioner to conduct telehealth appointments, and expanding patient treatment through the 340B program and HOPE Pharmacy, also located in Richmond.
At Hilltop Pharmacy in Pittsburgh, Pennsylvania, located in an underserved, minority community, the goal of the program was to expand non-clinic–based STI self-collection testing for chlamydia and gonorrhea, with the pharmacy serving as a treatment access point.
For Joni C. Carroll, PharmD, BCACP, TTS, an assistant professor at the University of Pittsburgh School of Pharmacy and the lead pharmacist at the Allegheny County Health Department, one of the most important things to highlight about the program is that it came about because of NCPA: Owner Alex Rothey reached out to Carroll after an NCPA webinar. “She said, ‘Hey, I know you work with the health department, something could be happening here.’” Carroll reached out to the bureau director at the health department, and the project was up and running.
“We wrote the grant in 72 hours,” Carroll said. “Don’t underestimate the power of student pharmacists.”
The Allegheny County program focuses on specific zip codes in underserved communities in the area, men who have sex with men, and adults over the age of 18; marketing—which the health department helps with—targets community members between 18 and 24 years of age.
“They did some marketing through press releases. They did Tinder and Grindr, so dating app advertisements. And they also did social media,” she explained.
After patients ordered, activated, and used their test kits, samples were sent for analysis. Positive results were confirmed through the Pennsylvania National Electronic Disease Surveillance System, and patients were evaluated to ensure that they were a candidate for pharmacy-based treatment.
There have been several key learnings from the program so far, Carroll said, including work done to remedy restrictive collaborative practice regulations through a standing order for treatment, increased marketing through the implementation of paid advertisements on busses, billboards, social media, and dating apps, and explorations into the sustainability and expansion of the program through 340B options, billing for clinical services at the health department, and—like Kaefer—the addition of a second pharmacy to the program.