The Role of Local Health Departments in Providing Sexually Transmitted Disease Services and Surveillance in Rural Communities

Angelia M. Paschal; Julie Oler-Manske; Tracy Hsiao

Disclosures

J Community Health. 2011;36(2):204-210. 

In This Article

Abstract and Introduction

Abstract

Local health departments (LHDs) are an important source for screening and treating sexually transmitted diseases (STDs) in rural communities. Yet, they oftentimes lack the resources needed to adequately assess and monitor these conditions. The purpose of this study was to (1) explore how rural LHDs assess and monitor STDs; (2) identify barriers to effective surveillance; (3) examine STD patterns in their communities; and (4) provide recommendations for improving surveillance. Data were collected from questionnaires, LHD site visits, client management system records, and state reports. One of the greatest challenges to adequately monitoring STDs was the lack of standardized data collection methods among LHDs. In addition, race/ethnicity information, which is critical to monitoring disparities, was lacking in most records. Among records where recorded, racial/ethnic minorities were most affected. STD patterns indicated adolescents lead all age groups in STDs. LHDs should consider regionalized or statewide approaches to assessing and monitoring STDs and develop standardized STD interview/intake forms, paying particular attention to race, ethnicity, and income data. Demographic and coding variables should be included and standardized across all forms for consistency. STD interventions and campaigns targeting adolescents and racial/ethnic minorities in rural counties should also be considered. Due to limited time and resources, little can be done by rural LHDs in regards to prevention and education, yet, state and federal agencies should consider how additional resources and enhanced support could be provided to assist them in fulfilling their public health role in STD surveillance.

Introduction

In the United States, sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) are among the most commonly reported infectious diseases and affect all population groups.[1] Approximately 19 million new STD cases occur annually,[2,3] resulting in a spectrum of potential health consequences ranging from mild acute illness to serious long-term complications such as cervical, liver and other cancers, and reproductive health problems.[4] The situation may be even more serious in rural locations, as research suggests that some rural areas experience higher than national averages for certain infections, including chlamydia and hepatitis B.[5]

Local health departments (LHDs) serve as central providers of testing and treatment services for STDs and other conditions in many rural communities due to a limited number of local providers and resources.[6,7] As the public health officials of their communities, LHDs are responsible for monitoring the health status of the community and its determinants, which includes the identification of health risks and health service needs.[8–10] Yet, at present rural LHDs may be unable to accomplish effective public health surveillance for STDs.[6] Based on the notion that population health improvement and surveillance should occur at the local level, this study provides an assessment of the STD services and surveillance performed by LHDs in rural communities.

STD Services at the Local Level

In Kansas, it is not uncommon for a single home health agency to provide services to residents of more than one town or county. The state health department relies heavily on LHDs to screen, treat, and monitor STDs, yet LHDs often do not have the capacity to provide services for STDs and other health conditions.[11,12] For example, LHDs, especially those serving rural areas, oftentimes lack the expertise and resources needed to obtain, collect, interpret, and use health data.[11–13] As such, comprehensive data on STDs may be especially lacking among rural communities.

At the state level in Kansas, STD-related public health matters are handled by the Kansas Department of Health and Environment (KDHE), Bureau of Disease Control and Prevention, STD Section, with the purpose of reducing morbidity and mortality from chlamydia, gonorrhea, syphilis, and HIV in Kansas by providing a continuous network of surveillance, intervention, prevention, and education across the state.[6] The STD program releases biannual reports on the total cases of chlamydia, gonorrhea, and syphilis in the state based on data submitted by both public and private health providers.[14] Kansas STD reports are summarized for the entire state; LHDs do not receive regular reports on data for their specific county.

Local health departments in Kansas are required to submit STD data to the KDHE, which in turn reports state data to the Centers for Disease Control and Prevention (CDC). STD data reported by LHDs is generally limited to HIV/AIDS, chlamydia, gonorrhea, and syphilis;[15] linformation on other STDs (e.g., human papillomavirus (HPV), genital herpes, and hepatitis B) is largely unavailable.[15] Furthermore, reported demographics are limited to month of infection, age, race, sex, and residing county. Additional data on STDs could be used to elucidate how rural populations are affected as well as improve upon existing efforts in STD prevention at the state and county level.

Description of Study

Although a variety of health providers (e.g., hospitals, community-based health clinics) deliver care to individuals affected by STDs, the study investigators partnered specifically with LHDs to assess STDs in rural communities. The LHDs of six rural counties, with populations ranging from approximately 4,789–53,597,[16] located in the central region of the state were examined. This study provides an assessment of STD services provided by LHDs in rural areas and presents recommendations towards developing a more effective surveillance system based on limited resources.

The objectives of the current study were to: (1) explore how rural LHDs assess, attempt to prevent, and monitor STDs; (2) identify barriers to effective assessment and surveillance; (3) examine STD patterns in the six-county rural region; and (4) provide recommendations for improving STD surveillance. Toward these ends, a central point of investigation was to determine what STD data is available through LHDs and to identify efforts that are currently being made or still needed to effectively address STDs at the local level.

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