Background:
High prevalence of STIs, HIV, and viral hepatitis co-occur within specific populations that may experience barriers to regular testing for all three types of infections. Integrating STI and hepatitis services into HIV counseling and testing venues maximizes opportunities for prevention, early diagnosis, and treatment of STIs, viral hepatitis, and HIV.

Objective:
To describe integration of STI/HIV/viral hepatitis services within state public health department Integrated Counseling, Testing, and Referral (ICTR) programs.

Method:
A workgroup composed of members of a state HIV/AIDS Bureau, Division of STD Prevention, and Viral Hepatitis Program met to develop integrated counseling and testing processes, as well as evaluation measures for this project. A comprehensive algorithm for integrated STI/HIV/viral hepatitis testing, treatment, vaccination and follow-up care was developed by this workgroup. We reviewed testing data from the first 5 months of integration.

Result:
Twelve ICTR programs adapted the algorithm to the specific staff and structure of their individual sites. Over 6477 visits from 4/1/07-9/30/07, 5611 HIV antibody, 689 chlamydia urine, 688 gonorrhea urine, 1020 syphilis antibody, and 1364 hepatitis C antibody tests were performed at ICTR sites. Median age of clients seen was 32 years. Positivity rates were as follows: 0.68% HIV, 5.80% chlamydia, 0.58% gonorrhea, 1.18% syphilis, 11.14% hepatitis C.

Conclusion:
Service integration is a viable way to enhance access to STI, HIV, and viral hepatitis screening and prevention and promotes linkage to treatment and follow-up care.

Implications:
Service integration requires development of policies and procedures to support assessment, counseling, and referrals that respond to clients' risks for HIV, STIs and viral hepatitis. There is a need for integrated data collection systems, capacity to determine rates of co-infection, and measures of the extent to which screening, vaccination, and treatment of active infections may prevent the acquisition or progression of STIs, HIV, and/or viral hepatitis.