Examining Program Collaboration and Service Integration (PCSI) for HIV/AIDS, STD, Viral Hepatitis, and TB Prevention in Local Health Departments

Background: Program collaboration and service integration (PCSI) to reduce illness and disease is a high priority of the Centers for Disease Control and Prevention’s (CDC’s) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. However, the level of PCSI implementation in local health departments (LHDs) is largely unknown.

Objectives: To determine whether and where LHDs are providing STD, HIV, viral hepatitis, and TB services; if these services are integrated or coordinated at the client level; and to identify factors that supported or discouraged LHDs to integrate services.

Methods: A web-based survey was administered to a purposeful sample of 80 LHD HIV/STD programs participating in the National Association of County and City Health Officials’ HIV/STD Sentinel Network in April 2009.

Results: Eighty percent of respondents indicated that their LHD provides integrated services; the majority have been doing so for 5 years or more. Of those LHDs providing STD services, 97% offer HIV services in the STD program. The majority (88%) of LHDs providing HIV services have integrated STD screening into their HIV programs.

Conclusions: Some level of integration of STD, HIV, TB, and/or viral hepatitis is occurring at most of the responding LHDs, although this varied across service type. Limited LHD resources and state health department encouragement to LHDs were cited as key reasons that PCSI was implemented.

Implications for Programs, Policy, and/or Research: Future PCSI efforts should build on the experiences of those LHDs who already integrate services. Policy to maximize enabling factors and to reduce barriers to PCSI should be developed. Future research on PCSI should include collecting qualitative data to explore why LHDs did or did not implement PCSI and identify how the services included in and related to PCSI are perceived and defined. Finally, research should determine whether or not health care fragmentation decreased and STD, HIV, viral hepatitis, and TB outcomes improved as a result of PCSI.