A Model for Providing Comprehensive Services for High Risk Populations: Integration of Infectious Disease Control with Harm Reduction Interventions in a Public Health Department

Background: US health reform efforts are unlikely to eliminate health inequities in the US. The public health system will need to continue its role as safety net provider for the poor, uninsured, homeless, immigrants, adolescents, racial and ethnic minorities, gay, lesbian and transgender populations, incarcerated populations, and persons with substance abuse disorders. While integration of programs has been an important goal of the Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, models of broad integration of are needed.

Objectives: To describe the evolution of integrated public health programs for high risk populations by the NM Department of Health (NMDOH). 

Methods: Description of programs and data collected on public health interventions that a) address the high rates of overdose deaths and hepatitis C that disproportionately impacts Hispanics, b) integrate STD, HIV, TB, and hepatitis clinical and prevention services with family planning and harm reduction interventions, c) provide medication assisted therapy with buprenorphine/naloxone (Suboxone) for persons with opiate addiction.

Results: Public health offices in NM provide syringe exchange programs in addition to infectious disease control and family planning services. Over 5,000 clients have been trained in overdose prevention with naloxone (Narcan) and more than 1500 overdoses have been reversed. Three locations offer medication assisted therapy with Suboxone. Collaborations with jails and juvenile detention centers offer STD, HIV, and hepatitis prevention services including testing, counseling, and immunizations, gonorrhea and chlamydia screening. A pilot program provides opiate addicted inmates with Suboxone upon release from jail to prevent relapse and overdose deaths.

Conclusions: Successful integration of core public health programs with harm reduction and opioid addiction treatment is possible and has a positive impact.

Implications for Programs, Policy, and/or Research: Public health departments can decrease mortality and morbidity in high risk populations by integration of services.