A National Overview of Challenges Faced by STD Programs and Their Engagement in External Partnerships, As Reported in Annual Progress Reports Submitted to CDC

Background: Public STD programs in the United States face numerous challenges, but also new opportunities.   

Objectives: Using progress reports submitted to CDC by city and state health departments, we assessed how STD programs are affected by and adjusting to this changing context.

Methods: A trained researcher coded the 2009 annual progress reports (APR) for any content that described a challenge to implementing STD programs, recorded all collaborative endeavors involving external partners, and summarized the resulting qualitative and quantitative data.

Results: The majority of project areas described how budget cuts and staff turnover, furloughs, and shortages negatively affected program activities.  Sixty-nine percent of project areas noted at least one challenge pertaining to surveillance and data management, such as incomplete records, technological issues, and difficulties in obtaining data from partner organizations.  Just over 40% of project areas indicated a challenge pertaining to partner services, most commonly, the inability to locate partners.  Collaborating with external partners, the scale-back and closure of STD clinics, and non-compliance with screening recommendations are examples of challenges pertaining to screening, which were noted by 36% of project areas.  

The 58 project areas named a total of 516 organizations in the APRs.  The most commonly cited types were non-profit organizations (27.5% of all cited organizations), correctional/drug treatment facilities (20.4%), schools (13.2%), and health care facilities (10.1%).  Screening activities and community-wide initiatives most frequently involved external partners.  Project areas that cited budget problems were less likely to report working with a large number of external partners (29.6% versus 55.2%, p=0.05).

Conclusions: Several challenges were repeatedly described by project areas across the country; other issues were observed, such as a scarcity of collaborations involving health care providers.

Implications for Programs, Policy, and Research: Identifying solutions to common problems should be a research and programmatic priority.