Silo-Busting: Integrating Activities Across HIV, Sexually Transmitted Disease (STDs), TB, and Viral Hepatitis Programs At the New York City Department of Health and Mental Hygiene

Background: In many US health departments, syphilis, chlamydia and gonorrhea prevention activities are often programmatically separate from those of other infectious diseases, such as HIV, TB, and viral hepatitis. Silo-ed health department programs share goals of primary prevention and optimal screening and treatment for at risk groups.  Separation of programs can reduce efficiency of administration and prevention services.  In 2010, DOHMH was awarded funding from CDC to identify ways to integrate program activities. 

Objectives: To integrate cross-cutting activities on STDs and other related infectious diseases across DOHMH and reduce the silo-ing  of programs. 

Methods: We interviewed key DOHMH staff; reviewed syphilis, chlamydia, gonorrhea, HIV, TB and viral hepatitis surveillance data; and reviewed program priorities and activities.

Results: Priority needs that emerged included: data sharing and linkage projects; unified training and outreach for community-based organizations (cbos) and providers; and review of contracts awarded by DOHMH to service providers.  Analyses of integrated data revealed 19% of zip codes with high rates of all or some of the following infections: HIV, syphilis, chlamydia, gonorrhea, TB, hepatitis B, and hepatitis C.  Over the next two years we will link disease surveillance registries to measure prevalence of co-infection and provide technical assistance to providers in heavily impacted areas to integrate services. We will also coordinate agency contracts with community providers and develop an integrated training curriculum for community-based organizations whose populations are at risk for multiple infections.

Conclusions:  By focusing on common populations and services, health departments may be better able to utilize resources to do more with less.  

Implications for Programs, Policy, and Research: Silo-ed public health programs miss opportunities for prevention of all important infectious diseases; this can result in gaps in knowledge and fragmented services for the public.  Efforts to integrate infectious disease activities should create greater efficiencies within health departments and improve services to the public.