Local health departments (LHDs) are on the frontlines of the COVID-19 pandemic. LHD HIV, STI, and viral hepatitis (HSH) programs are being called upon to contribute their clinical, epidemiological, disease investigation, and outreach and education expertise to COVID-19 response efforts. To protect their clients and communities, LHD HSH programs are adapting to this new reality, finding ways to enhance COVID-19 control efforts and continue offering HSH services, all while implementing social distancing and other best practices.

To support LHD HSH programs as they respond and adapt to COVID-19, NACCHO is collecting information on the impact of COVID-19 on their programs and communities. As of early April, more than 50 LHDs—including members of NACCHO’s HIV, STI, and Viral Hepatitis Sentinel Network—have shared their experiences, concerns, and strategies for addressing HSH during the pandemic. This page will be updated regularly based on what we’re hearing from LHD HSH programs. To share your LHD’s experience, please complete please contact Kat Kelley ([email protected]).

Impact of COVID-19 on HSH Programs and Services

Many HIV, STI, and hepatitis programs have reduced or suspended services and activities in response to COVID-19, often because staff are pulled away to focus on the response or to implement social distancing guidelines. Outreach, education, and prevention efforts have been hit the hardest, with many LHDs reporting that these efforts have been suspended and several noting that they are no longer starting clients on pre-exposure prophylaxis (PrEP).

A handful of LHDs have reported clinic closures, but far more have reported reductions in clinical services. Many LHDs report that they are no longer taking walk-in clients and are only offering a limited number of appointments. Many LHD STI clinics are prioritizing cases, only taking symptomatic or confirmed cases and the contacts of people who have tested positive.

Innovative Service Delivery Strategies

LHD HSH programs are exploring innovative ways to continue offering services during the pandemic. Several LHDs reported using telehealth—offering screening, counseling, case management, partner services, and other services via telephone of conferencing platforms such as Zoom. Other LHDs report using express STI testing, so that clients can get tested without having to see a provider, limiting face-to-face contact to reduce the spread of COVID-19. LHDs may also consider syndromic management and presumptive treatment of STI cases, as detailed in a recent Dear Colleague letter from CDC. (To share this guidance from CDC with providers in your community, check out NACCHO’s customizable letter.)

Unfortunately, several LHDs have suspended harm reduction services, but others report offering syringe services by phone, enabling clients to place orders and pick up syringes with limited contact. Several LHDs have also reported that they’ve increased the number of syringes they distribute per visit, so that clients can visit the exchange less frequently. Notably, this is a best practice beyond the context of COVID-19, ensuring people who inject drugs have an adequate supply of syringes and enabling secondary syringe exchange. Another LHD reported that they are considering mailing naloxone, the overdose reversal medication, to clients. This is a promising strategy that may be of interest to other LHDs, as several reported concerns that there will be an increase in overdoses as harm reduction programs close and as first responders and healthcare facilities are responding to the pandemic.

Without LHD Services, HSH Infections and Complications May Increase

One of the most common concerns reported by LHDs is that HIV, STI, and viral hepatitis cases will increase as people are unable to get tested and treated—either due to service reductions or “because they are afraid to go out.” Several reported concerns that “people are continuing to have intercourse and passing along STIs” or that “people will be re-using needles,” and one LHD suggested that there may be “an increase in drug use possibly related to the stress” of COVID-19.

Many LHDs reported that their jurisdictions have already experienced an increase in STIs—including syphilis cases and clusters—and discussed the risk for an outbreak during or following the pandemic. Others discussed the risk for complications, especially those associated with untreated STIs, such as congenital syphilis, pelvic inflammatory disease, and infertility.

In addition to STIs, LHDs also expressed concerns regarding the spread of HIV and viral hepatitis. As one LHD explained, “individuals who have expressed interest in PrEP will be lost to care or [will] have been exposed to HIV by the time that we are able to provide PrEP services to them.” Others expressed concern that “we’re going to miss a sudden increase in hepatitis C,” in part due to the “risk of limited harm reduction supplies and support.”

Remaining Concerns

In addition to sharing the impact of COVID-19 on their HSH programs, LHDs have expressed a variety of concerns they have for their communities in the wake of COVID-19. Many expressed concerns for their clients and marginalized populations in their communities. As one stated, “I’m worried about my clients and hope that they are safe.” Some of them were barely getting by BEFORE this pandemic came along.” Others noted that the focus on COVID-19 is undermining other healthcare services. As one LHD explained, “Everybody’s rightly focused on responding to this pandemic, but the cost of that singular focus is going to include worse outcomes for lots of non-respiratory diseases, especially among vulnerable populations.” Others discussed their relationships with clients, expressing concerns about “the inability to interact with regular clients and put ‘eyes on’ them to monitor for health issues that may require intervention, or to monitor for need for mental health support.”

Several LHDs also expressed concern that existing programs and services won’t rebound after COVID-19 or that new initiatives will be abandoned. LHDs also reported that small LHDs are “stretched to our limits” and concerns that “larger departments with resources to respond will be better positioned to return to normal faster than smaller and rural departments.”

What LHDs Need—from NACCHO, Policymakers, and other LHDs

LHDs emphasized the need for increased funding, staffing, and supplies—and several have discussed how COVID-19 comes after years of budget cuts, when local public health is already “woefully underfunded.” As another explained, “the continued lack of funding for public health over the years has now resulted in a work force that is not adequate to continue the basic services and meet the challenge of the coronavirus pandemic.”

As LHDs respond and adapt to COVID-19, many expressed interest in learning from other LHDs about innovative strategies for service delivery. As one LHD explained, they “would like to hear what other LHDs are doing to provide services in an ‘express,’ ‘low-touch’ manner that reduces interaction among patients and between patient and provider.” Other requests include: guidance on high-risk screening that can be used by clinic receptionists and healthcare workers to prioritize cases; strategies for conducting virtual education, outreach, and community engagement; and best practices in telehealth and home testing.

We applaud LHD HSH programs as they continue to respond and adapt to COVID-19, promoting and protecting the health, well-being, and safety of their communities. We encourage you to continue sharing your experiences, concerns, requests, and strategies with NACCHO by completing this this brief form.

To contact NACCHO’s HSH team directly, email Kat Kelley, Program Analyst, at [email protected]