Evaluation of STD Programs Deploying Disease Intervention Specialist (DIS) to Improve Human Immunodeficiency Virus (HIV) Outcomes

intervention to be evaluated under this proposal is the deployment of the skilled Disease Investigation Specialist (DIS) workforce to focus on these HIV outcomes in their routine interactions with people at high risk of HIV. For decades, state and local STD programs have supported Disease Intervention Specialists (DIS) to conduct partner services and various other critical public health functions. DIS are specialized public health outreach workers who concentrate on finding, counseling, and bringing STD-infected persons and their contacts to testing and treatment. The work of the DIS is intensive, and can involve confidentially visiting persons at home, on the streets, or in any location where the patient might be found. DIS are experts at eliciting sexual and other contacts from patients, as well as at using databases and other available resources in order to both locate patients and link them with medical care. In doing this, they are very familiar with the communities in which they operate, including relevant provider and CBO networks in those communities.Through this work, DIS have long served as gateways to HIV services for their clients. It is well-established that STD infection among some populations, particularly men-who-have-sex-with-men, is a marker of increased risk for HIV. For this reason, clinical guidelines have recommended testing STD patients for HIV for decades, and partner services guidelines recommend HIV testing of patients and their partners as well. Risk reduction counseling, education and referrals to HIV prevention and care services, and to other medical and social services, are part and parcel of DIS’ work with patients and their contacts or partners. While HIV has been a part of the work of DIS for a long time, it has been heightened and enhanced in recent years due to various convergent forces, including 1) release of the US National HIV/AIDS Strategy, 2) release of new guidelines for PrEP, 3) increases in information technology capacity at the health department and clinic levels, 4) closer integration of programs at the health department level, and 5) data demonstrating the extent of both co-infection of STDs and HIV (particularly for syphilis). Today, many programs are exploring new ways to build upon these opportunities and use DIS to extend their public health contributions. In some areas, this workforce is beginning to devote even more time towards HIV case identification, linkage to pre-exposure prophylaxis for HIV (PrEP), linkage to HIV care, and re-engagement in HIV care. As promising as this model seems, however, not much is known or documented about how best to implement this enhanced approach within state and local health department contexts, and what the costs/benefits are for patients and program. Under this FOA, a select number of STD programs across the country will conduct process and outcome evaluations of their strategies that deploy DIS to improve various HIV outcomes. This multi-site evaluation will assess the effectiveness of integrating HIV outcomes into DIS work and will identify practical lessons for further implementation in those areas and in settings nationwide that are considering similar shifts.