Good afternoon, my name is Taryn Couture, I am the Associate Director of Government Relations for the National Coalition of STD Directors. I am speaking to you on behalf of our membership, the 65 states and localities funded by the CDC Division of STD Prevention.  Thank you for the opportunity to provide input on the first ever STI Federal Action Plan. This plan comes at a time when the United States if facing STI’s that are at an all time high and continuing to worsen. We expect that this plan will be a roadmap for the Federal Government’s response. It will provide goals, objectives and measurable standards across all Federal agencies and within DHHS.

My comments today are the result of work being done by a group of our members. I will present our thoughts on goals, objectives and activities which we feel must be taken into consideration when developing this plan.

In our view, these epidemics are so widespread and are increasing at such rapid rates, that there is no one action or sector that can stem this tide. All aspects of the healthcare and related systems must play a role. Barriers to preventing, finding and treating these diseases in the areas of funding, regulations and societal attitudes must be identified and eliminated.

I will start with some of the broader goal areas for consideration, and these include:

• Improving STI Surveillance
• Expanding STI Screening
• Improving STI Treatment
• Engaging all areas of the healthcare system to provide STI services
• Expanding STI behavioral and clinical research
• Reducing disparities in STI testing and treatment

In addition to these broad goals, key components that our members identified as essential to the development of a successful plan include:

In the area of surveillance

• • Improve surveillance systems that allow for better sharing between HIV and STI systems, as well as increasing data sharing between jurisdictions, especially adjacent jurisdictions.
  • Improve surveillance efforts to identify STI hot-spots to help prevent new cases, and treat active cases to prevent them from spreading. This means calling for investment in a national standard for base level technology used to track and identify cases.

In the area of Expanding STI Screening

• • All Federal health care programs should increase screening and appropriate treatment for STIs.
  • Engage new options for STI testing: We know due to stigma not everyone is comfortable coming to a healthcare provider, or, that many people do not live near an accessible STI care center. Therefore, we must develop and push-out new options for testing including home-testing, leveraging mobile apps, and telemedicine.
  • Increase STI services at school-based health centers, and medically accurate comprehensive sex education.
  • Increase the use of three site testing for STIs, and get approval for NAAT testing for extragenital testing to improve case ascertainment and prevention. This will require intervention by CMS and in other health insurance entities to ensure this base level of care is covered and available.

In the area of Improving STI treatment

• • Improve and increase training of healthcare providers to obtain sexual health history and test for STIs. If we do not ensure all providers have this basic knowledge, we will continue to see STIs, and increase the likelihood of new STI cases.

In the area of engaging the Healthcare system

• • Increase STI coordination, including testing and treatment, across all Federal agencies – Departments of Defense, Justice, Agriculture (WIC) and within DHHS, including with MCH, HIV, family planning, primary care, substance abuse, and school health.
  • Working with CMS to reduce barriers to adequate payment for STI screening and treatment in both public and private insurance.

In the area of research

• • Work with NIH to develop vaccinations to prevent against STIs
  • Work with NIH and pharmaceutical industry to develop new diagnostic and treatment modalities.

In the area of reducing disparities

• • Reduce stigma around STIs by engaging and encouraging the voices of people living with, or who have had, an STI via wide-spread media campaigns.

Finally, some additional comments, at a time when there are almost 1200 infants born in the country with Congenital Syphilis, a totally preventable disease. It is time to implement congenital syphilis review boards, which review each CS case and identifies missed opportunities for prevention, and opportunities for follow-up actions and system level changes, in all states. Unfortunately, we are at the point now where most states have at least one case of congenital syphilis and the numbers continue to rise. We must also increase pre-natal testing, correct treatment and follow-up. We must develop strategies to deal with women who for a range of reasons to not receive pre-natal care but are infected with syphilis.

These are just a few of the suggestions that we have heard from the national STI prevention community.  At the foundation of a Federal STI Action Plan are the existing STI prevention programs who are on the front lines of STI prevention around the country.  We look forward to providing more detailed suggestions in writing by June 3 and thank you for this opportunity