More than 1 in 5 people in the U.S. have a sexually transmitted infection (STI), according to the U.S. Centers for Disease Control and Prevention. And rates are climbing thanks to pandemic-related drops in screening, diagnosis and treatment.
To stem the tide, a team of University of Pittsburgh pharmacists, students and alumnae recently launched an innovative pilot program in collaboration with the Allegheny County Health Department to expand testing and treatment locally, particularly among young adults in underserved communities. They’re committed to sharing what they learn with pharmacists across the country.
The idea was born when Dr. Alexandria Rothey, who graduated from Pitt’s School of Pharmacy in 2018, approached her alma mater about a grant opportunity from the National Association of County and City Health Officials to launch a community-based STI testing pilot program. With help from Lindsey Kampas and Leah Castelnovo, who are both Pitt Pharmacy students, Dr. Joni Carroll, assistant professor from the Community Leadership and Innovation in Practice (CLIP) Center at Pitt’s School of Pharmacy, led the team in applying for the grant, which they received.
The pilot program examines how pharmacies can expand access to STI services by providing young adults ages 18 to 24 with the ability to test for gonorrhea and chlamydia at home. Among the most common STIs in the U.S., gonorrhea and chlamydia are very treatable once diagnosed.
“Pharmacies are one of the most accessible health care providers,” Carroll explained, noting that Pitt research found 9 in 10 Americans live close to a community pharmacy. “Being able to open up an access point for both testing and treatment is key.”
Given the sensitive nature of STIs, however, encouraging young adults to seek testing and treatment can be challenging, noted Rothey, who is now the pharmacist at Hilltop Pharmacy in the Allentown neighborhood of Pittsburgh.
“Many people don’t have transportation, or they don’t want to walk into a clinic labeled ‘STI,’” she said. “Hopefully this program will start to destigmatize this testing and create a trusted contact point for health care.”
Young adults seeking the newly available STI tests can access them through an online portal provided by Color Health. After they complete a demographic form, a test kit will be sent to their home or, if preferred, Hilltop Pharmacy. Results will be made available through the online portal, which is also accessible on smartphones. And if the test is positive and treatment is needed, the portal will provide direction.
Rothey describes the process for clients who choose to have their test sent to Hilltop Pharmacy as very discreet. “When you come to pick up your STI test, we put it in a regular prescription bag so that it is as inconspicuous as possible. We do the same thing on the treatment side — we can take them aside to a private room to provide consultation. This way no one knows what they are there for.”
Dr. Thai Nguyen, public health pharmacy fellow at Pitt, serves as the liaison between the Allegheny County Health Department STI Program and Hilltop Pharmacy.
“The county’s STI program has been running for a long time, and they have a lot of knowledge on different medications,” Nguyen said. “We’re able to share what they know from experience with the team at Hilltop Pharmacy, and also share what the pharmacy learns about community outreach with the county’s STI clinic. It’s a great partnership.”
Increasing access and removing barriers to testing and treatment is the key goal of the pilot program, said Dr. Kelsey Hake, the senior program manager in the CLIP Center.
“This program is a perfect example of how patients can go to their community pharmacy and receive various types of patient-centered services,” she said. “Young adults can go to the pharmacy, receive the STI test or have it mailed to their home, and get treatment in a place where there is maybe less stigma or more accessibility.”
The Pitt Pharmacy team will evaluate the implementation of the pilot program, assessing how feasible and acceptable community STI testing is for both community members and pharmacists. Their hope is that if this pilot is successful, the program can expand into testing other STIs such as syphilis and HIV.
In addition, Pitt Pharmacy students Jordan Ciraolo and Emily Drake are working with Nguyen and Hake to lead the development of a Community Pharmacy Home STI Testing Toolkit using the findings from this project so that community pharmacies nationwide can easily implement their own home testing program.
“While COVID-19 may have contributed to the rising rates of STIs, it also created new partnerships and elevated the importance of the community pharmacy in providing care to some of the hardest-to-reach communities. Think of all the COVID-19 vaccinations and tests administered in pharmacies,” Carroll said. “We believe those connections can now be leveraged to fight the spread of STIs and address many other barriers to health in our communities.”
Dr. Julia O’Brien is a postdoctoral fellow in the University of Pittsburgh School of Nursing. She is participating in the UPMC Science Writing Mentorship Program.