STI Prevention and Treatment Services Enhancement Project - Puerto Rico Community Network for Clinical Services, Research and Health Advancement (PRCONCRA), Inc. is requesting $500,000 annually for 5 years under the funding opportunity Enhancing STI and Sexual Health Clinic Infrastructure (ESSHCI) - CDC-RFA-PS-23-0011, to enhance the scope of existing sexual health services provided in-house and improve the current prevention and treatment strategies that aim to diagnose STDs as early as possible; treat them quickly and effectively; prevent new infections; and provide access to support services, essential to address barriers to access care. PRCONCRA’s proposed project will address the burden of STDs in the San Juan Metropolitan Statistical Area (MSA), specifically among Hispanic Men that have sex with men (MSM), Transgender, and women, 13 years of age and older, who are underserved, un or underinsured, and have gaps and barriers to access services. The proposed project aims to achieve this by increasing the identification of new STIs and the access to rapid treatment; improving the patient clinic experience; and increasing linkage to public health partners for prevention and care services for co-occurring conditions. The most recent data of 2021 from the CDC, showed the rates of diagnoses of human immunodeficiency virus (HIV) infection among persons aged ≥13 years and Puerto Rico is the top of the six dependent areas of the United States and is in the top twelve of all United States and dependent areas. In 2020, Puerto Rico had a rate of 564 people living with HIV per 100,000 versus 382 in the United States.2 The primary transmission category is men who have sex with men (MSM) (54%) followed by heterosexual contact (33%). In terms of STDs, in 2020, the reported cases of chlamydia in Puerto Rico were 3,929, with a rise of 885 (4,814) in 2021. Gonorrhea cases reported were 383 in 2020 and 1,013 in 2021 (a rise of 630 cases). The reported cases of syphilis were 775 in 2020, with a rise of 368 cases (1,143) in 2021. The existing infrastructure of STI specialty clinics in Puerto Rico is insufficient to address the STI epidemic, including reducing STI and other related infection morbidity and disparities. In Puerto Rico there are 8 Centers for the Prevention and Treatment of Communicable Diseases (CPTET for its acronym in Spanish), Tuberculosis and Hepatitis to address the needs of all of Puerto Rico. These clinics, located within the 7 health regions of the Puerto Rico Department of Health (PRDOH), are public and have limited resources. The Division of STD/HIV Prevention offers a few basic services through the CPTET, and through collaborative agreements with community-based organizations (CBOs). These services are: (1) Screening tests for syphilis, gonorrhea, chlamydia, and HIV. (2) STI and HIV prevention orientation for people at high risk. (3) Education for people living with HIV about treatment and diagnoses disclosure. (4) Counselling, testing and referral services for sexual partners exposed to HIV. The proposed project also aims to increase program monitoring and accountability by enhancing data collection, reporting and evaluation of outcomes, and developing performance measures specifically for this project. Despite ongoing prevention efforts in Puerto Rico to stop the chain of contagion of HIV and STSs among the communities at highest risk, it continues to cause a burden, especially among men that have sex with men (MSM) and women. By the end of the project period, PRCONCRA expects to achieve the following outcomes, as identified in the logic model: 1: Increase community involvement in clinic-level planning for provision of comprehensive sexual health services. 2: Increase engagement with public health partners addressing the STI epidemic. 3: Increase clinic capacity to provide quality comprehensive sexual health services. 4: Improve patient clinic experience. 5: Increase identification of new STIs by clinics. 6: Increase linkage to public health partners for prevention and care.
