In this newsletter, you will find updates from the Division of HIV and STI Programs (DHSP). If you have any questions or feedback about the newsletter, please reach out to us at: MDHHS-SHOARS-Support@Michigan.gov.
Dear Partners,
I want to thank you for everything you have done to support the mission of HIV/STI Care and Prevention in 2021. This has been another challenging year for us all and I am not sure if the end is in sight. What I do know, is that this field, and the people who work in it, have shown great adaptability and resilience in supporting services for people affected by HIV and STIs. I know this has not gone without its own set of challenges. Many of us are juggling multiple hats, are stressed by the unknown and workloads, and have had stressors outside of work that have been significant—whether that for you is isolation, family burdens, or the loss of a loved one—I want you all to know that I see you. And I greatly appreciate you.
In the field of HIV and STIs, there are some major obstacles ahead that we need to continue to focus on in 2022. We know that there remain interruptions to safety net services, especially at local health departments. With increasing STI rates and decreasing testing rates for STIs and HIV, we need to make sure that those who seek services can get timely testing and treatment. We need to continue to focus on the concerning increase in congenital syphilis by implementing innovative strategies to increase testing and outreach to pregnant women, women of child-bearing age, and providers. We also need to continue to implement projects related to Ending the HIV Epidemic in Wayne County and focus on providing services for people living with HIV.
Amid all the hard work, there is a lot to look back and be thankful for this year. One is the development and implementation of the STI/HIV Operations and Resource System (SHOARS). Our Division, like you, has so many needs related to training, grants and contracts, and various requests. SHOARS increases productivity for us so that we can dedicate more time and energy to the people we serve. Thank you for your engagement with SHOARS in the last few weeks. Secondly, is the unprecedented funding to our Division to build a DIS workforce. We believe that DIS are one of our strongest tools in the HIV/STI care and prevention toolbox. DIS make up the backbone of HIV/STI public health work. We are so excited to have been awarded additional funding to increase our DIS workforce capacity and create a huge impact. While we await appropriation of these state funds, we have plans to increase the DIS workforce and ramp up training, especially for hepatitis C, perinatal HIV/STI, gonorrhea and DIS at the local health department level.
Once again, I want to thank you all. I appreciate all of the hard work and dedication you put towards HIV/STI public health and I look forward to another year of impactful work. I hope you have a safe, healthy, restful, and rejuvenating holiday season.
Katie Macomber | Director | Division of HIV and STI Programs
Females with Syphilis? - Yes, it's a Thing!
The rate of females diagnosed with primary and secondary (P&S) syphilis cases has increased over 300% since 2017: rising from 33 in 2017 to 120 in 2020. P & S syphilis refers to cases that have been contracted in approximately the last six months. These are the stages when syphilis is most infectious and easy to spread. As shown in the figure below, the proportion of Michigan syphilis cases that are female has increased substantially in recent years.
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A total of 426 female syphilis cases were reported in 2020 in Michigan; more than we have seen in decades. Not coincidently, the number of congenital syphilis cases (babies born exposed to syphilis), increased 80% in just one year from 2019 to 2020. At MDHHS, a workgroup has been assembled to develop a plan to address this increase from multiple perspectives. Through a combination of provider and community education, increased wrap-around services, and patient engagement, we will work to achieve the following intervention goals:
- Increase awareness among females of childbearing age that syphilis “is a thing” for them and encourage them to seek screening.
- Increase the number of females of childbearing age who are screened for syphilis in all/any healthcare setting or visit.
- Increase the number of pregnant women who access early prenatal care.
- Increase the number of pregnant women who are screened at recommended points in their pregnancy.
- Increase the number of women diagnosed with syphilis who complete their treatment and follow-up testing in a timely manner.
Our hope is to achieve these intervention goals and reduce the number of cases of female syphilis that we are seeing in Michigan.
If you would like to explore how you or your program can join the fight against syphilis among females and babies, please contact Amy Peterson at petersona7@michigan.gov, or Karen Lightheart at lightheartk@michigan.gov.
Together we will make a difference.
On November 29th, our division launched the STI/HIV Operations and Resource System, also known as SHOARS. This system allows our partners to interact with us easily and efficiently. Many of our partners have already registered and started to use SHOARS. You should plan on registering and using SHOARS if you are someone who:
- is a DHSP partner.
- is associated with an HIV/STI program.
- receives funding from DHSP.
- attends trainings, events, or conferences run by DHSP.
- requests HIV/STI: supplies, data, health promotion materials, technical assistance, etc. from DHSP.
- interacts with DHSP.
Learn more at Michigan.gov/SHOARS.
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Over the past year, members of the HIV Care and Prevention Section and STI Section have been working with United Way and 211 to develop a HIV/STI Prevention and Care specific 211 landing page.
This project emerged from an amazing site visit with a local health department who was part of the MDHHS Medicaid SIMs project 2015-2017. Reflecting on the need for a more accurate resource inventory, and seeing the connection between community resources, the LHD, and 211, was what truly sparked this initiative. To foster the success of this effort, DHSP staff have worked to update contract language to ensure agencies have the most up to date information in 211, developed HIV/STI specific language for the landing page, and provided updated services i.e. self-testing, case management, etc. to 211. Look for more information regarding this project coming in Spring 2022.
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Tackling the rate of HIV transmission is one of the highest priorities for MDHHS. One of the most useful tools to do this is Non-occupational Post Exposure Prophylaxis (nPEP). Per guidelines from the CDC, nPEP is an antiretroviral medication regimen that is recommended for individuals without HIV infection who have experienced a potential HIV exposure in the last 72 hours. When used as directed, nPEP is highly effective at preventing new HIV infections when initiated within this 72 hour window (the sooner nPEP can be initiated within this window, the better). To highlight CDC guidelines on nPEP, MDHHS has developed two guidance documents to assist healthcare providers with the prescribing of nPEP. You can view an extensive guidance on nPEP here or an excerpt quick reference guidance here. If you have any questions about nPEP, please contact Levi Berkshire, Biomedical Prevention Coordinator, at BerkshireL@michigan.gov.
Below is a sneak peak of the 2022 DHSP training calendar. These trainings are currently being added into SHOARS and will be available to view in early January. All 2022 trainings and conferences will be held virtually. In SHOARS, you can view all details pertaining to the trainings as well as register to attend trainings. From now on, in order to attend any training or conference offered by DHSP, you must go through SHOARS to register.
In July, the CDC released new treatment guidelines for STIs that include major changes to its chlamydia and trichomoniasis regimens for index clients. DHSP consulted with representatives from the Michigan Pharmacy Association, Family Planning and Adolescent Health Nurse Practitioners, and fellow state Expedited Partner Therapy (EPT) champions to gain their perspectives on the best treatment modalities for EPT. The consensus among these stakeholders was to align Michigan’s EPT regimen with the CDC recommendations for index patient treatment. The chart below presents the newest MDHHS recommendations for EPT when treating chlamydia, gonorrhea, and trichomoniasis in Michigan. You can also view Michigan's EPT guidance for health care providers here. Providers are encouraged to utilize shared clinical decision making with index clients to determine the best treatment modality for sexual partners. For additional questions please contact the Bianca Clarke, Partner Health Improvement Coordinator, at ClarkeB3@michigan.gov.
It is estimated that 8-9% of PLWHA who are involved with Ryan White programming experience housing instability/homelessness. In the homelessness response system, the Continuum of Care (CoC) is a federal Housing and Urban Development (HUD) program that provides funding to address homelessness. A CoC is also a local or regional planning body that determines needs, priorities, and funding distribution for the homeless response system. The CoC is made up of a variety of community-based organizations, local government, and individuals who have experienced homelessness.
Larger communities have their own CoC that receives funding directly from HUD but in Michigan, we also have 61 rural counties that are covered by the Michigan Balance of State CoC (MIBoSCoC). In this case, each community has a Local Planning Body (LPB) that has representation in the larger MIBoSCoC.
If you are working with PLWHA experiencing housing instability/homelessness, please consider being a voice at the table of your local CoC. Check out the MSHDA CoC and Local Planning Body contact list to find your CoC or LPB. Meetings are open to the public and offer a great opportunity for you to learn about what your local community is doing in response to housing instability/homelessness and how it could potentially help some of your clients/patients.
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MDHHS DHSP has partnered with Oakland County Health Department (OCHD) to launch a successful 340B Pre-Exposure Prophylaxis (PrEP) Program to expand PrEP services in Oakland County. The PrEP 340B Program was launched with OCHD in July 2020 and has provided the ability for OCHD to build sustainability in offering PrEP and other STI-related services at their agencies, as well as allowing MDHHS to use shared cost-savings to expand access to PrEP services across the state. The PrEP 340B Program has shown great potential to generate program income for 340B covered entities that would support the expansion of PrEP for HIV prevention in areas that are currently unsupported by available federal funding streams.
The 340B PrEP Program allows MDHHS to purchase relevant drugs at the federal 340B negotiated discount and to bill patient health insurance (if available) at the full price of the medication. Revenue generated by the 340B program must be reinvested back into services and activities within the scope of the federal grant used in the 340B designation.
The Michigan Medical Monitoring Project (MMP) recently released two documents to support MMP efforts throughout the state:
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Detroit Metropolitan Area (DMA) vs. Outstate Report: This document highlights areas of key differences between our MMP participants in the DMA and those outstate. The report details areas such as demographics, transportation, needed and received services, and ART use among other variables.
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Stigma/Mental Health Fact Sheet: Stigma can have a negative impact on the mental and physical health of those affected by it. This fact sheet displays the relationship between instances of stigma and how those instances compare to a participant’s depression and anxiety scores. There is emphasis within this fact sheet on stigma in relation to gender and mental health.
To learn more about MMP, please visit Michigan.gov/MedMonitor.
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Thank you for reading our newsletter.
DHSP newsletters come out four times a year. Please send any feedback to MDHHS-SHOARS-Support@Michigan.gov. Please feel free to share this newsletter.
Michigan.gov/HIVSTI
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