Public Health Nursing Case Management: Reducing Sexually Transmitted Infections

The purpose of this Indian Health Service (IHS) program is to mitigate the prevalence of sexually transmitted infections (STI) within Indian Country through a case management model that utilizes the Public Health Nurse (PHN) as a case manager. The emphasis is on raising awareness of STIs as a high-priority health issue among American Indian / Alaska Native (AI/AN) communities and to support prevention and control activities of comorbid conditions. Case management involves the client, family, and other members of the health care team. Quality of care, continuity, and assurance of appropriate and timely interventions are also crucial. In addition to reducing the cost of health care, case management has proven its worth in terms of improving rehabilitation, improving quality of life, and increasing client satisfaction and compliance by promoting client self-determination. The goals and outcomes of the PHN case management model are early detection, diagnosis, treatment, and evaluation that will improve health outcomes in a cost effective manner. This model uses all prevention components of primary, secondary, and tertiary prevention in the home and community with patient and family.

The PHN Case Management program supports raising awareness of rising STI rates, increasing access to care, strengthening surveillance, and decreasing serious health consequences of undiagnosed STIs. This also supports timely linkage to care in follow-up and treatment to reduce the spread of STIs. The IHS goal is to support and strengthen surveillance systems to monitor STI trends, promote awareness, and identify effective interventions for reducing morbidity and improving outbreak response efforts. Currently, AI/AN men and women are disproportionately affected by STIs compared to other populations within the United States. Chlamydia and gonorrhea rates are four to five times higher in AI/AN populations than non-Hispanic whites. Syphilis and human immunodeficiency virus (HIV) also have disproportionately higher impact on AI/AN people. In 2019, AI/AN women had the highest syphilis rate at seven times the rate among non-Hispanic white females. Effective diagnosis, management, and prevention of STIs requires a combination of clinical and public health activities.