Title "Advancing Rural Health: Routine Sexual and Substance Use Histories"

Abstract

In collaboration with TRAIN, the Kansas Department of Health and Environment (KDHE), HIV Section, and the Colorado Department of Public Health and Environment (CDPHE), STI/HIV/Viral Hepatitis Branch, have developed a new online course, Advancing Rural Health: Sexual and Substance Use Histories. This self-paced online course is designed to offer rural primary care providers the rationale and tools to conduct a patient sexual and substance use history in the context of routine visits and address the unique challenges and approaches to implementing this practice in rural primary care settings.

KDHE and CDPHE recognized that they both have geographical statistical areas (GSAs) which are defined as rural and frontier, and these GSAs also shared similar prevalence and incident rates for HIV/STIs/VH and substance use. Further both KDHE and CDPHE face the same barriers in offering provider training in those regions to adopt routine sexual health and substance use screening into their medical practice.

Provider time and resources are limited, and while a provider may wish to incorporate sexual health and substance use screening into their practice, the desire may not be enough to overcome barriers of limited time. Further, continuing education opportunities are limited, even more so for specialized training in relation to HIV/STIs/VH/SA. Even when these opportunities are available, they often lack the perspective to address the rural context. To address these challenges, this course was designed to reward the provider’s time by awarding CMEs.

This project demonstrates collaboration across jurisdictions to leverage limited funding and human resources to address an identified and common needs in both rural provider populations. Further, this project demonstrates that cross-jurisdictional collaborations can be an effective means to effectively and efficiently leverage resources to meet the needs of similar populations.

While rural settings vary in a multitude of ways, the quaint and connected communities resting in wide-open spaces are still commonly held images of rural/frontier America. Beyond these notions is a rural America that is unique, complex, diverse, and fraught with health disparities.

Today's rural communities are not immune to the problems often associated with urban areas: high-risk sexual behaviors, substance use, STIs, HIV, and viral hepatitis C (HCV). Data suggests that approximately 1 in 5 Americans live in rural areas, with nearly one-half suffering from a significant chronic illness/disease. Yet, rural Americans access healthcare at a significantly lower rate than their urban counterparts.

To address these health disparities, an essential component of every patient’s medical history is incorporating a sexual and substance use history. While many primary care providers in rural communities recognize the importance of taking a sexual and substance use history for the prevention and management of STIs, HIV, and HCV, integration into routine patient visits remains uncommon within primary care practices. By taking a sexual and substance use history, primary care providers play a crucial role in the prevention of STIs, HIV, and HCV. Without sexual health and substance use histories, providers are missing vital opportunities for addressing unknown health concerns, or discovering presenting health problems are only symptoms of unidentified health conditions.

A convergence of unique social, economic, and environmental factors create a multitude of obstacles and challenges for rural providers wishing to implement sexual health and substance use histories into routine medical care. For patients in rural settings, there are also a number of intersectional barriers that patients face in having their sexual behaviors and/or substance use addressed, such as stigma, confidentiality, privacy, and language barriers.

Training provides an opportunity to address stigma, skills, and knowledge, as well as an opportunity for practice/application, to equip rural/frontier providers to conduct sexual health and substance use screenings. However, due to time, staffing, and geographic constraints, attending live trainings can often be a barrier to rural/frontier providers.