(Missouri Independent) – As the case counts of the novel coronavirus began to tick up last March across Missouri, providers who offer tests for sexually transmitted infections (STIs) found their resources were being pulled in two directions.
Swabs were in short supply as they became needed for COVID-19 testing. Contact tracers, who reach out to track an infection’s spread, had to be shifted to doing the same for the novel coronavirus.
Clinics cut back locations and scaled back hours. Some had to temporarily pause their STI testing services altogether. At a state level, data entry of case surveillance was delayed.
It has left providers concerned that as the state and globe poured its energy into curbing one pandemic, an epidemic was quietly spreading.
“Not being able to have routine testing definitely increased the rates of infections that we’re seeing now,” said Carla Lantz, a certified nurse-midwife at Planned Parenthood’s Springfield Health Center.
A new program aims to help curb the spread of new infections, by offering free STI testing and treatment services to patients at Planned Parenthood’s Springfield and Joplin locations — areas where sexually transmitted infections have been on the rise amid high uninsured rates in southwest Missouri.
“So whether they have one partner or 17 partners, we can make sure everyone in their cohort has been treated,” Lantz said.
Routine testing is especially necessary for STIs, which often don’t exhibit external symptoms. If people don’t suspect they have an infection, they can unknowingly pass it on to others, or it can develop into serious complications, like pregnancy problems as a result of syphilis — which has been on the rise throughout rural Missouri.
Nicole Massey, the outreach and prevention director for the AIDS Project of the Ozarks, a nonprofit that also offers free STI testing and treatment in southwest Missouri, said the more opportunities for such services, the better.
“There is certainly the need for that,” Massey said. “And I don’t see that declining or changing anytime soon.”
A new high
Providers say accessible STI testing services are especially needed now. Before the COVID pandemic began, STI rates were already on the rise.
New data released last month by the Centers for Disease Control and Prevention found that nationwide reported STI cases reached an all-time high in 2019 of more than 2.5 million cases — the sixth consecutive year of a new record. Black, Latino and Indigenous people, gay and bisexual men, and 15-24-year-olds were some of the hardest-hit groups.
Previous progress in curbing the spread of STIs like gonorrhea, syphilis, and chlamydia “has since unraveled,” Paul Romaguera, the acting director for CDC’s Division of STD Prevention, said in a news release last month.
How the pandemic has impacted reported cases is not yet fully known. At a state level, STI case data for 2020 is delayed. Currently, provisional monthly numbers are only available through April 2020.
That’s because staff reassignments to respond to the COVID pandemic has caused a data entry delay, said Lisa Cox, a spokeswoman for the Department of Health and Senior Services.
Despite the lack of statewide data, providers in southwest Missouri say demand hasn’t wavered.
“We did not see any kind of decrease in the number of patients who wanted testing and who wanted care,” Lantz said.
What did dwindle was the number of testing opportunities that providers could offer.
At Planned Parenthood’s Springfield Health Center, the number of appointments was limited in order to maintain social distance and keep people safe within the clinic. And with a shortage of testing supplies early on in the pandemic, meant patients exhibiting symptoms had to be prioritized — limiting options for preventative care.
At the AIDS Project of the Ozarks, walk-in clinics had to be limited to one appointment an hour, and a downtown Springfield location that served a large number of people experiencing homelessness had to be temporarily suspended for roughly five months.
“That was a real struggle for people, particularly if you’re calling in with some symptoms,” Massey said. “You can imagine, it’d be a real struggle to wait a week or two to be able to get in for testing and then wait a week or two after that to get your result.”
This year, demand reached a recent high for the AIDS Project of the Ozarks.
From January to April 2021, the organization’s clinics have averaged 324 tests per month — more than double a low of 147 tests per month between April and August 2020 when its downtown location was closed amid the pandemic. And that’s compared to an average of 222 tests per month for all of 2019.
Massey said the heightened demand is likely due to what she suspects is increased infections, in addition to handling patients that may have otherwise gone to other high-volume providers who had to stop their services amid the pandemic.
Due to the coronavirus’s spread, the Springfield-Greene County Health Department paused its STI testing services altogether last March.
“Individuals who staffed the STI clinic were redirected to assist with disease investigations and serve as vaccinators,” Sean Barnhill, a spokesman for the department, said.
Instead, residents were referred to the AIDS Project of the Ozarks. The department is planning for a phased-in opening of the STI clinic in June, Barnhill said.
Providers having to choose between testing for COVID versus for STIs exemplifies the lack of funding for STI services, and public health more broadly, Massey said.
Michelle Trupiano, the executive director of the Missouri Family Health Council, Inc., said the pandemic did help foster new approaches, with health centers in their network setting up telehealth services for the first time, holding drive-by clinics, or mailing STI testing kits home to patients when necessary.
With COVID cases declining and vaccinations rising, both Massey and Lantz said services are beginning to resume to normal levels — with more availability and shorter wait times. Massey predicts it will likely be a full year before providers understand the true impacts the pandemic had on infections.
While many barriers were exacerbated by the pandemic, free testing services help eliminate at least one hurdle to getting tested: cost.
“We also see quite a few people coming to APO who might have been tested at the emergency department or some other setting, but don’t have the money to afford that treatment,” Massey said.
Lantz hopes Planned Parenthood’s new program, which is funded through a grant from the Planned Parenthood Federation of America, can help “to try to make a dent in this epidemic.”
‘It’s patients who lose out’
But at a statewide level, Lantz says more funding is being left on the table.
Last week, Gov. Mike Parson announced that Missouri would not expand voter-approved Medicaid coverage July 1 because lawmakers refused to include funding for the health care program in the state budget.
Lawmakers also ended the 2021 legislative session Friday without renewing a tax bill, known as the federal reimbursement allowance, that last year accounted for $2.3 billion of Missouri’s $10.8 billion Medicaid program. The reason why: a fight over whether to bar public funds from being used to pay for some methods of birth control — which could put the entirety of Missouri’s Medicaid program in jeopardy — and an effort to exclude Planned Parenthood from the program.
At a federal level under the Trump administration, Planned Parenthood left the title Title X program, a national grant program that covers family planning services for low-income individuals, after a rule prohibited providers from referring patients for abortion. A recently proposed rule under the Biden administration would roll back that restriction.
If Title X funds are available, Lantz said that would help Planned Parenthood offer programs like free STI testing and treatment at more of its locations across Missouri.
Eliminating providers from accessing funds ultimately creates holes in the safety net, leaving other budget-strapped providers to try and hold it up as best they can, Trupiano said.
Ultimately, patients are left having to navigate the changes, she said. One year, they may receive services at no cost. Whereas the next, they may no longer be able to access those same services for free.
“And so at the end of the day,” Trupiano said, “it’s patients who lose out when we create all that uncertainty.”