Yuba County is a small, mainly rural county in northern CA with an approximate population of 83,421 residents per the US Census. Sexually transmitted diseases (STDs) have increased exponentially in the past several years locally in Yuba County. In the past five years, the rates of chlamydia has increased in Yuba County from 401.6 to 415.4 cases per 100,000 residents. The rates of syphilis has significantly increased from 17 to 84.1 cases per 100,000 residents nearly a 5-fold increase.
In California, incarcerated individuals are among the individuals most impacted by STDs and among one of the high-risk groups recommended by the CA Department of Public Health for targeted interventions. Beginning in 2021, Yuba County Public Health initiated conversations with Yuba County Jail and their jail medical provider (WellPath) to discuss the implementation of an STD opt-out testing program to allow for timely diagnosis and if positive, treatment of chlamydia, gonorrhea and syphilis among Yuba County jail inmates. Timely treatment for STDs not only allows for reduction in further medical complications for the inmates, but also assist in reducing the risk of transmission to others in Yuba County general population.
The intent of this project is to provide opt-out testing for each inmate for chlamydia, gonorrhea and syphilis as soon as possible after booking into the Yuba County Jail. Opt-out testing is defined as performing STDs testing after notifying the patient/inmate that the tests will be conducted and that they may decline or defer testing. Opt-out testing is conducted regardless of symptoms presence since often patients with STDs do not have symptoms.
If the STDs testing is positive, medical evaluation including treatment will be provided by WellPath as the contracted Jail medical provider. A public health nurse will provide further linkage to care on release from the jail, including case management, referral to outpatient clinics if needed, and initiation of contact tracing of sexual contacts. A public health social worker will assist with connection to community supports including but not limited to assistance with connections to Medicaid enrollment, housing connections, etc. The objective of this project is is to address not only the STDs medical needs of the inmates, but also other medical/behavioral health needs and social determinants of health, ultimately addressing these high-risk patients utilizing a whole-person approach.
The agreement between the Sheriff Department and Health Human Services Department with WellPath took a year to be executed. Negotiations took a long time since it occurred between two county departments, and then when finalized within the county, between Yuba County and WellPath. Finally, the agreement was presented publicly to the Yuba County Board of Supervisors in September 2022 and once approved by the Board, the project implemented in mid-September 2022. Since then, the STD Opt-Out testing has been successfully implemented with key monthly metrics submitted back to Yuba County Public Health as below:
Monthly Data Submitted to Yuba County Public Health:
· Number of inmates booked in a 30 day period
· Number of inmates tested for chlamydia, gonorrhea, and syphilis in a 30 day period
· Number of inmates who tested positive for chlamydia, gonorrhea, and syphilis in a 30 day period
· Number of inmates who tested positive and treated for chlamydia, gonorrhea, and syphilis in a 30 day period
In the few months of the opt-out implementation, we have seen remarkable results. Of the new inmates coming into the Jail, from 13-20% of new inmates have agreed to STDs testing. Of those who agreed to testing, the test positivity rate for chlamydia and gonorrhea was 7-9% and the test positivity rate for syphilis was 7-13%. All positive cases were successfully treated fully within the Jail.
The success of this program relies on close engagement between Yuba County Public Health and the Sheriff Department and WellPath from project planning to implementation. Throughout 2021 and 2022, Yuba County Public Health met several times with the Sheriff Department and WellPath to explain our proposal and the need for STD opt-out testing to ensure timely diagnosis and treatment of asymptomatic patients with STDs. In addition, we were able to utilize STD grant funding to accommodate the additional STD testing and treatment costs thereby alleviating any concerns from the Sheriff Department that this will increase their medical payments to WellPath. In addition, we stressed that the monitoring metrics will be easy to collect through Survey Monkey and all the analysis will be with our Public Health Department. Finally, we initiated monthly check-in meetings with the Sheriff Department and WellPath to ensure that we can identify any areas of improvement in a timely manner. For instance after the decline of STD opt-out testing in October 2022, we heard from WellPath that inmates were concerned that the test samples would be utilized for drug testing, in addition to STDs. Upon hearing that, our team was able to draft scripted messages to provide to WellPath staff to reassure inmates that these tests can only be utilized for its intended purpose and no drug testing can be done without the inmates' consent.
We have not implemented the embedding of social workers and public health nurses within Yuba County Jail but are planning on doing so by January 2023. Once they are embedded within the Jail, Yuba County Public Health will be working with the Jail and WellPath to track the post-release referrals categorized as medical referrals, behavioral health referrals, insurance referrals, housing referrals, etc.
Yuba County Public Health does not have its own website, however below is the website for Yuba County Health and Human Services:
https://www.yuba.org/departments/health_and_human_services/index.php