I present in this commentary a critical analysis of the main messages and practical applications of 8 articles regarding prevention and control of sexually transmitted infections such as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection, syphilis, gonorrhea, Chlamydia infection, and human papillomavirus (HPV) infection, included in this month's Journal of Public Health Management & Practice. Four articles on HIV/AIDS prevention describe efforts to improve retention in HIV/AIDS care,1 opt-out HIV/AIDS screening,2 quality of HIV/AIDS testing data,3 and the impact of patient care navigators for homeless persons living with HIV infection.4 Two articles report on improving sex partner services to prevent HIV infection, Chlamydia infection, gonorrhea, or syphilis5 and assessing the relative effectiveness of methods for delivering sex partner services to prevent gonorrhea.6 Two articles on HPV vaccine report on improving adolescent HPV vaccine coverage in managed care plans7 and an intervention to increase adolescent HPV vaccine uptake in federally qualified health centers.8

Considered together, the 4 articles on HIV/AIDS prevention reinforce the notion that the public health principles of surveillance, screening, early diagnosis, and treatment to achieve viral suppression can be applied in sequence to substantially reduce the risk for HIV transmission that sustains the epidemic in particular geographic locations.9 A critical analysis of the main message and practical application of each article supports the following perceptions. First, Tesoriero et al1 evaluated a pilot study in Erie, Monroe, Onondaga, and Westchester counties in upstate New York during September 2013-August 2014. They concluded that HIV/AIDS surveillance data can be used along with extended partner services delivered by disease intervention specialists to link persons living with diagnosed HIV infection back into medical care after a period out of care. Their evidence and reasoning persuaded me that this approach can be effective outside large metropolitan areas or closed health care systems when the activity can be justified in similar counties elsewhere. Second, Lin et al2 demonstrated that a decision-support algorithm in an electronic medical record system can successfully automate routine opt-out screening for HIV infection among patients examined in a university hospital emergency department in Chicago, Illinois, during November 2014-July 2015. Because HIV/AIDS screening increased from a monthly average of 7 tests before to 550 tests after implementation, the authors attributed the change to the decision-support algorithm. Although the increase was large, there were no concurrent controls in a similar system without the algorithm; therefore, the change could have been caused by other factors. Thus, the authors' assertion that similar innovations can be useful in screening for other diseases in similar clinical settings elsewhere still needs to be validated with empirical evidence. Third, Beltrami et al3 used data collected by providers of HIV testing services and delivered to clients during 2008-2011 to assess data quality before and after the Centers for Disease Control and Prevention (CDC) provided feedback regarding data quality (eg, percentages of missing and invalid values of selected variables) to 44 state and local health departments that had provided data to the CDC. Because the evidence supports the authors' conclusion that feedback reporting contributed to increased data quality, their recommendation that the CDC and health departments continue monitoring data and implement measures to improve variables with low completeness is reasonable. Fourth, Sarango et al4 conducted content analysis of transcripts of 81 in-depth interviews with clinic staff and 2 focus group discussions with patient navigators at 9 demonstration sites across the United States during 2012-2015. The analysis identified key roles and responsibilities required to help patients with HIV infection and mental or substance abuse disorders, who were homeless or living in unstable housing, to acquire effective medical care and stable housing. The authors concluded that patient navigators can help clients secure a patient-centered medical home with completed appointments, comprehensive care plans, caring relationships with providers inside and outside health care systems, increased patient self-management, and stable housing. Because the authors did not clearly describe the population represented by the sample studied, however, the populations to which the findings can be generalized remain unclear.

Considered together, the 2 articles on improving sex partner services reinforce the importance of partner notification and treatment of infected partners to interrupt repeated exposure of the index patient to infection that sustains a transmission network.10 A critical analysis of the main message and practical application of each article supports the following perceptions. First, Martin et al5 used data from 9 county and regional public health clinics in New York State to demonstrate that the time expended in processing index patients and following up with located sex partners did not vary for Chlamydia infection or gonorrhea but varied markedly for HIV infection or syphilis across the 9 study sites. Consequently, they recommended that public health agencies assess the variation by disease in time and effort expended for partner services and the number of new infections prevented to allocate scarce resources more efficiently across the agency's index patients with HIV infection, syphilis, gonorrhea, or Chlamydia infection. The message and its practical implications are clear and persuasive. Second, Fleming and Hogben6 synthesized the results of studies published during 2005-2012 to demonstrate that patient referral and patient-delivered partner therapy (PDPT) resulted in more partners notified, PDPT resulted in the most partners treated for gonorrhea, and disease intervention specialist referral, if used, was the most effective intervention in ensuring treatment among partners notified. Therefore, they recommended that public health agencies assess the relative effectiveness of using the index patient versus a disease intervention specialist for partner notification, treatment, and gonorrhea prevention, in deciding on the most effective mix of both strategies for use in their jurisdictions. Their advice is supported by the evidence and reasoning presented in the article.

Considered together, the 2 articles on improving HPV vaccination coverage among adolescents emphasize opportunities to increase the low HPV vaccination coverage in the United States.11 A critical analysis of the main message and practical application of each article supports the following perceptions. First, Ng et al7 inquired why some managed care plans that reported Health Effectiveness Data and Information Set (HEDIS; National Committee for Quality Assurance, Washington, District of Columbia) measures in 2013 were more successful than other plans in ensuring that female adolescent plan members received 3 doses of HPV vaccine at 9 to 13 years of age. They interviewed medical directors and quality improvement staff from 10 commercial and 10 Medicaid plans during March-June 2015. Although the top 10 performing plans reported low vaccination rates, the authors concluded that "normalizing" the vaccine, education, reminders, and provider feedback were among the most effective strategies for optimizing vaccination rates. Second, during August 2009-July 2010, Selove et al8 used a Consolidated Framework for Implementation Research (CFIR) to interview (by telephone or in person) a convenience sample of 30 health care providers who worked in 3 federally qualified health centers and a minority-serving academic medical clinic in Tennessee. They asked providers about their perspectives regarding HPV vaccine, patients in their clinic communities, barriers to HPV vaccination, and recommendations for a culturally appropriate educational intervention that could increase HPV vaccine acceptance by patients and their parents. The respondents identified facilitators and barriers related to the intervention, the communities where youth and parents live, the agencies offering vaccination, the vaccination providers, and the intervention implementation process. Although the authors describe the potential value of CFIR for promoting HPV vaccination, they recommended, with valid reasons, further research to determine whether an intervention developed with CFIR improved HPV vaccination rates among ethnically diverse communities. In closing, I encourage readers to critically assess the main messages and applications of the 8 articles as a whole, the main messages and applications in each of the 3 groups of topics, and the main message and application of each article separately to the readers' own settings and locations.

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