title: Sexually Transmitted Disease Program Evolution in Response to Changes in the Public Health Environment: A Massachusetts Example.
abstract: In 2008, the line item supporting sexually transmitted disease (STD) services in the Massachusetts state budget was cut as a result of budget shortfalls. Shortly thereafter, direct provision of STD clinical services supported by the Massachusetts Department of Public Health (MDPH) was suspended. Massachusetts Department of Public Health requested an initial assessment of its internal response and impact in 2010. A follow-up assessment occurred in September 2013.
  
  
  
  In 2010 and 2013, 39 and 46 staff, respectively, from MDPH and from clinical partner agencies, were interviewed about changes in the role of the MDPH, partnerships, STD services, challenges, and recommendations. Interview notes were summarized, analyzed, and synthesized by coauthors using qualitative analysis techniques and NVivo software.
  
  
  
  The withdrawal of state funding for STD services, and the subsequent reduction in clinical service hours, erected numerous barriers for Disease Intervention Specialists (DIS) seeking to ensure timely STD treatment for index cases and their partners. After initial instability, MDPH operations stabilized due partly to strong management, new staff, and intensified integration with human immunodeficiency virus services. Existing contracts with human immunodeficiency virus providers were leveraged to support alternative STD testing and care sites. Massachusetts Department of Public Health strengthened its clinical and epidemiologic expertise. The DIS expanded their scope of work and were outposted to select new sites. Challenges remained, however, such as a shortage of DIS staff to meet the needs.
  
  
  
  Although unique in many ways, MA offers experiences and lessons for how a state STD program can adapt to a changing public health context.
authors.affiliation: From the *US Centers for Disease Control and Prevention, Atlanta, GA; and †Massachusetts Department of Public Health, Boston, MA.
authors.forename: Marion W
authors.initials: MW
authors.lastname: Carter
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Hsu
authors.forename: Penny S
authors.initials: PS
authors.lastname: Loosier
authors.forename: Brandy L Peterson
authors.initials: BL
authors.lastname: Maddox
authors.forename: Sonal R
authors.initials: SR
authors.lastname: Doshi
authors.forename: Karen
authors.initials: K
authors.lastname: Kroeger
authors.forename: Kevin
authors.initials: K
authors.lastname: Cranston
mesh_terms: D002017:Budgets; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D019468:Disease Management; D006078:Government Programs / Q000191:economics / Q000458:organization & administration*; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D006296:Health Services; D006801:Humans; D008404:Massachusetts; D015397:Program Evaluation; D011634:Public Health / Q000191:economics; D011635:Public Health Administration / Q000191:economics*; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000628:therapy