The importance of partnerships—a snapshot of community-based rapid testing in Oklahoma

Health care services in Indian Country can be unintentionally complex. While the delivery of actual care happens within the walls of the health facility, be it IHS or Tribal, there are community health programs, county and state public health workers, and regional tribal public health entities. Often, these systems work in parallel rather than together, rarely intersecting in ways that truly benefit the patients they serve. After a patient has a medical visit, the follow up care isn’t coordinated, or a patient is tested in the community but there is not clear path to treatment for those who need it. It can leave patients navigating a maze of disconnected services. 

Tribal, State, Federal, Community all come together for testing 

Every partner brings something to the table, and each one has its boundaries. A recent community testing event planned by the Southern Plains Tribal Health Board (SPTHB) relied on multiple partners to plan and execute.   

The setting was a syphilis cluster that had been reported in the central part of the state. SPTHB coordinated with Tribes, the health care facility, the state, and federal IHS counterparts to make a community screening happen. SPTHB helped with necessary infrastructure such as event tents and a staffed mobile unit for testing. The state department of health dedicated  Disease Investigation Specialists (DIS) who not only tested, but could also access the state database that contained information on all syphilis patients who needed to complete treatment. The state also provided a licensed staff person for field treatment. Partners from IHS set aside clinic space and dedicated clinician time for patients who tested positive. These patients were given transport directly from the testing event to the clinic. Tribal health care workers were able to help with testing and interviewing patients and linking them to care. 

The strong Tribal role in this event did not happen by accident. SPTHB routinely presents each Tribal council or health board with a one-page summary of the proposed testing event, which is generally welcomed and gets things in motion. The Tribe and SPTHB help put out marketing materials together, such as digital/social media, physical signage, and even canvassing the community in advance. The Tribal healthcare workers are a critical part of staffing—not only do they know the community better than any outside partner can, they have often participated in community testing before, in other events coordinated by SPTHB. This dynamic means Tribal training is reciprocal, and mutually supportive--each community is part of a larger whole that fosters an informal inter-Tribal network of technical training and practical details of how a screening event works best. 

This screening event had three locations throughout the town, making it easier to meet patients where they were, both figuratively and literally For example, a church that regularly does community lunches hosted one of the screening sites, making it easy to access for anyone coming for a meal. At the end of the day, nearly 200 persons were tested, with a positivity rate of 14%. Not all these clients had an active syphilis infection; some had had a syphilis infection in the past, but the rapid test is still reactive to these antibodies. At least one case of congenital syphilis may have been averted--a prenatal patient was diagnosed and linked to care immediately with support and transport to treatment.  

At a higher level, these community screenings have been a catalyst for policy development for hosting Tribes and IHS service units. Once leadership experiences one of these events in person, they see opportunities to build out local policy and service delivery options for care management, linkage to care, and field treatment. This way of working and learning together has already resulted in Tribes doing their own community events and implementation of IHS service unit policies.  

There have been lessons learned along the way. There has to be a policy in place for field treatment, it sometimes isn’t clear how the state can share data with local partners, and other wrinkles that can be worked out in advance with input from partners who’ve done it before.  

SPTHB is on a strong road collaborating with partners to deliver respectful and effective screening and follow up services to Tribal communities. Working with partners, and meeting patients where they are at, can make for a successful event that builds trust while providing medical and public health services to address the syphilis epidemic. Tribes know their communities the best, and with their guidance and support, our health systems can work in unison and be of the greatest possible service to the clients they serve. 

If you’d like to connect with us on community screening and how you might partner, please reach out to Robbie Bright (rbright@spthb.org)