Term of Award

Spring 2021

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


College of Public Health

Committee Chair

William A. Mase

Committee Member 1

Linda Kimsey

Committee Member 2

Stacy Smallwood


Local Health Departments (LHDs) are critical providers of Human Immunodeficiency Virus (HIV) and sexually transmitted infection (STI) prevention efforts. HIV Pre-Exposure Prophylaxis (PrEP) is an evolving public health initiative and practitioners should consider PrEP interventions in context of ethical decision-making and a broad STI prevention strategy as global incidence of bacterial STIs remains high and those at-risk for HIV are generally at-risk for other STIs. An evaluation of the Thinking Ethically framework and LHD PrEP services was performed to fill a gap in the literature and support program decision-making. A retrospective review of PrEP user medical records from a LHD in north Georgia from July 2019 to June 2020 was performed and data were assessed using descriptive statistics, negative binomial, and logistic regression. Total STI tests performed by the LHD from July 2018 to June 2020 were calculated to determine the change in STI testing services associated with the onset of the COVID-19 pandemic. The Thinking Ethically framework was valuable to PrEP-related decision-making. There were 63 PrEP users in the study period of which most were White non-Hispanic (60.3%) men who have sex with men (61.9%). Retention in care was associated with clinic site. Most bacterial STI cases diagnosed among PrEP users were asymptomatic (75%). Fifty percent of PrEP users obtained services beyond STI prevention including vaccination and referrals. District STI testing declined between the second quarter of 2020 and 2019 with a decline in HIV testing by 38%, syphilis by 48%, gonorrhea and chlamydia by over 50%. LHD decision-makers can feasibly apply the Thinking Ethically framework to public health practice. Results support the need for LHD continuous quality management as retention in care differed by clinic site, and more resources will be needed to engage hard-to-reach populations at-risk for HIV like injection drug users. The COVID-19 pandemic impacted PrEP and STI services and more data is needed to determine the long-term effects of the COVID-19 pandemic on the STI landscape.

OCLC Number


Research Data and Supplementary Material