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Dialogue Article July 2024

A Syndemic Approach to Training and Technical Assistance in the Central East

By Andrew Wilson, Co-Project Director Central East ATTC

With World Hepatitis Day this month, we (the SAMHSA Region 3 ATTC) would like to highlight the interconnected health challenges that our communities face that has come to be known as a syndemic and collaborative approach we’ve taken to address this interplay.

A syndemic occurs “when two or more diseases or health conditions cluster and interact within a population because of social and structural factors and inequities, leading to an excess burden of disease and continuing health disparities.”1

In the Central East region (as in much of the country), we’re contending with a complex web of issues: overdose, mental health disorders, Hepatitis C (HCV), HIV, and other STDs.  The CDC reports that “the rate of new hepatitis C cases…among persons aged 18–40 years, a proxy for persons who inject drugs (PWID), has increased steadily since 2013 to a peak of 2.9 cases per 100,000 population in 2020.”2 In other words, these aren’t isolated problems; they interact and amplify each other, making the overall health crisis even more difficult to address. That’s why syndemic solutions are integral and needed.

At the Central East ATTC, we’ve been helping organizations and individuals tackle these intertwined epidemics head-on. One of our key strategies has been through an enduring partnership with other Federal Training and Technical Assistance (T/TA) Centers, coming together in a collaboration known as the Mid-Atlantic Training Collaborative for Health and Human Services (MATCHHS).

MATCHHS: Collaboration in Action

MATCHHS is a noteworthy example of how teamwork can lead to real, positive change. By combining our resources and expertise through ongoing, intentional collaboration, we’ve been able to share best practices and innovative strategies across our region. Here are a few practical examples of that partnership in action:

  • Best Practices Exchange: Regular meetings and workshops give us all a chance to swap insights, experiences and cross-pollinate ideas. This kind of environment generates innovation and helps us all learn about successful interventions happening across our region.
  • Resource Sharing: MATCHHS members tap into a treasury of knowledge and information not found solely in their own networks. This ultimately benefits those who receive T/TA because our perspectives and expertise are broadened.
  • Integrated Training and Technical Assistance: MATCHHS member organizations offer training and technical assistance that addresses the multifaceted nature of these syndemics, equipping providers, counselors, peers, social workers, and supervisors with the skills they need to offer integrated care.

Dr. Linda Frank, Principal Investigator, MidAtlantic AIDS Education & Training Center is one of the key (and original) members of the MATCHHS collaboration. I recently asked Dr. Frank a few questions about her involvement with MATCHHS over the years and am excited to share her insights below.

ATTC: Can you share a success story or a notable achievement from your collaboration within MATCHHS that demonstrates the power of a syndemic approach?

Dr. Frank: The collaborations between federally funded training centers facilitated by MATCHHS has made it possible to develop educational programming that includes evidenced-based approaches and interventions to address the issues of HIV, substance use, mental illness, hepatitis, and STIs as well as addressing the needs of specific populations.   Our collaborations are characterized by joint programming and thinking about our audiences to improve the uptake of this important information.

ATTC: With World Hepatitis Day approaching (on July 28), what message do you have for healthcare professionals about the importance of addressing HCV/HIV and other STIs within the context of other ongoing epidemics (i.e. SUD/Overdose and Mental Health Disorders)?

Dr. Frank: Hepatitis and STIs are a continuing threat to the health of our communities.  HIV, STI and related disorders, such as substance use disorder and psychiatric illness are stigmatized and thus remain a challenge for health care providers to reach those at risk. Through the collaborations of federal training centers we aim to destigmatize all of these problems through the education of health care providers in giving them the tools and the words to discuss with their patients and engage patients to build strong patient-provider relationships with the recognition for patients that all of these disorders are treatable.

ATTC: What are your hopes and expectations for the future of MATCHHS and its impact on addressing the syndemic in the Mid-Atlantic region?

Dr. Frank: MATCHHS is the cutting-edge collaboration that is not replicated anywhere in the US. This group has the potential for being THE MODEL for the country.  This is important because the collaborations that take place not only provide a method and approach to delivering the best education and mentoring for health care providers but it is a cost saving and makes the best use of federal resources within USPHS Region 3.   I am proud to be a founding member of this group and so appreciate the leadership of Dr. McKenna from the USPHS regional office.

The syndemic approach isn’t a new concept—it’s a practical strategy that’s making a difference in the Central East. As we’re challenged to confront the interconnected realities of overdose, mental health disorders, HCV, HIV, and other STDs, it’s crucial that we both sustain and expand our collaborative efforts.

About Dr. Linda Frank:

Linda Rose Frank, PhD, MSN, CS, ACRN, FAAN is Professor, Department of Infectious Diseases, School of Public Health with secondary appointments in School of Nursing and School of Medicine at the University of Pittsburgh. She is currently the Principal Investigator, MidAtlantic AIDS Education & Training Center, funded by DHHS, HIV/AIDS Bureau with continuous funding since 1988. She has been on the frontlines of the HIV epidemic providing training, consultation and technical assistance to organizations, clinics, community health centers, prisons, and others domestically and internationally.



  1. “Defining the Term “Syndemic.””, 29 April 2024,
  2. CDC. “Reduce Reported Rate of New Hepatitis C Virus Among PWID.” CDC, 4 April 2024,