Effectiveness of a Quality Improvement Intervention to Improve Rates of Routine Chlamydia Trachomatis Screening in Female Adolescents Seeking Primary Preventive Care

Wood, Sarah; McGeary, Andrea; Wilson, Michèle; Taylor, April; Aumaier, Brenna; Petsis, Danielle; Campbell, Kenisha

doi:10.1016/j.jpag.2018.10.004

Cited by 18 publications

(13 citation statements)

References 26 publications

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“…We conducted a retrospective cohort study of a convenience sample of youth aged 13–24 years who sought STI testing and treatment between June 2014 and June 2019 at two academically affiliated clinics that both provided collocated paediatric/adolescent primary care services and confidential sexual/reproductive health services in Philadelphia, Pennsylvania [ 36 , 50 ]. Youth without insurance were not able to access primary care services at the sites.…”

Section: Methodsmentioning

confidence: 99%

“…An institution‐wide EHR was implemented prior to January 2014. STI and HIV testing data from the two clinics were captured in near‐real time from the medical system's STI database using a commercial business intelligence application (Qlik, Radnor, PA) [ 36 , 50 ]. We performed EHR data abstraction using a standardized electronic data abstraction instrument to obtain information associated with each STI encounter collected as part of routine patient care measures.…”

Section: Methodsmentioning

confidence: 99%

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A retrospective study of HIV pre‐exposure prophylaxis counselling among non‐Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014–2019

et al. 2022

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Introduction Youth account for a disproportionate number of new HIV infections; however, pre‐exposure prophylaxis (PrEP) use is limited. We evaluated PrEP counselling rates among non‐Hispanic Black youth in the United States after a bacterial sexually transmitted infection (STI) diagnosis. Methods We conducted a retrospective cohort study of Black youth receiving care at two academically affiliated clinics in Philadelphia between June 2014 and June 2019. We compared PrEP counselling for youth who received primary care services versus those who did not receive primary care services, all of whom met PrEP eligibility criteria due to STI diagnosis per U.S. Centers for Disease Control and Prevention clinical practice guidelines. Two logistic regression models for receipt of PrEP counselling were fit: Model 1 focused on sexual and gender minority (SGM) status and Model 2 on rectal STIs with both models adjusted for patient‐ and healthcare‐level factors. Results Four hundred and sixteen patients met PrEP eligibility criteria due to STI based on sex assigned at birth and sexual partners. Thirty patients (7%) had documentation of PrEP counselling. Receipt of primary care services was not significantly associated with receipt of PrEP counselling in either Model 1 (adjusted OR (aOR) 0.10 [95% CI 0.01, 0.99]) or Model 2 (aOR 0.52 [95% CI 0.10, 2.77]). Receipt of PrEP counselling was significantly associated with later calendar years of STI diagnosis (aOR 6.80 [95% CI 1.64, 29.3]), assigned male sex at birth (aOR 26.2 [95% CI 3.46, 198]) and SGM identity (aOR 317 [95% CI 39.9, 2521]) in Model 1 and later calendar years of diagnosis (aOR 3.46 [95% CI 1.25, 9.58]), assigned male sex at birth (aOR 18.6 [95% CI 3.88, 89.3]) and rectal STI diagnosis (aOR 28.0 [95% CI 8.07, 97.5]) in Model 2. Fourteen patients (3%) started PrEP during the observation period; 12/14 (86%) were SGM primary care patients assigned male sex at birth. Conclusions PrEP counselling and uptake among U.S. non‐Hispanic Black youth remain disproportionately low despite recent STI diagnosis. These findings support the need for robust investment in PrEP‐inclusive sexual health services that are widely implemented and culturally tailored to Black youth, particularly cisgender heterosexual females.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A retrospective study of HIV pre‐exposure prophylaxis counselling among non‐Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014–2019

et al. 2022

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“…In this retrospective study, we used electronic health record (EHR) data from 2 urban pediatric/adolescent primary care clinics with high rates of incident STIs and that were affiliated with a large academic health system in Philadelphia. 22 During the observation period, HIV screening was performed only by laboratorybased, fourth-generation antigenantibody testing. We intentionally limited the observation period to when rapid HIV testing was unavailable because rapid test results were not routinely documented in the EHR, and the barriers to laboratorybased versus rapid HIV testing likely differ.…”

Section: Study Design and Data Sourcementioning

confidence: 99%

“…Patients at both sites are mostly African American (87%) and Medicaid insured (79%). 22 Each clinical site has a co-located primary care practice and Title X-funded adolescent program that provides confidential sexual health (family planning) services irrespective of insurance coverage. Primary care patients may receive sexual health services through either primary care or family planning.…”

Section: Study Participants and Settingmentioning

confidence: 99%

HIV Testing Among Adolescents With Acute Sexually Transmitted Infections

et al. 2020

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BACKGROUND AND OBJECTIVES: Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing. METHODS:Retrospective study of STI episodes (gonorrhea, Chlamydia, trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis. RESULTS:The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing.CONCLUSIONS: HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.

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“…10 In addition, there are many known barriers to STI screening for both patients and clinicians. [11][12][13][14] Strategies are needed to improve rates of guideline-concordant sexual health care among women Veterans within the Veterans Health Administration (VHA), especially gonorrhea and chlamydia screening.…”

Section: Introductionmentioning

confidence: 99%

Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration

et al. 2022

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Background United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans may be at increased risk for STIs due to high rates of sexual trauma. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans. Objective To examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the Veterans Health Administration (VHA) in 2019. Design We performed a retrospective cohort study of all women Veterans in VHA care between January 1, 2018, and December 31, 2019. Participants Women Veteran patients were identified as receiving VHA care if they had at least one inpatient admission or outpatient visit in 2019 or the preceding calendar year. Key Results Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, correlates of testing in women under age 25 included Black race (aOR: 2.11, CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05, CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (chlamydia case rate: 265, gonorrhea case rate: 97/100,000) and those with mental health diagnoses (chlamydia case rate: 263, gonorrhea case rate: 72/100,000.) Conclusions Gonorrhea and chlamydia testing remains underutilized among women in VHA care, and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates.

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Effectiveness of a Quality Improvement Intervention to Improve Rates of Routine Chlamydia Trachomatis Screening in Female Adolescents Seeking Primary Preventive Care

Cited by 18 publications

References 26 publications

A retrospective study of HIV pre‐exposure prophylaxis counselling among non‐Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014–2019

A retrospective study of HIV pre‐exposure prophylaxis counselling among non‐Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014–2019

HIV Testing Among Adolescents With Acute Sexually Transmitted Infections

Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration

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