P099Statewide changes in service trends at utah title x clinics around the domestic gag rule, 2017–2021

Abstract

<h3>Objectives</h3> Utah is one of six states that lost all Title X funding with the passage of the Domestic Gag Rule in July 2019. We explored trends in service provision at Utah Title X clinics from 2017 to 2021 to evaluate the impact of the loss of this funding. <h3>Methods</h3> Using service delivery data from seven Title X clinics collected between January 2017 and August 2021, we identified most frequently used diagnostic and procedural codes and compared trends in service provision and service utilization using interrupted time series analyses (ITSA), risk ratios, and regression models. <h3>Results</h3> We saw decreases in average patient age and higher proportions of patients with public/private insurance compared to self-payers each year. Type of care provided changed significantly over time: odds decreased that a visit was related to contraception (OR, 0.86; 95% CI, 0.85–0.86) or cervical cancer screening (OR, 0.81; 95% CI, 0.80–0.82), and increased that a visit included sexually transmitted infection (STI) screening (OR, 1.10; 95% CI, 1.10–1.11). Despite these trends, our ITSA found the impact of the Gag Rule to be nonsignificant atop the already decreasing trend in monthly contraceptive visits (p=0.58). <h3>Conclusions</h3> Despite concerns that loss of Title X funding would decrease contraception provision, our analyses identified a shift in care provision away from contraception and preventive health, towards more acute services like STI testing and treatment. Trend analysis showed this shift beginning as early as 2017, with no significant level change after the Gag Rule was enacted. This suggests that other factors influenced service changes.