Transmitted Infection Testing Research Articles

Facilitators of and Barriers to the Use of a Digital Self-Management Service for Diagnostic Testing: Focus Group Study With Potential Users.

Health care lags in digital transformation, despite the potential of technology to improve the well-being of individuals. The COVID-19 pandemic has accelerated the uptake of technology in health care and increased individuals' willingness to perform self-management using technology. A web-based service, Directlab Online, provides consumers with direct digital access to diagnostic test packages, which can digitally support the self-management of health. This study aims to identify the facilitators, barriers, and needs of Directlab Online, a self-management service for web-based access to diagnostic testing. A qualitative method was used from a potential user's perspective. The needs and future needs for, facilitators of, and barriers to the use of Directlab Online were evaluated. Semistructured focus group meetings were conducted in 2022. Two focus groups were focused on sexually transmitted infection test packages and 2 were focused on prevention test packages. Data analysis was performed according to the principles of the Framework Method. The Consolidated Framework for Implementation Research was used to categorize the facilitators and barriers. In total, 19 participants, with a mean age of 34.32 (SD 14.70) years, participated in the focus groups. Important barriers were a lack of privacy information, too much and difficult information, and a commercial appearance. Important facilitators were the right amount of information, the right kind of tests, and the involvement of a health care professional. The need for a service such as Directlab Online was to ensure its availability for users' health and to maintain their health. According to the participants, facilitators and barriers were comprehension of the information, the goal of the website, and the overall appearance of the service. Although the service was developed in cocreation with health care professionals and users, the needs did not align. The users preferred understandable and adequate, but not excessive, information. In addition, they preferred other types of tests to be available on the service. For future research, it would be beneficial to focus on cocreation between the involved medical professionals and users to develop, improve, and implement a service such as Directlab Online.

National Outpatient Sexually Transmitted Infection Testing in Pregnant Patients in the United States.

Introduction: Sexually transmitted infections (STIs) continue to increase in the United States and pregnant patients who acquire STIs are at risk for serious complications. This study estimated the utilization of preventative STI testing among pregnant outpatients on a national scale. Methods: This was a retrospective, cross-sectional study of outpatient visits in the National Ambulatory Medical Care Survey from 2014 to 2016 and 2018 to 2019. All patients reported as pregnant were included to assess STI testing for chlamydia, gonorrhea, hepatitis, and HIV. STI testing was described per 1,000 total visits overall and by subpopulations. Data weights were applied to generate national estimates. Results: Over 177 million visits were included, of which 87.5 per 1,000 included an STI test. Chlamydia testing was the most common, followed by HIV, gonorrhea, and hepatitis (58.0 vs. 42.3 vs. 41.5 vs. 20.3 per 1,000). STI testing rates varied across subpopulations (72.1-236.6 per 1,000 visits). Patients of Hispanic ethnicity, Black race, age ≤25 years old, and those seen by an obstetrics and gynecology (OB/GYN) provider had the highest rates of STI testing. Independent predictors of STI testing included: Black race (adjusted odds ratio [aOR]: 2.24, 95% confidence interval [95% CI]: 2.23-2.24), first trimester (aOR: 5.15, 95% CI: 5.14-5.16), government and private insurance (aOR: 1.90, 95% CI: 1.89-1.91 and aOR: 1.70, 95% CI: 1.69-1.71), and an OB/GYN provider specialty (aOR: 2.93, 95% CI: 2.93-2.94). Conclusions: STI testing in United States outpatient physician offices varied by subpopulations and across individual test types. Certain patient attributes, such as race, provider specialty, and payment source, were predictive of testing.

An mHealth Intervention for Gay and Bisexual Men's Mental, Behavioral, and Sexual Health in a High-Stigma, Low-Resource Context (Project Comunică): Protocol for a Randomized Controlled Trial.

The World Health Organization reported that 80% of new HIV diagnoses in Europe in 2014 occurred in Central and Eastern Europe. Romania has a particularly high HIV incidence, AIDS prevalence, and number of related deaths. HIV incidence in Romania is largely attributed to sexual contact among gay and bisexual men. However, homophobic stigma in Romania serves as a risk factor for HIV infection for gay and bisexual men. The Comunică intervention aims to provide a much-needed HIV risk reduction strategy, and it entails the delivery of motivational interviewing and cognitive behavioral therapy skills across 8 live text-based counseling sessions on a mobile platform to gay and bisexual men at risk of HIV. The intervention is based on the information-motivation-behavior and minority stress models. There is preliminary evidence suggesting that Comunică holds promise for reducing gay and bisexual men's co-occurring sexual (eg, HIV transmission risk behavior), behavioral (eg, heavy alcohol use), and mental (eg, depression) health risks in Romania. This paper describes the protocol for a randomized controlled trial designed to test the efficacy of Comunică in a national trial. To test Comunică's efficacy, 305 gay and bisexual men were randomized to receive Comunică or a content-matched education attention control condition. The control condition consisted of 8 time-matched educational modules that present information regarding gay and bisexual men's identity development, information about HIV transmission and prevention, the importance of HIV and sexually transmitted infection testing and treatment, heavy alcohol use and its associations with HIV transmission risk behavior, sexual health communication, finding social support, and creating sexual health goals. Participants undergo rapid HIV and syphilis testing and 3-site chlamydia and gonorrhea testing at baseline and the 12-month follow-up. Outcomes are measured before the intervention (baseline) and at the 4-, 8-, and 12-month follow-ups. The study was funded in September 2018, and data collection began in May 2019. The last participant follow-up was in January 2024. Currently, the data analyst is cleaning data sets in preparation for data analyses, which are scheduled to begin in April 2024. Data analysis meetings are scheduled regularly to establish timelines and examine the results as analyses are gradually being conducted. Upon completion, a list of manuscripts will be reviewed and prioritized, and the team will begin preparing them for publication. This study is the first to test the efficacy of an intervention with the potential to simultaneously support the sexual, behavioral, and mental health of gay and bisexual men in Central and Eastern Europe using motivational interviewing support and sensitivity to the high-stigma context of the region. If efficacious, Comunică presents a scalable platform to provide support to gay and bisexual men living in Romania and similar high-stigma, low-resource countries. ClinicalTrials.gov NCT03912753; https://clinicaltrials.gov/study/NCT03912753. DERR1-10.2196/52853.

Youth and Guardian Expectations of Privacy in Adolescent Health Care

PurposeAdolescent access to confidential care is codified by most states with age-specific laws; however, adolescent and guardian awareness of these laws are poorly understood. In this study, we assessed adolescent and guardian perceptions of conditional confidentiality in health care. MethodsWe surveyed youth aged 11–18 years, and guardians accompanying youth seeking care at an urban adolescent outpatient clinic that provides adolescent primary and subspecialty care. Participants completed brief True/False surveys which queried whether a parent would be notified for common, hypothetical scenarios. We analyzed adolescent responses by age group and compared responses of adolescents and guardians. ResultsTwo hundred seventy nine adolescents and 178 guardians completed the survey. Among participants, 86% of adolescents and 67% of guardians believed they understood which health topics were confidential. Adolescent and guardian answers aligned with mandatory reporting laws for scenarios concerning safety and suicidality. Younger adolescents consistently underestimated their legal right to privacy for all hypothetical scenarios. Many adolescents anticipated disclosure to parents for confidential services, including contraception, pregnancy, and sexually transmitted infection testing. Guardians expected disclosure about sexual health services at higher rates than they did about substance use. DiscussionWe identified age-associated knowledge gaps among participants pertaining to adolescent privacy in the clinical setting. These deficits were found in a setting where adolescent privacy is routinely discussed, and our findings may underestimate the knowledge gap in the general pediatric population where confidentiality may not be discussed as often. Providers caring for adolescents share the responsibility of educating both youth and families about the importance of adolescent confidentiality.

Assessing the Performance of ChatGPT in Correctly Evaluating Preventive Screening Clinical Vignettes Commonly Seen in Obstetrics and Gynecology Practice [ID 2683617

INTRODUCTION: Preventive screening is vital in obstetrics and gynecology practice, where the accurate assessment of clinical vignettes is pivotal for delivering optimal care. This research delves into ChatGPT’s performance, an advanced language model, in evaluating common obstetrics and gynecology preventive screening scenarios. METHODS: We compiled a diverse dataset of obstetrics and gynecology clinical vignettes, covering areas like cervical and breast cancer screening, sexually transmitted infection testing, and prenatal care. Using 20 vignettes initially generated by ChatGPT and enriched with specific details, we rigorously assessed ChatGPT’s responses for clinical accuracy and relevance. Our evaluation was guided by quantitative metrics, aligning ChatGPT’s performance with recognized guidelines such as United States Preventive Services Task Force, American Society for Colposcopy and Cervical Pathology, American College of Obstetricians and Gynecologists, and more. RESULTS: ChatGPT displayed promise in comprehending obstetrics and gynecology clinical information. Out of 20 vignettes, only 2 (10%) fell short of evaluating the clinical vignette adequately. Among the remaining 18 vignettes, an impressive 15 (83%) adhered to the latest clinical guidelines, whereas 3 (17%) evaluations proved inaccurate. Notably, in 19 out of 20 vignettes (95%), ChatGPT deferred to the provider’s clinical judgment. CONCLUSION: This study underscores ChatGPT’s potential to assist obstetrics and gynecology practitioners in preventive screening decision-making. While promising, ChatGPT should complement, not replace, human expertise. Limitations include a focus on quantitative metrics; future research should delve into qualitative aspects of ChatGPT’s performance. Integrating ChatGPT into obstetrics and gynecology practice could enhance preventive screening quality and efficiency, potentially improving women’s health care outcomes. This research contributes to the broader discourse on AI integration in health care, particularly in women’s preventive health care, paving the way for further AI-driven solutions.

Lessons learned from conducting a community-based, nurse-led HIV prevention trial with youth experiencing homelessness: Pivots and pitfalls.

This article highlights key lessons learned while conducting a nurse-led community-based HIV prevention trial with youth experiencing homelessness (YEH), focusing on sexually transmitted infections testing and treatment, intervention sessions, community partnerships, and participant recruitment and retention. The insights and experiences shared aim to inform future research and the design of interventions targeting populations at high risk, particularly when facing unanticipated challenges. By addressing these areas, the article contributes to the decision-making for the design and delivery of effective strategies to improve the health outcomes among marginalized populations. The findings underscore the importance of flexibility and active participant engagement, cultivating strong relationships with community partners, utilizing technology and social media, and fostering a diverse research team that represents the heterogeneity of youth experiencing homelessness across race/ethnicity, gender identity, sexual orientation, and lived experiences. These recommendations aim to enhance participant access, engagement, and retention, while promoting rigorous research and meaningful study outcomes for YEH.

What Adolescents Say in Text Messages to Motivate Peer Networks to Access Health Care and Sexually Transmitted Infection Testing: Qualitative Thematic Analysis.

While rates of HIV and sexually transmitted infections (STIs) are extremely high among adolescents and young adults in the United States, rates of HIV and STI testing remain low. Given the ubiquity of mobile phones and the saliency of peers for youths, text messaging strategies may successfully promote HIV or STI testing among youths. This study aimed to understand the types of messages youths believe were motivating and persuasive when asked to text friends to encourage them to seek HIV or STI testing services at a neighborhood clinic. We implemented an adolescent peer-based text messaging intervention to encourage clinic attendance and increase STI and HIV testing among youths (n=100) at an adolescent clinic in San Francisco, California. Participants were asked to send a text message to 5 friends they believed were sexually active to encourage their friends to visit the clinic and receive STI or HIV screening. Thematic analysis was used to analyze the content of the text messages sent and received during the clinic visit. Member checking and consensus coding were used to ensure interrater reliability and significance of themes. We identified four themes in the messages sent by participants: (1) calls to action to encourage peers to get tested, (2) personalized messages with sender-specific information, (3) clinic information such as location and hours, and (4) self-disclosure of personal clinic experience. We found that nearly all text messages included some combination of 2 or more of these broad themes. We also found that youths were inclined to send messages they created themselves, as opposed to sending the same message to each peer, which they tailored to each individual to whom they were sent. Many (40/100, 40%) received an immediate response to their message, and most participants reported receiving at least 1 positive response, while a few reported that they had received at least 1 negative response. There were some differences in responses depending on the type of message sent. Given the high rates of STI and HIV and low rates of testing among adolescents, peer-driven text messaging interventions to encourage accessing care may be successful at reaching this population. This study suggests that youths are willing to text message their friends, and there are clear types of messages they develop and use. Future research should use these methods with a large, more diverse sample of youths and young adults for long-term evaluation of care seeking and care retention outcomes to make progress in reducing HIV and STI among adolescents and young adults.

Improving awareness and uptake of pre-exposure HIV prophylaxis amongst service users accessing Sexual Health London, a regional online postal sexually transmitted infection testing health service.

The UK pledged commitment to the global strategy of zero new HIV infections and HIV-related deaths by 2030. PrEP was commissioned in England in 2020 and is fundamental to achieving these targets, yet awareness and uptake are suboptimal in certain populations. Sexual Health London (SHL) incorporated questions on its e-triage questionnaire estimating need for PrEP amongst online service users. Two types of signposting messaging were shown to users directing them to more detailed online content: PrEP-discussion (potential need) and PrEP-eligible (assumed need). The effectiveness of this signposting was evaluated by reviewing demographics and triage responses in returning users. 426,149 SHL users requested STI screening between 1.7.21-31.10.22. 16% (69,867/426,149) and 32.2% (137,489/426,149) of individuals received PrEP-eligible and PrEP-discussion signposting. The PrEP-eligible cohort were: 41.0% gay/bisexual or other men who have sex with men (GBMSM), 16.3% heterosexual males, 33.1% heterosexual females, and 60.6% were of white ethnicity. The PrEP-discussion cohort were: 9.3% GBMSM, 34.3%% heterosexual males, 45.5% heterosexual females and 63.7% of white ethnicity. 50.4% (35,190/69,867) and 41.3% (56,808/137,489) of the PrEP-eligible and PrEP discussion cohorts ordered a subsequent SHL STI testing kit, during which 10.0% (3510/35,190) and 5.9% (3364/56,808) reported taking PrEP. Of those who denied taking PrEP, 59% (18,702/31,680) and 61.0% (32,559/53,444) triggered PrEP signposting again. 95.4% of PrEP starters were GBMSM (6562/6874) and 1.4% (97/6874) heterosexual males/females. The e-service demonstrated feasibility in estimating PrEP need and signposting service users. Up to 16% of returning users subsequently commenced PrEP. This highlights significant missed opportunities for the remaining online users, who continue to report HIV acquisition risk(s). Further efforts regionally/nationally to optimise uptake of PrEP, particularly among under-represented groups are warranted.

Digital Triage Tools for Sexually Transmitted Infection Testing Compared With General Practitioners' Advice: Vignette-Based Qualitative Study With Interviews Among General Practitioners.

Digital triage tools for sexually transmitted infection (STI) testing can potentially be used as a substitute for the triage that general practitioners (GPs) perform to lower their work pressure. The studied tool is based on medical guidelines. The same guidelines support GPs' decision-making process. However, research has shown that GPs make decisions from a holistic perspective and, therefore, do not always adhere to those guidelines. To have a high-quality digital triage tool that results in an efficient care process, it is important to learn more about GPs' decision-making process. The first objective was to identify whether the advice of the studied digital triage tool aligned with GPs' daily medical practice. The second objective was to learn which factors influence GPs' decisions regarding referral for diagnostic testing. In addition, this study provides insights into GPs' decision-making process. A qualitative vignette-based study using semistructured interviews was conducted. In total, 6 vignettes representing patient cases were discussed with the participants (GPs). The participants needed to think aloud whether they would advise an STI test for the patient and why. A thematic analysis was conducted on the transcripts of the interviews. The vignette patient cases were also passed through the digital triage tool, resulting in advice to test or not for an STI. A comparison was made between the advice of the tool and that of the participants. In total, 10 interviews were conducted. Participants (GPs) had a mean age of 48.30 (SD 11.88) years. For 3 vignettes, the advice of the digital triage tool and of all participants was the same. In those vignettes, the patients' risk factors were sufficiently clear for the participants to advise the same as the digital tool. For 3 vignettes, the advice of the digital tool differed from that of the participants. Patient-related factors that influenced the participants' decision-making process were the patient's anxiety, young age, and willingness to be tested. Participants would test at a lower threshold than the triage tool because of those factors. Sometimes, participants wanted more information than was provided in the vignette or would like to conduct a physical examination. These elements were not part of the digital triage tool. The advice to conduct a diagnostic STI test differed between a digital triage tool and GPs. The digital triage tool considered only medical guidelines, whereas GPs were open to discussion reasoning from a holistic perspective. The GPs' decision-making process was influenced by patients' anxiety, willingness to be tested, and age. On the basis of these results, we believe that the digital triage tool for STI testing could support GPs and even replace consultations in the future. Further research must substantiate how this can be done safely.

Retrospective Cohort Study of Syphilis-Related Stillbirths in Winnipeg, Manitoba From 2017–2020

ObjectiveSyphilis-related stillbirths (SRSBs) disproportionately affect marginalized women with 11% of all local stillbirths having maternal syphilis as a contributory factor in 2020. This study describes the incidence and perinatal factors associated with SRSB. MethodsThis was a retrospective cohort study of all stillbirths occurring from 1 January 2017 to 31 December 2020, at a single tertiary-level referral hospital in Winnipeg, Manitoba. Cases that met criteria for SRSB were identified from hospital records and included in the final analysis. Maternal demographics, comorbidities, prenatal care attendance, sexually transmitted infection testing, treatment, and diagnostic investigations at time of stillbirth were collected from hospital charts using a standardized data collection form. Descriptive statistics were performed to present the results. ResultsThe proportion of SRSB increased over the period of study from 0%–11%. Eleven cases were identified as SRSB, with diagnosis occurring intrapartum in 7 cases and antenatally in 4 cases. Of the 4 antenatal cases, only 2 had identifiable treatment responses indicated by microbiological and pathology workup. Commonly identified risk factors for SRSB were homelessness, mental illness, substance use, sexually transmitted co-infections, and lack of prenatal care. ConclusionsCases of SRSB are rising in Winnipeg with 11% of all stillbirths having maternal syphilis as a contributory factor by 2020. SRSBs disproportionately affect marginalized women. The dramatic and rapid changes in the epidemiology of syphilis in Winnipeg are likely shared by other Canadian regions and warrant increased prevention strategies to improve outcomes.

Lasting Impact of the COVID-19 Pandemic on Care and Prevention of Sexually Transmitted Infections in the Midwest.

The COVID-19 pandemic reduced the general accessibility of health services. Many sexually transmitted infection (STI) testing and treatment sites modified services (e.g., reduced hours, limited walk-in availability, decreased testing capacity), changes that may result in permanent change in STI service availability. At the same time, systems were driven to innovate in ways that could benefit patients. This study aimed to describe how the COVID-19 pandemic changed STI clinical services, with a focus on long-term impacts. In July 2022, a phone survey was designed to assess services for STIs at the 105 STI testing and treatment providers in the St. Louis metropolitan statistical area. Sexually transmitted infection testing providers included STI clinics, primary care clinics that cater to a broad population, and community-based organizations, and excluded emergency departments and urgent care centers. In most cases, the survey was completed by a clinic manager, medical director, or nursing staff member. Of the 75 locations that were interviewed, 12 (16%) had not returned to prepandemic capacity and operations as of July 2022. Five sites had closed completely since the pandemic began, 3 of which are in the northwestern region of the metropolitan statistical area. Most (58.6%) of the open clinics had added telehealth appointments. Sexually transmitted infection testing sites decreased during the pandemic with lasting impact in one area of the Midwest. Resources to support STI infrastructure should be expanded. Maintaining updated information on STI care providers in the region can aid future assessments.

Transportability Without Positivity: A Synthesis of Statistical and Simulation Modeling.

Studies designed to estimate the effect of an action in a randomized or observational setting often do not represent a random sample of the desired target population. Instead, estimates from that study can be transported to the target population. However, transportability methods generally rely on a positivity assumption, such that all relevant covariate patterns in the target population are also observed in the study sample. Strict eligibility criteria, particularly in the context of randomized trials, may lead to violations of this assumption. Two common approaches to address positivity violations are restricting the target population and restricting the relevant covariate set. As neither of these restrictions is ideal, we instead propose a synthesis of statistical and simulation models to address positivity violations. We propose corresponding g-computation and inverse probability weighting estimators. The restriction and synthesis approaches to addressing positivity violations are contrasted with a simulation experiment and an illustrative example in the context of sexually transmitted infection testing uptake. In both cases, the proposed synthesis approach accurately addressed the original research question when paired with a thoughtfully selected simulation model. Neither of the restriction approaches was able to accurately address the motivating question. As public health decisions must often be made with imperfect target population information, model synthesis is a viable approach given a combination of empirical data and external information based on the best available knowledge.

2681. National Outpatient Sexually Transmitted Infection Testing in Pregnant Patients in the United States, 2012 to 2019

Abstract Background Sexually transmitted infections (STI) continue to increase annually in the United States (US) with 2.5 million infections reported by the Centers for Disease Control and Prevention (CDC) in 2021. Pregnant patients are at risk for serious complications due to infection. It is recommended that pregnant women are screened early in pregnancy to avoid poor outcomes; however, few studies have used nationally representative data to assess STI testing in pregnancy in the US. This study aimed to estimate the utilization of preventative STI care on a national scale in pregnant patients. Methods This was a retrospective, cross-sectional study of outpatient visits in the CDC's National Ambulatory Medical Care Survey from 2012 to 2019. All patients reported as pregnant were included for analysis to assess STI testing (e.g., chlamydia, gonorrhea, hepatitis, HIV) overall. STI testing was described per 1000 total visits. Subgroup analyses were conducted by race, ethnicity and region. Multivariable logistic regression was used to identify predictors of receiving at least one STI test. Data weights were applied to analyses to generate national estimates. Results Over 232 million visits were included for analysis, of which 7.6% included an STI test. Overall, rates of receiving any STI test varied over the study period (39.6-136.0 per 1000 visits). Chlamydia testing was the most common, followed by gonorrhea, HIV, and hepatitis (48.5 v. 42.1 v. 39.5 v. 19.6 per 1000). Patients of non-Hispanic ethnicity, White race, and those in the West region had the lowest rates of STI testing (74.1 v. 55.8 v. 43.4 per 1000). Overall, Hispanic ethnicity (aOR 1.152, 95%CI 1.150-1.155), Black and more than one race (aOR 2.837, 95%CI 2.831-2.843 and aOR 3.06, 95%CI 3.04-3.09), government and private insurance (aOR 4.63, 95%CI 4.58-4.68 and aOR 4.71, 95%CI 4.66-4.76), metropolitan areas (aOR 1.865, 95%CI 1.859-1.871), and the Northeast region (aOR 2.449, 95%CI 2.442-2.455) were predictive of receiving any STI test. Conclusion STI testing in US outpatient physician offices varied over the study period and across test types, though was consistently low. Additionally, certain patient attributes, such as race, ethnicity, and payment source were predictive of testing. Disclosures Kelly Reveles, PharmD, PhD, Ferring Pharmaceuticals: Advisor/Consultant|Ferring Pharmaceuticals: Honoraria

2667. Bridging the Gap: Sexually Transmitted Infections Testing, Treatment, and Prevention at a Miami Syringe Services Program for Women Who Inject Drugs

Abstract Background Women who inject drugs (WWID) remain understudied despite their compounded vulnerability to HIV. WWID experience increased mortality and multilevel barriers to care, including violence, homelessness, stigma, and competing priorities of childcare. In 2016, Florida passed the Infectious Disease Elimination Act (IDEA), legalizing IDEA Syringe Services Program (SSP) as the first in the state. Located in one of the country’s highest-incidence areas of HIV, IDEA SSP in Miami offers harm reduction and health opportunities outside of the traditional health care system. Previous IDEA SSP data show that WWID, representing 27% of participants overall, are more likely to report opioid injection, syringe sharing, injecting more than 5 times a day, sexual activity in the past 30 days, and transactional sex compared to their male counterparts. Methods IDEA SSP offered sexually transmitted infection (STI) testing and treatment July 1, 2022 through March 31, 2023. This descriptive study included women of childbearing age (18-44 years old) who injected drugs and were SSP participants (N=47). Results Among chlamydial infections, 2.1% had oropharyngeal, 4.3% had urethral, and 6.4% had rectal involvement. Three women (6.4%) experienced both gonococcal pharyngitis and urethritis. Rectal gonorrhea was detected in four of the 47 women (8.5%), with half testing positive twice within a 3-month period. 14 women (29.8%) demonstrated reactive syphilis testing. Of 37 women consenting to testing, three screened positive for pregnancy (8.1%). One had gonococcal pharyngitis, proctitis, and urethritis and two had other STI co-infections. Within this cohort of 47 women, 31 of the 32 HIV-negative participants initiated pre-exposure prophylaxis (PrEP) of HIV at IDEA SSP. Of the 12 with HIV, 83% reported adherence to antiretroviral therapy (ART). Three women had unknown HIV status. Conclusion Despite high HIV/STI co-infection and stigma precluding care in traditional health settings, WWID accessing IDEA SSP engaged with PrEP/ART and STI screening, including 100% of women receiving treatment for gonorrhea, chlamydia, and syphilis. Tailoring STI services at an SSP where WWID access nonjudgmental care caters to a historically neglected but key cohort in Ending the HIV Epidemic. Disclosures Hansel Tookes, III, MD, MPH, Gilead sciences: Grant/Research Support|Viiv: Grant/Research Support

Examining the Association Between Affordable Care Act Medicaid Expansion and Sexually Transmitted Infection Testing Among U.S. Women

IntroductionSexually transmitted infection (STI) rates are rising among women in the United States, increasing the importance of routine STI testing. Beginning in 2014, some states expanded Medicaid under the Affordable Care Act, providing health coverage to most individuals in and near poverty. Here, we investigate whether Medicaid expansion changed rates of STI testing among U.S. women. MethodsWe analyzed nationally representative 2011–2017 National Survey of Family Growth data from U.S. women ages 15–44. Using difference-in-differences analysis, we assessed whether Medicaid expansion was associated with within-state changes in the prevalence of STI testing in the past 12 months, among women overall and by race/ethnicity and sexual orientation, during each year following Medicaid expansion. Models were adjusted for individual- and state-level demographic and socioeconomic factors. ResultsOur sample included 14,196 U.S. women. Medicaid expansion was associated with higher STI testing rates, which increased over time. By 3 years post-expansion, expansion states had increased STI testing by 12.7 percentage points more than nonexpansion states (95% confidence interval [CI] [2.5, 23.0], p = .016). This association was imprecisely estimated within racial/ethnic and sexual orientation subgroups, but trended strongest among white, Latina, and heterosexual women, followed by Black and bisexual women (who tested more often at baseline). ConclusionsMedicaid expansion is associated with increased STI testing among U.S. women; these benefits grew over time but varied by both race/ethnicity and sexual orientation. State governments that fail to expand Medicaid may harm their residents’ health by allowing more spread of STIs.

Muslim women's perspectives on the barriers to sexually transmitted infections testing and diagnosis in Saudi Arabia.

Muslim women are especially vulnerable to sexually transmitted infections (STI) and are at higher risk of under-detection. Evidence on the unique barriers to STI testing and diagnosis among Muslim communities is severely lacking. Understanding the complexity of accessing STI testing and diagnosis in Muslim communities is an area that requires further exploration. We aimed to explore the multilevel barriers to STI testing and diagnosis among Muslim women. We conducted qualitative semi-structured interviews informed by the ecological model of health. This study took place in Riyadh Saudi Arabia in 2019 with women aged over 18. Data were analysed using reflexive thematic analysis. Twenty-eight women were interviewed from different ages, marital status, employment, and educational levels. Muslim women's perceived barriers to STI testing and diagnosis included personal, socio-cultural, and service-level barriers. Lack of knowledge about STIs, denial, and underestimating the seriousness of infection and symptoms were among the many individual barriers to STIs testing and diagnosis. Religious views towards extramarital sex and negative views of people with STIs is a significant barrier to STI testing and diagnosis. Lack of patient confidentiality and providers' judgement and mistreatment were also cited as barriers to seeking healthcare. Barriers to STI testing and diagnosis exist on many levels including personal, socio-cultural, religious, and healthcare services, and at policy level. Multilevel interventions are needed to reduce the stigma of STIs and facilitate access to sexual health services among Muslims. It is our recommendation that policy and research efforts are directed to enhance trust in the doctor-patient relationship through better clinical training as well as implementing stricter regulations to protect patients' confidentiality in healthcare settings.

Longitudinal assessment of bacterial vaginosis prior to and during incident pregnancy: an observational study in Kenyan adolescent girls and young women

ObjectiveTo determine bacterial vaginosis (BV) status at multiple time points among adolescent girls and young women (AGYW) and assess the impact of pregnancy on their BV status.DesignLongitudinal cohort study.SettingThika, Kenya.ParticipantsAGYW...

415 Assessing Missed Opportunities for Sexually Transmitted Infection Testing and Linkage to Prenatal Care During Emergency Department Visits in Early Pregnancy

415 Assessing Missed Opportunities for Sexually Transmitted Infection Testing and Linkage to Prenatal Care During Emergency Department Visits in Early Pregnancy

Viral load and sexually transmitted infection testing among youth with HIV in a southern United States clinic.

Background: As compared to their older peers, youth with HIV (YWH) are less likely to attain viral suppression and have higher rates of sexually transmitted infections (STI). In this exploratory study, we examine the relationship between HIV viral suppression, STI testing, and STI diagnosis among YWH receiving care at a clinic in the southern United States.Methods: Data from 933 clinical visits (2017-2020) were aggregated into singular patient records for YWH aged 10-24years in Alabama (N = 139). Analyses included univariate generalized linear mixed models performed with the PROC GLIMMIX procedure approximating the marginal likelihood by using Laplace's method.Results: Sample median age was 22years at the index visit. Most YWH were 20-24years old (69.1%), male (67.6%), and identified as Black (77%); 58.3% were virally unsuppressed at index visit. YWH who identified as White or of other races had 4.79times higher odds of being virally suppressed as compared to Black YWH (p < .01); STI testing behavior and STI positive diagnosis were associated with lower odds of being virally suppression.Conclusions: Findings suggest that among YWH, receiving STI testing and having an STI diagnosis is associated with a lack of viral suppression, suggesting that extra efforts may be necessary to support YWH who have an STI to attain suppression. Research is needed to examine individual behaviors, structural forces, and clinic features that could impact STI care engagement, specifically among unsuppressed YWH.

Utilizing Digital Health Technology to Increase Sexual Health Care Access: Youth Preferences on Self-Collect, Mail-In Sexually Transmitted Infection Testing in a High Sexually Transmitted Infection Prevalence Area

PurposeThe COVID-19 pandemic highlighted the need for innovative approaches to delivering care. Self-collect, mail-in sexually transmitted infection (STI) testing could address barriers to in-person STI testing, particularly for youth, who bear a disproportionate burden of STIs. This study sought to obtain youth input on the development of a free self-collect, mail-in STI testing program. MethodsFocus group discussions (n = 5, 45–60 minutes each) were conducted with 28 youth ages 14–19 years old living in Baltimore, Maryland. Focus group discussions were based on a conceptual framework of patient-centered health-care access, and a prototype online program was discussed. Transcribed data were coded thematically. Memos were written to synthesize findings and identify representative quotes. ResultsParticipants noted existing barriers to in-person STI testing barriers including individual-level (e.g., lack of knowledge), interpersonal-level (e.g., stigma), and structural-level (e.g., financial). Although participants expressed concerns about self-collect, mail-in STI testing (e.g., accuracy of self-swabbing), there was overall acceptance of the program, and many felt it would address current barriers to testing. Opportunities to improve the testing program included all four steps of testing process: kit ordering, receipt of the kit and swabbing, post-testing experience, and communication of results and treatment. Specifically, participants desired expanded shipping options to schools, and mail drop-off points such as lockers and local convenience stores; more transparency about testing and treatment; and hearing directly from health-care providers to assuage any concerns. DiscussionSelf-collect, mail-in STI testing was favorable among youth, and could be a viable option for increasing youth access to STI testing.