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Sexually Transmitted Infection Testing in the National Veterans Health Administration Patient Cohort During the
Lauren A Beste1,2, Shimrit Keddem3,4, Joleen Borgerding5
1General Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
Insights
Sexually transmitted infection (STI) testing dropped significantly in 2020 but largely recovered by 2021. However, testing recovery for chlamydia, gonorrhea, syphilis, and HIV was slower for rural, female, and minority Veterans.
Area of Science:
- Public Health
- Infectious Diseases
- Health Services Research
Background:
- The Veterans Health Administration (VHA) provides care to a diverse population, necessitating monitoring of sexually transmitted infection (STI) testing trends.
- Understanding testing patterns for chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV) is crucial for public health surveillance.
Purpose of the Study:
- To analyze trends in chlamydia, gonorrhea, syphilis, and HIV testing within the VHA from 2019 to 2021.
- To identify disparities in STI testing declines and recovery across various demographic and clinical groups.
Main Methods:
- Retrospective study utilizing electronic health record data from the VHA.
- Analysis of annual testing numbers and rates for chlamydia, gonorrhea, syphilis, and HIV from 2019-2021.
- Stratification of testing rates by age, birth sex, race, geographic region, rurality, HIV status, and preexposure prophylaxis use.
Main Results:
- A significant drop in STI testing occurred in 2020 compared to 2019, with declines of 24% for chlamydia/gonorrhea, 25% for syphilis, and 29% for HIV.
- By 2021, testing rates had largely recovered to near baseline levels (88-91%).
- Testing recovery was uneven, with rural Veterans, women (for chlamydia/gonorrhea), Asian Americans, Native Hawaiians/Pacific Islanders, and Black Veterans experiencing slower recovery for certain STIs.
Conclusions:
- STI testing experienced substantial reductions in 2020 but showed significant recovery by 2021.
- Disparities in testing recovery were observed, particularly impacting rural, female, Asian American, Native Hawaiian/Pacific Islander, and Black Veterans.
- Targeted interventions may be needed to address persistent testing gaps in vulnerable populations.
Background:
We performed a retrospective study of chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV) testing in the Veterans Health Administration (VHA) during 2019-2021.
Methods:
We determined the annual number of chlamydia, gonorrhea, syphilis, and HIV tests from 2019 through 2021 using electronic health record data. We calculated rates by age, birth sex, race, census region, rurality, HIV status, and use of preexposure prophylaxis.
Results:
The VHA system experienced a 24% drop in chlamydia/gonorrhea testing, a 25% drop in syphilis testing, and a 29% drop in HIV testing in 2020 versus 2019. By the conclusion of 2021, testing rates had recovered to 90% of baseline for chlamydia/gonorrhea, 91% for syphilis, and 88% for HIV. Declines and subsequent improvements in sexually transmitted infection (STI) testing occurred unequally across age, sex, race, and geographic groups. Testing for all 4 STIs in 2021 remained below baseline in rural Veterans. Excluding those aged <25 years, women experienced a steeper decline and slower recovery in chlamydia/gonorrhea testing relative to men, but quicker recovery in HIV testing. Asian Americans and Hawaiian/Pacific Islanders had a steeper decline and a slower recovery in testing for chlamydia/gonorrhea. Black and White Veterans had slower recovery in HIV testing compared with other race groups. People living with HIV experienced a smaller drop in testing for syphilis compared with people without HIV, followed by a near-total recovery of testing by 2021.
Conclusions:
After dramatic reductions from 2019 to 2020, STI testing rates returned to near-baseline in 2021. Testing recovery lagged in rural, female, Asian American, Hawaiian/Pacific Islander, and Black Veterans.
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