Enhanced Surveillance of Sexually Transmitted Infections to Foster a Learning Public Health System

Area of Science:

• Public Health
• Health Informatics
• Epidemiology

Background:

• Sexually transmitted infections (STIs) present a significant public health challenge.
• Fragmented reporting systems limit effective disease surveillance and data-driven public health strategies.
• A learning public health system requires near real-time, integrated data for informed decision-making.

Purpose of the Study:

• To explore the use of health information exchanges (HIEs) and open government data for enhanced public health surveillance.
• To characterize and compare patterns in STI diagnosis versus testing at a regional level.
• To foster a learning public health system through data-driven insights.

Main Methods:

• Cross-sectional study analyzing chlamydia, gonorrhea, and HIV testing and diagnosis data from January 1, 2018, to June 30, 2023.
• Utilized patient-level electronic health record data from over 4.7 million patients in New York City via the Healthix HIE.
• Linked HIE data with American Community Survey neighborhood-level socioeconomic information.

Main Results:

• Analysis included 4,767,322 patients; testing and positivity rates varied significantly across demographic and socioeconomic groups.
• Identified incongruent testing behaviors, with individuals in high-poverty areas less likely to be tested but more likely to test positive for gonorrhea.
• Chlamydia and gonorrhea co-occurred in 7% of chlamydia and 21% of gonorrhea cases.

Conclusions:

• HIEs and open data sources can augment traditional public health reporting for disease surveillance.
• This approach can identify critical testing gaps, disparities, and trends related to STI positivity and coinfections.
• Leveraging such data fosters a learning public health system, enabling continuous improvement in public health strategies.