Outcomes of an Opt-Out Chlamydia Testing Program Across 21 Northern California Pediatric Clinics.

Area of Science:

• Public Health
• Pediatric Medicine
• Infectious Disease Prevention

Background:

• Chlamydia is a prevalent sexually transmitted infection (STI) disproportionately affecting adolescents.
• Traditional opt-in STI testing models may present barriers to screening in pediatric settings.
• Opt-out testing strategies have shown promise in increasing screening uptake in various healthcare contexts.

Purpose of the Study:

• To evaluate the impact of implementing an opt-out chlamydia testing protocol on diagnosis rates among female pediatric patients.
• To assess changes in chlamydia testing and diagnosis across different demographic subgroups following the intervention.

Main Methods:

• Retrospective study analyzing data from 21,660 female patients aged 16-24 across 21 pediatric clinics.
• Comparison of testing and diagnosis rates between pre-implementation (2023) and post-implementation (2024) of opt-out testing.
• Statistical analysis using Chi-square tests to determine the significance of changes in testing and diagnosis rates.

Main Results:

• Chlamydia testing rates more than doubled, increasing from 12.9% in 2023 to 31.7% in 2024 (p < .001).
• Testing increases were observed across all demographic groups, with notable gains among privately insured and Hispanic/Latino or non-Hispanic Asian patients.
• The proportion of positive diagnoses decreased from 1.6% to 0.9% (p = .02), but the absolute number of diagnoses increased from 22 to 30.

Conclusions:

• Integrating opt-out chlamydia testing into routine pediatric visits is an effective and scalable strategy for enhancing STI prevention.
• This approach successfully increased screening coverage, leading to a higher absolute number of chlamydia diagnoses identified.
• Opt-out testing facilitates broader STI screening, contributing to public health goals for adolescent sexual health.