Correlates of Sexually Transmitted Infection Positivity and Implementation of Point-of-Care Sexually Transmitted...

Women who inject drugs (WWID) face complex barriers to engagement in sexual healthcare. We used point-of-care (POC) testing to assess sexually transmitted infection (STI) prevalence, correlates, and treatment delivery, as well as testing acceptability and feasibility, at a mobile clinic for WWID in Seattle, Washington.

We implemented a mobile clinic offering substance use and sexual health services for women ≥18 years with a history of injecting drugs and negative or unknown HIV status. We offered POC testing for trichomonas, syphilis, chlamydia, gonorrhea, and HIV at enrollment, 3 months, and 6 months. Participant surveys assessed demographics, behaviors, and acceptability of POC testing. Provider surveys assessed the feasibility of care delivery. We used bivariate analysis to identify correlates of STI positivity.

Among 50 WWID enrolled, 73% were unstably housed, and 56% reported a previous STI. In the preceding 3 months, 34% reported transactional sex, and 38% had ≥2 sexual partners. During the study period, 26% of women tested positive for trichomonas, 4% for syphilis, 3% each for chlamydia and gonorrhea, and 0% for HIV. Same-day treatment was provided in 94% of cases. STI positivity was associated with ≥2 sexual partners (odds ratio: 5.8, P = 0.02) and transactional sex (odds ratio: 4.8, P = 0.02). POC testing was acceptable, and 84% preferred it over traditional methods. Staff encountered challenges with POC logistics and competing participant priorities.

STI prevalence, particularly trichomonas, was high among WWID, but low-barrier POC STI testing services were acceptable and feasible, leading to same-day STI treatment in most cases.