National Testing Assessment of Select Bacterial STIs During the COVID-19 Pandemic

Background. Chlamydia, gonorrhea, and syphilis infections rose in the US for 6 consecutive years before the COVID-19 pandemic. Patterns of sexually transmitted infection (STI) testing during the COVID-19 pandemic have yet to be fully assessed. Methods. We performed a retrospective study of STI testing in the Veteran's Health Administration (VHA) healthcare system during each calendar year 2019-2021 using electronic health record data. We determined the number of chlamydia (CT) and gonorrhea (GC), and syphilis tests performed overall and in demographic groups defined by age, birth sex, self-reported race, region, and HIV status. Results. VHA performed 202,503 CT tests, 201,314 GC tests and 250,790 syphilis tests in 2019, followed by a 23% and 25% decrease in 2020 for CT/GC and syphilis testing, respectively. We observed decreases among all subgroups defined by age, sex, race, and geography. Race groups with the biggest decreases in 2020 include Asian Americans (-28%) and Hawaiian and Pacific Islanders (-27%). By 2021, overall testing rates demonstrated a partial recovery to 89.8% of their 2019 levels. Testing rates in 2021 in rural/ highly rural residents remained 17% below baseline, compared with 10% for urban dwellers. Veterans living in the Northeast, South, or Midwest had the least recovery among geographic regions (16%, 11% and 11% below baseline, respectively). People with HIV experienced a decline in CT/GC testing of 15% but by the end of 2021 this had recovered to 1.9% below baseline. Women experienced both a steeper drop and a smaller recovery in CT and GC testing relative to men Conclusion. After dramatic reductions in STI testing during the COVID-19 pandemic, rates returned to near-baseline levels nationally by 2021. Testing rates have lagged in some patient groups, most notably rural and highly rural populations, women, and Black and Asian American Veterans, placing them at risk for disparities in STI diagnosis, and therefore treatment. Testing rates in Veterans under age 25 years have reached or exceeded pre-pandemic levels. (Figure Presented).

Improving HIV Pre-Exposure Prophylaxis (PrEP) Uptake During the COVID-19 Pandemic

Background: Acute HIV cases have doubled during the COVID-19 pandemic. We implemented a quality improvement (Ql) project to standardize PrEP telehealth at a large metropolitan medical center in a HIV hotspot to ensure PrEP access and uptake. Methods: A 2-arm recruitment approach was implemented from August 31st, 2020-December 16th, 2020 targeting (1) patients through weekly social medial outreach and (2) providers in high-volume departments through educational in-services and dedicated chart reviews. Results: Provider referrals from the Emergency and Primary Care Departments increased 460% (p=0.03). PrEP users shifted to a majority<35 years old (n=12, 38.7%), but remained mostly Black (n=16, discontinuation during the pandemic. The low percentage of PrEP users may be related to COVID-19 on clinic follow-up. The younger demographic shift may translate to a larger decrease in HIV transmission given the relative risk of different cohorts. © 2022, ResearchTrentz Academy Publishing Education Services. All rights reserved.