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Topics in Antiviral Medicine ; 30(1 SUPPL):350, 2022.
Article in English | EMBASE | ID: covidwho-1880027


Background: Sexually transmitted infection (STI) diagnosis serves as an important linkage to HIV testing and pre-exposure prophylaxis (PrEP) for adolescents. The COVID-19 pandemic disrupted sexual health services for young people, with a potential consequence of increasing undiagnosed STIs. This study aimed to describe STI testing changes and estimate undiagnosed STI cases during the pandemic. Methods: We analyzed electronic medical records for chlamydia, gonorrhea, and trichomonas testing encounters from six pediatric primary care clinics in Philadelphia, July 2014-November 2020. We assessed whether testing was asymptomatic screening, risk-based testing, or symptomatic testing, and whether any result was positive. We evaluated STI trends over time, comparing pre-pandemic (before March 1st, 2020) and pandemic periods (after March 1st, 2020). Missed STI cases during the pandemic were estimated using decreases in patient volume and asymptomatic screening as compared to the previous year. Generalized linear mixed-effects models estimated the effects of patient-level and neighborhood-level characteristics on STI outcomes. Results: 35,548 STI testing encounters were analyzed, including 2,958 during the pandemic period. The median patient age was 17.5 years, 57% of patients were female, and 84% were Black/African American. Mean monthly STI testing encounters decreased from 479/month pre-pandemic to 329/month during the pandemic. Test positivity increased from 12.5% pre-pandemic to a peak of 27.5% in April 2020. The percent of STI tests performed as asymptomatic screening dropped from 72.5% pre-pandemic to a nadir of 54.5% in April 2020 (Figure). We estimate that the decrease in asymptomatic screening in the pandemic period would be associated with 159 missed cases (23.8% of expected cases) based on patient volume from the previous year. In multivariate models controlling for testing type (asymptomatic screening, risk-based testing, or symptomatic testing), the odds of test positivity were 50% higher during the pandemic (OR: 1.50, p<0.001). Conclusion: STI test positivity increased during the pandemic while asymptomatic screening decreased. Test positivity was higher for asymptomatic patients, suggesting increased STI prevalence. These changes likely resulted in a substantial number of undiagnosed STIs, representing missed opportunities for PrEP linkage. Efforts are needed to re-establish and sustain access to STI services for adolescents in response to disruptions caused by the pandemic.