Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19

Jungwon Min; Stephen Bonett; Vicky Tam; Spandana Makeneni; Neal D Goldstein; Sarah Wood

doi:10.1016/j.amepre.2024.02.016

Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19

Am J Prev Med. 2024 Feb 28:S0749-3797(24)00070-9. doi: 10.1016/j.amepre.2024.02.016. Online ahead of print.

Authors

Jungwon Min¹, Stephen Bonett², Vicky Tam³, Spandana Makeneni³, Neal D Goldstein⁴, Sarah Wood⁵

Affiliations

¹ Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: minj1@chop.edu.
² School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
³ Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
⁴ Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania.
⁵ Clinical Futures and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

PMID: 38417592
DOI: 10.1016/j.amepre.2024.02.016

Abstract

Introduction: Early in the COVID-19 pandemic, routine sexually transmitted infection (STI) screenings decreased, and test positivity rates increased due to limited screening appointments, national-level STI testing supply shortages, and social distancing mandates. It is unclear if adolescent preventive STI screening has returned to pre-pandemic levels and if pre-existing disparities worsened in late-pandemic.

Methods: This cross-sectional study examined 22,974 primary care visits by 13-19-year-olds in the Philadelphia metropolitan area undergoing screening for gonorrhea and chlamydia in a 31-clinic pediatric primary care network during 2018-2022. Using interrupted-time-series analysis and logistic regression, pandemic-related changes in the asymptomatic STI screening rate and test positivity were tracked across patient demographics. Neighborhood moderation was investigated by census-tract-level Child Opportunity Index in 2023.

Results: The asymptomatic STI screening rate dropped by 27.8 percentage points (pp) and 13.5pp when the pandemic and national STI test supply shortage began, respectively, but returned to pre-pandemic levels after supply availability was restored in early 2021. Non-Hispanic-Black adolescents had a significant pandemic drop in STI screening rate, and it did not return to prep-andemic levels (-3.6 pp in the late-pandemic period, p<0.01). This decrease was more pronounced in socioeconomically and educationally disadvantaged neighborhoods (7.5 pp and 9.9 pp lower, respectively) than in advantaged neighborhoods (both p<0.001), controlling for sex, age, insurance type and clinic characteristics.

Conclusions: Neighborhood socioeconomic and educational disadvantage amplified racial-ethnic disparities in STI screening during the pandemic. Future interventions should focus on improving primary care utilization of non-Hispanic-Black adolescents to increase routine STI screening and preventive care utilization.