P2.O294: Opt-out urine testing for Gonorrhea and Chlamydia: Increasing STI testing rates in a Primary Care Setting

Purpose/Objectives: Gonorrhea and chlamydia are sexually transmitted infections (STI) that are becoming more prevalent in the United States. While often asymptomatic, both can lead to serious adverse health outcomes including pelvic inflammatory disease, epididymitis, and infertility. A CDC report in 2018 showed nearly half of new STIs were among youth aged 15-24 years old. Despite these high numbers, testing rates of adolescents in the US continue to be low. The 2019 Youth Risk Behavior Survey demonstrated that of those sexually active, only 20% had been tested for STIs in the past year. Testing in the pediatrician’s office is often opt-in and based on self reports of sexual activity. This project seeks to increase STI screening rates by implementing opt-out STI screening during adolescent well visits.

Design/Methods: This IRB approved QI project analyzes data from Slicer Dicer, a reporting data analytics tool within the Epic EHR. Pre- and post-intervention data was obtained and compared for patients aged 13 to 20 being seen for adolescent physical exams at our hospital-based outpatient clinic. The primary objective measure was STI testing rate. Secondary objectives included differences in testing rates between different ages, sexes, and races. Pre-intervention data was collected from September 2022 to March 2023 and post-intervention from March 2023 to August 2023. A PDSA intervention included education for residents on the importance of screening, how to approach the topic of opt-out STI screening, and maintaining confidentiality about testing. We provided patients with an information sheet at check-in and placed urine collection cups outside patient rooms to encourage providers to complete the screening. If the patient wanted to opt out from STI screening, they had to verbally decline.

Results: An interrupted time series analysis indicated a significant increase in STI testing rates at the implementation of opt-out testing (p-value = 0.02), with the effect size quantified as a 14.5% increase in the rate of STI testing among adolescents. The shift from 'risk-based' screening to 'opt-out' screening significantly elevated the percentage of adolescents screened for STIs, underscoring the effectiveness of the intervention. While the initial effect of the intervention was markedly positive, a subsequent analysis over a 6-month post-intervention period revealed a decreasing trend in testing rates. There were no differences in testing groups when looking at age, gender, or races.

Conclusion/Discussion: We were able to demonstrate that opt-out STI screening, starting at age 13, increased the overall rates of adolescent STI testing, with an overall 14.5% increase in testing. Looking forward, we propose evaluating the rates of positive results before and after opt-out screening.