First name
Sarah
Last name
Wood

Title

Racial Inequities in Adolescent Contraceptive Care Delivery: A Reproductive Justice Issue.

Year of Publication

2023

Number of Pages

298-303

Date Published

06/2023

ISSN Number

1873-4332

Abstract

STUDY OBJECTIVE: The objective of this study was to examine racial/ethnic disparities in contraceptive delivery for adolescent patients within an adolescent medicine subspecialty clinical system before and during the COVID-19 pandemic. Secondarily, we aimed to assess the relationship between race and contraceptive delivery by telehealth.

DESIGN: Retrospective cohort study using electronic health record data SETTING: Three adolescent medicine subspecialty clinics in a large academic hospital system, including an urban location and 2 suburban locations PARTICIPANTS: Patients assigned female sex at birth prescribed hormonal contraception between January 1st, 2018, and May 31st, 2021.

MAIN OUTCOME MEASURES: Method and type of contraceptive prescribed (short-acting, medium-acting, long-acting reversible contraception [LARC]) RESULTS: There were 2453 patients in the study; 47.5% were White, 36.0% were Black, and 8.1% identified as Hispanic. After controlling for insurance and age, Black patients, compared with non-Black patients, had twofold higher odds of receiving LARC compared with a short-acting method across the study period (aOR = 2.0; 95% CI, 1.52-2.62). We identified effect modification with significant interaction between Black race and the pandemic period, with evidence of a higher marginal probability of Black patients receiving LARCs during the pandemic. Additionally, during the pandemic, patients receiving new contraceptive prescriptions via telehealth were less likely to be Black (aOR = 0.63; 95% CI, 0.41-0.94) or publicly insured (aOR = 0.56; 95% CI, 0.38-0.81).

CONCLUSION: Our data show significantly higher prescribing of LARCs to Black adolescents by clinicians, which could suggest differences in physician contraceptive counseling with a bias toward preferentially counseling Black patients toward LARCs. Our data also show that Black and publicly insured patients had decreased utilization of contraceptive care by telehealth during the pandemic.

DOI

10.1016/j.jpag.2022.11.004

Alternate Title

J Pediatr Adolesc Gynecol

PMID

36423806
Featured Publication
No

Title

Measuring quality STI care among adolescent female primary care patients in Philadelphia.

Year of Publication

2023

Date Published

03/2023

ISSN Number

1472-3263

Abstract

OBJECTIVES: Engagement in guideline-recommended sexually transmitted infection (STI) care is fundamental to ending the STI epidemic in the USA. However, the US 2021-2025 STI National Strategic Plan and STI surveillance reports do not include a framework to measure quality STI care delivery. This study developed and applied an STI Care Continuum that can be used across settings to improve STI care quality, assess adherence to guideline-recommended care and standardise the measurement of progress towards National Strategic goals.

METHODS: Review of the Centers for Disease Control and Prevention STI Treatment guidelines identified seven distinct steps of STI care for gonorrhoea, chlamydia and syphilis: (1) STI testing indication, (2) STI test completion, (3) HIV testing, (4) STI diagnosis, (5) partner services, (6) STI treatment and (7) STI retesting. Steps 1-4, 6 and 7 for gonorrhoea and/or chlamydia (GC/CT) were measured among females aged 16-17 years with a clinic visit at an academic paediatric primary care network in 2019. We used Youth Risk Behavior Surveillance Survey data to estimate step 1, and electronic health record data for steps 2, 3, 4, 6 and 7.

RESULTS: Among 5484 female patients aged 16-17 years, an estimated 44% had an STI testing indication. Among those patients, 17% were tested for HIV, of whom none tested positive, and 43% were tested for GC/CT, 19% of whom were diagnosed with GC/CT. Of these patients, 91% received treatment within 2 weeks and 67% were retested within 6 weeks to 1 year after diagnosis. On retesting, 40% were diagnosed with recurrent GC/CT.

CONCLUSIONS: Local application of an STI Care Continuum identified STI testing, retesting and HIV testing as areas for improvement. The development of an STI Care Continuum identified novel measures for monitoring progress towards National Strategic indicators. Similar methods can be applied across jurisdictions to target resources, standardise data collection and reporting and improve STI care quality.

DOI

10.1136/sextrans-2022-055623

Alternate Title

Sex Transm Infect

PMID

36868813
Featured Publication
No

Title

Adherence to New CDC Chlamydia Treatment Guidelines in Adolescents: Effective Uptake and Equitable Implementation.

Year of Publication

2023

Number of Pages

63-65

Date Published

02/2023

ISSN Number

1557-7449

DOI

10.1089/apc.2022.0190

Alternate Title

AIDS Patient Care STDS

PMID

36662591
Featured Publication
No

Title

Chlamydia Trachomatis/Neisseria Gonorrhea Retesting Among Adolescents and Young Adults in a Primary Care Network.

Year of Publication

2022

Date Published

08/2022

ISSN Number

1879-1972

Abstract

PURPOSE: Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) retesting three months after diagnosis is a guideline-recommended strategy to detect re-infections. Adolescents and young adults are priority populations in the U.S. Sexually Transmitted Infections National Strategic Plan, but there is a lack of research examining CT/NG retesting among these populations. This study describes retesting following CT/NG diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting.

METHODS: We evaluated electronic medical records from 2014 to 2020 from an academic urban-suburban primary care network. The primary outcome was retesting, defined as a diagnostic test for CT or NG ordered 8-16 weeks after index diagnosis. Mixed effects logistic regression modeling stratified by Title X funding was conducted to evaluate the association of patient-level factors with CT/NT retesting.

RESULTS: Overall, 23.5% (n = 731) of patients were retested within 8-16 weeks following index CT/NG diagnosis. A significantly greater proportion of Title X patients were retested compared to non-Title X patients. Males were significantly less likely to be retested compared to females, and the proportion of patients retested decreased significantly over the study period.

DISCUSSION: Guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients. Decreases in CT/NG retesting over the study period may be contributing to worsening of the STI epidemic. Our results provide insights into CT/NG retesting that can inform efforts to end the STI epidemic.

DOI

10.1016/j.jadohealth.2022.06.014

Alternate Title

J Adolesc Health

PMID

35963759

Title

HIV pre-exposure prophylaxis: assessment of acceptability among members of HIV serodiscordant/serostatus unknown couples.

Year of Publication

2022

Number of Pages

9564624221097753

Date Published

2022 Apr 29

ISSN Number

1758-1052

Abstract

<p><strong>BACKGROUND: </strong>Pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection but is not yet widely available in resource-limited settings such as the Dominican Republic. We aimed to ascertain PrEP acceptability among people living with HIV in the Dominican Republic who are part of HIV serodiscordant partnerships and understand relationships between PrEP acceptability, HIV stigma, and intimate partner violence. A cross-sectional survey of people in care for HIV infection included acceptability-related questions and assessments of HIV stigma and intimate partner violence. We also explored the expected impact of PrEP on HIV disclosure rates and fertility intentions. Of the 100 participants, 74% had been in their current partnership for &gt;1&nbsp;year; 38% had not disclosed to their partner; 29% reported condomless sex, and 23% reported sex with multiple partners. PrEP was highly acceptable with 84% of participants saying they were "very likely" to offer PrEP to their partner if available and 21% stating it would allow them to have more children. Of those who had not disclosed to their partner, 71% stated PrEP would help them do so. No relationship was found between PrEP acceptability, HIV stigma, and intimate partner violence. However, higher than expected rates of PrEP acceptability limited the power of these analyses. Pre-exposure prophylaxis was considered to be highly acceptable among people living with HIV in the Dominican Republic who are part of serodiscordant partnerships.</p>

DOI

10.1177/09564624221097753

Alternate Title

Int J STD AIDS

PMID

35488451

Title

Identifying Opportunities to Discuss Pre-Exposure Prophylaxis During Contraceptive Coaching Discussions With Urban Adolescent Women.

Year of Publication

2021

Date Published

2021 Jun 05

ISSN Number

1879-1972

Abstract

<p><strong>PURPOSE: </strong>HIV pre-exposure prophylaxis (PrEP) reduces HIV transmission and is approved for adolescents aged 12-17 years. Adolescent girls and young women (AGYW) have modest PrEP uptake rates, while many receive reproductive health counseling. We sought to identify opportunities for incorporating PrEP education in contraceptive counseling delivered to AGYW.</p>

<p><strong>METHODS: </strong>We performed a secondary analysis of data from the Health Coaching for Contraceptive Continuation pilot study, which supported contraceptive use among AGYW. Participants were 14-22 years old, sexually active with males, and not desiring pregnancy within 12 months. Coaches were sexual health educators with ≥5&nbsp;years' experience providing contraceptive and PrEP counseling to youth. Participants completed a baseline visit within 30 days of contraceptive initiation and completed up to five monthly coaching sessions. Of 33 enrollees, this analysis includes the 21 who completed ≥4 sessions. Two coders deductively coded session transcripts for five themes: opportunities to discuss PrEP; HIV knowledge, risk perception, and testing attitudes; changes in HIV risk status; condom use knowledge and skills; and sexually transmitted infection knowledge and risk perception.</p>

<p><strong>RESULTS: </strong>Of the 111 transcripts coded, 24 contained opportunities to discuss PrEP and were inductively analyzed. Thematic analysis demonstrated three types of opportunities for PrEP discussions: failure to introduce information, and provision of incomplete information or misinformation. Analysis also revealed four opportunity contexts: sexually transmitted infection prevention strategies, HIV risk reduction, avoidance of adverse sexual health outcomes, and disclosures of condom nonprotected sexual behaviors. Only one transcript mentioned PrEP.</p>

<p><strong>CONCLUSIONS: </strong>Multiple opportunities to introduce PrEP counseling exist within contraceptive counseling provided to AGYW.</p>

DOI

10.1016/j.jadohealth.2021.04.031

Alternate Title

J Adolesc Health

PMID

34103237

Title

Facilitators and Barriers to Implementation of Long-Acting Reversible Contraceptive Services for Adolescent Girls and Young Women in Gaborone, Botswana.

Year of Publication

2021

Date Published

2021 Mar 22

ISSN Number

1873-4332

Abstract

<p><strong>STUDY OBJECTIVE: </strong>Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana.</p>

<p><strong>DESIGN: </strong>Cross-sectional mixed methods.</p>

<p><strong>SETTING: </strong>Gaborone, Botswana.</p>

<p><strong>PARTICIPANTS: </strong>20 sexually active AGYW ages 18-24; 20 health system stakeholders.</p>

<p><strong>INTERVENTIONS: </strong>Surveys and semi-structured interviews grounded in the Consolidated Framework for Implementation Research (CFIR).</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Themes reflecting barriers and facilitators of LARC implementation.</p>

<p><strong>RESULTS: </strong>The median age for AGYW was 22 (IQR 21-23). Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators to LARC implementation spanned factors at each CFIR domain: 1) LARC characteristics like side effects; 2) the clinics' inner settings, including availability of youth-friendly services; 3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes and beliefs about LARCs; 4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and 5) the implementation process level such as the availability of free or low-cost LARCs.</p>

<p><strong>CONCLUSIONS: </strong>We identified multi-level, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.</p>

DOI

10.1016/j.jpag.2021.03.005

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33766793

Title

Effect of Prior Adverse Reproductive Health Outcomes on Young Women's Engagement in a Health Coaching Intervention to Improve Contraceptive Continuation.

Year of Publication

2021

Date Published

2021 Feb 08

ISSN Number

1873-4332

Abstract

<p><strong>OBJECTIVE: </strong>Nonadherence in sexual risk reduction interventions may be common among adolescents. We compared intervention completion rates among adolescent and young adult women with and without a prior pregnancy or sexually transmitted infection (STI) participating in a program to improve contraceptive continuation.</p>

<p><strong>DESIGN: </strong>Secondary data analysis from a feasibility study of a health coaching intervention to improve contraceptive continuation.</p>

<p><strong>SETTING: </strong>Three urban pediatric clinics in Philadelphia.</p>

<p><strong>PARTICIPANTS: </strong>Women ages 14-22 years who were English-speaking, sexually active in the past year, not desiring pregnancy in the next year, and starting a new contraceptive method.</p>

<p><strong>INTERVENTIONS: </strong>At baseline, participants completed a sociodemographic questionnaire and semi-structured interview, followed by five monthly coaching sessions. Interviews and coaching sessions were audio-recorded, transcribed, and coded for thematic content.</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Intervention completion was defined as the number of completed coaching sessions.</p>

<p><strong>SECONDARY OUTCOMES: </strong>Qualitatively explored group differences in reproductive knowledge, attitudes, and risk perception.</p>

<p><strong>RESULTS: </strong>Participants with a prior adverse outcome (a prior STI and/or a prior pregnancy) completed fewer coaching sessions than those without such history (median: 2 vs. 4, p=0.03). Both groups had low HIV/STI knowledge, negative attitudes towards pregnancy, and low HIV/STI risk perception. Those with a prior adverse reproductive outcome held more negative attitudes towards condoms.</p>

<p><strong>CONCLUSION: </strong>Despite similar reproductive knowledge, attitudes, and risk perception, young women who have experienced an adverse reproductive outcome may be less likely to fully engage in sexual risk reduction interventions. Future studies should confirm these findings and consider strategies to optimize interventions reach for vulnerable youth.</p>

DOI

10.1016/j.jpag.2021.02.003

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33571659

Title

HIV Testing Among Adolescents With Acute Sexually Transmitted Infections.

Year of Publication

2020

Date Published

2020 Mar 16

ISSN Number

1098-4275

Abstract

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing.</p>

<p><strong>METHODS: </strong>Retrospective study of STI episodes (gonorrhea, <em>Chlamydia,</em>&nbsp;trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis.</p>

<p><strong>RESULTS: </strong>The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing.</p>

<p><strong>CONCLUSIONS: </strong>HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.</p>

DOI

10.1542/peds.2019-2265

Alternate Title

Pediatrics

PMID

32179661

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