A Renewed Call to Action for Addressing the Alarming Rising Rates of Sexually Transmitted Infections in U.S. Adolescents and Young Adults

Examining County-Level Associations between Federally Qualified Health Centers and Sexually Transmitted Infections: A Political Ecology of Health Framework

Federally Qualified Health Centers (FQHCs) are the largest providers of healthcare for sexually transmitted infections (STIs) in medically underserved communities in the United States (US). Through the Affordable Care Act (ACA), FQHCs have grown in number, but the impact of this growth on STIs is poorly understood. This ecological study seeks to quantify the association between FQHCs and STI prevalence in all US counties. Variables were described utilizing medians and interquartile ranges, and distributions were compared using Kruskal-Wallis tests. Median rates of chlamydia in counties with high, low, and no FQHCs were 370.3, 422.6, and 242.1 cases per 100,000 population, respectively. Gonorrhea rates were 101.9, 119.7, and 49.9 cases per 100,000 population, respectively. Multivariable linear regression models, adjusted for structural and place-based characteristics (i.e., Medicaid expansion, social vulnerability, metropolitan status, and region), were used to examine county-level associations between FQHCs and STIs. Compared to counties with no FQHCs, counties with a high number of FQHCs had chlamydia rates that were an average of 68.6 per 100,000 population higher (β = 68.6, 95% CI: 45.0, 92.3) and gonorrhea rates that were an average of 25.2 per 100,000 population higher (β = 25.2, 95% CI: 13.2, 37.2). When controlled for salient factors associated with STI risks, greater FQHC availability was associated with greater diagnosis and treatment of STIs. These findings provide empirical support for the utility of a political ecology of health framework and the critical role of FQHCs in confronting the STI epidemic in the US.

Voluntary Medical Male Circumcision for HIV Prevention: a Global Overview

PURPOSE OF REVIEW

With the promise of HIV prevention, there has been a scale-up of voluntary medical male circumcision (VMMC) in high HIV incidence/low circumcision prevalence nations worldwide. Nonetheless, debates over the implementation and the effectiveness and safety of the VMMC in real-world settings persist. We revisit the role of VMMC in HIV prevention to inform health professionals, policymakers, and advocates or opponents in this new era.

RECENT FINDINGS

There has been substantial progress on VMMC scale-up to date, but this has varied considerably by region. The evidence of solid and direct protection of VMMC is available for heterosexual men and older adolescent boys in sub-Saharan Africa. The protective effect in men who have sex with men is suggested by systematic reviews but is not confirmed by clinical trials. Sexual partners, including women, likely benefit indirectly from the increased VMMC coverage through a decreased risk of exposure to infected male partners. Fortunately, the preponderance of studies does not suggest higher sexual risk behaviors among circumcised men, so-called risk compensation. VMMC requires health systems strengthening and continued promulgation of other evidence-based HIV prevention strategies to be successful. Health authorities in high HIV incidence areas that have low circumcision coverage should implement VMMC within a context of complementary biomedical and behavioral prevention strategies.

Impact of Early Stages of the COVID-19 Pandemic on Sexually Transmitted Infection Screening Claims Among Adolescent Females in a Pediatric Accountable Care Organization in Ohio, United States

Background Testing for sexually transmitted infections (STIs) decreased during the early months of the coronavirus disease 2019 (COVID-19) pandemic. Less is known about the extent to which screening of asymptomatic adolescents for STIs was specifically affected. Our aim was to describe the impacts of early stages of the COVID-19 pandemic on asymptomatic STI screening and overall STI testing among adolescent females aged 13 to 19. We hypothesized that screening would decrease more than overall testing. Methods We evaluated claims data from a pediatric accountable care organization responsible for approximately 40,000 adolescent females. We assessed rates of asymptomatic screening and overall testing for chlamydia and gonorrhea in this population, comparing the early pandemic to pre-pandemic levels. Results Both STI screening and overall STI testing were found to be significantly decreased during the early period of the COVID-19 pandemic compared to pre-pandemic levels. The proportion of tests billed as screening was 70% of tests for April to August 2020 (early pandemic), compared to 67% for October 2019 to February 2020 and 64% for April to August 2019, contrary to our hypothesis. Conclusion Asymptomatic screening represented a similar proportion of STI testing among this population of adolescent females during the early COVID-19 pandemic compared to pre-pandemic testing. More work is needed to understand how asymptomatic screening was proportionally maintained despite COVID-19 pandemic restrictions.