Purpose
To explore the impact of constrained healthcare resources, together with limited healthcare access during the COVID-19 pandemic, on adolescent sexual health care delivery, including Chlamydia trachomatis (CT) and Neisseria gonorrhea(GC) testing and care.
Methods
This retrospective cohort study queried Military Health System (MHS) Data Repository (MDR) records of military connected dependents aged 13-17 from February 2019-Feb 2020 (pre-pandemic (PP)) and March 2020-July 2021 (COVID-19 pandemic (CP)). We calculated monthly infection rates using clinical encounters with an ICD10 code indicating gonorrhea and chlamydia. We calculated CT/GC testing rates and percent positivity rates using outpatient lab records. We utilized unadjusted and adjusted Poisson regression analysis to calculate rates by age, sex, sponsor rank (proxy for socio-economic status) and PP and CP time periods. We used Joinpoint software to evaluate trends in testing and percent positivity over the study period.
Results
A monthly average of 533,761 military beneficiaries were included, 51% were male, 40% 13-15 years old, 60% 15-17 years old, 6% had junior enlisted (JE) parents, 26% officer/other, and 68% senior enlisted (SE) parents. Over the study period, CT clinical encounter rates were higher in females (RR 6.6, 95%CI 5.7-7.7), those aged 16-17 (RR 9.3, 95%CI 8.0-10.8) and those with a JE parent, vs. SE (RR 1.7, 95%CI 1.44-2.04). GC clinical encounters were also higher in females (RR 2.9, 95% CI 2.4-3.5), 16-17 year olds (RR 8.9, 95% CI 7.1-11.3), and JE sponsors vs. SE (RR 1.3, 95%CI 0.98-1.8). After adjusting for sex, age, and sponsor rank, rate of adolescent encounters for CT was lower during the CP time period (CT aRR: 0.52, 95%CI 0.51-0.62), whereas GC encounters were not significantly different by time period GC (aRR: 1.03, 95%CI: 0.87-1.2). CT and GC testing initially decreased 30% (Jan-Man 2020), increased 30% (May-June 2020), and then steadily declined 2.5% monthly from July 2020-July 2021. CT percent positivity was overall steady in the PP period (5-7%) increased in April (11%) and May (9%) 2020, then decreased starting June 2020 (7%) through July 2021 (4%). There was no change in GC test positivity.
Conclusions
Encounters for CT were less frequent during the COVID-19 pandemic for military connected adolescents, with no change in GC encounters, which may relate to the often symptomatic nature of GC prompting individuals to seek care in spite of the pandemics related barriers. Testing for GC/CT showed a precipitous drop in testing between Jan 2020-May 2020, and though testing has subsequently increased, rates have not reached PP levels. The trends in percent positivity suggest that despite decreased encounters for CT related care, symptomatic individuals still sought care. As we move into a post-pandemic area, opportunities to reengage adolescents in sexual healthcare and optimize opportunities for feasible and accessible solutions to provide STI screening services should be sought out.
Sources of Support
Uniformed Services University VPR Intramural funding.