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.
- sexual health
- delivery of health care
- health services research
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Handling editor Eric P F Chow
Contributors DTdS, SW and HW conceptualised the study. DTdS and SM analysed the data. SW supervised the overall study. JAB provided substantial contributions to the interpretation of the data. DTdS wrote the first draft of the manuscript, and all authors contributed to manuscript revisions and approved the final version of the manuscript.
Funding This work was supported by the National Institute of Mental Health (5K23MH119976), the National Institute of Allergy and Infectious Diseases (P30 AI045008) and the Agency for Healthcare Research and Quality (T32 HS026116).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.