The Relationship Between Directly Observed Therapy for Chlamydia Infections and Retesting Rates in an Adolescent Population.
Journal
Sexually transmitted diseases
ISSN: 1537-4521
Titre abrégé: Sex Transm Dis
Pays: United States
ID NLM: 7705941
Informations de publication
Date de publication:
01 06 2023
01 06 2023
Historique:
pmc-release:
01
06
2024
medline:
15
5
2023
pubmed:
3
3
2023
entrez:
2
3
2023
Statut:
ppublish
Résumé
Chlamydia trachomatis is the most common reportable sexually transmitted infection in the United States, with >60% of reported cases occurring in individuals aged 15 to 24 years. US practice guidelines recommend directly observed therapy (DOT) for the treatment of chlamydia in adolescents, but almost no research has been done to evaluate whether DOT results in improved outcomes. We conducted a retrospective cohort study of adolescents who sought care at 1 of 3 clinics within a large academic pediatric health system for a chlamydia infection. The study outcome was return for retesting within 6 months. Unadjusted analyses were performed using χ2 , Mann-Whitney U , and t tests, and adjusted analyses were performed using multivariable logistic regression. Of the 1970 individuals included in the analysis, 1660 (84.3%) received DOT and 310 (15.7%) had a prescription sent to a pharmacy. The population was primarily Black/African American (95.7%) and female (78.2%). After controlling for confounders, individuals who had a prescription sent to a pharmacy were 49% (95% confidence interval, 31%-62%) less likely than individuals who received DOT to return for retesting within 6 months. Despite clinical guidelines recommending the use of DOT for chlamydia treatment in adolescents, this is the first study to describe the association between DOT and an increase in the number of adolescents and young adults who return for sexually transmitted infection retesting within 6 months. Further research is needed to confirm this finding in diverse populations and explore nontraditional settings for the provision of DOT.
Sections du résumé
BACKGROUND
Chlamydia trachomatis is the most common reportable sexually transmitted infection in the United States, with >60% of reported cases occurring in individuals aged 15 to 24 years. US practice guidelines recommend directly observed therapy (DOT) for the treatment of chlamydia in adolescents, but almost no research has been done to evaluate whether DOT results in improved outcomes.
METHODS
We conducted a retrospective cohort study of adolescents who sought care at 1 of 3 clinics within a large academic pediatric health system for a chlamydia infection. The study outcome was return for retesting within 6 months. Unadjusted analyses were performed using χ2 , Mann-Whitney U , and t tests, and adjusted analyses were performed using multivariable logistic regression.
RESULTS
Of the 1970 individuals included in the analysis, 1660 (84.3%) received DOT and 310 (15.7%) had a prescription sent to a pharmacy. The population was primarily Black/African American (95.7%) and female (78.2%). After controlling for confounders, individuals who had a prescription sent to a pharmacy were 49% (95% confidence interval, 31%-62%) less likely than individuals who received DOT to return for retesting within 6 months.
CONCLUSIONS
Despite clinical guidelines recommending the use of DOT for chlamydia treatment in adolescents, this is the first study to describe the association between DOT and an increase in the number of adolescents and young adults who return for sexually transmitted infection retesting within 6 months. Further research is needed to confirm this finding in diverse populations and explore nontraditional settings for the provision of DOT.
Identifiants
pubmed: 36863059
doi: 10.1097/OLQ.0000000000001790
pii: 00007435-202306000-00004
pmc: PMC10175119
mid: NIHMS1878260
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
342-345Subventions
Organisme : NIMH NIH HHS
ID : K23 MH119976
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI045008
Pays : United States
Informations de copyright
Copyright © 2023 American Sexually Transmitted Diseases Association. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest and Sources of Funding: None declared.
Références
Centers for Disease Control and Prevention. Preliminary 2021 STD Surveillance Data. 2022. Available at: https://www.cdc.gov/std/statistics/2021/default.htm . Accessed November 11, 2022.
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2020. 2022. Available at: https://www.cdc.gov/std/statistics/2020/tables.htm . Accessed November 11, 2022.
Shannon CL, Klausner JD. The growing epidemic of sexually transmitted infections in adolescents: A neglected population. Curr Opin Pediatr 2018; 30:137–143.
Farley TA, Cohen DA, Elkins W. Asymptomatic sexually transmitted diseases: The case for screening. Prev Med 2003; 36:502–509.
Kreisel KM, Weston EJ, St Cyr SB, et al. Estimates of the prevalence and incidence of chlamydia and gonorrhea among US men and women, 2018. Sex Transm Dis 2021; 48:222–231.
Allen UD, MacDonald NE, et al; Canadian Paediatric Society. Sexually transmitted infections in adolescents: Maximizing opportunities for optimal care. Paediatr Child Health 2014;19:429–433.
Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021: Chlamydial Infection. Available at: https://www.cdc.gov/std/treatment-guidelines/chlamydia.htm . Accessed February 7, 2022.
Haggerty CL, Gottlieb SL, Taylor BD, et al. Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis 2010; 201(Suppl 2):S134–S155.
Lanjouw E, Ouburg S, de Vries HJ, et al. 2015 European guideline on the management of Chlamydia trachomatis infections. Int J STD AIDS 2016; 27:333–348.
McCool-Myers M, Turner D, Henn MC, et al. Finding the gaps in retesting for chlamydia and gonorrhea: Differences across high-volume testing departments in an urban health care setting. Sex Transm Dis 2021; 48:819–822.
Hoover KW, Tao G, Nye MB, et al. Suboptimal adherence to repeat testing recommendations for men and women with positive chlamydia tests in the United States, 2008–2010. Clin Infect Dis 2013; 56:51–57.
Dee EC, Hsu KK, Kruskal BA, et al. Temporal patterns in chlamydia repeat testing in Massachusetts. Am J Prev Med 2019; 56:458–463.
Platt L, Elder H, Bassett IV, et al. Chlamydia treatment practices and time to treatment in Massachusetts: Directly observed therapy versus pharmacy prescriptions. J Prim Care Community Health 2021; 12:21501327211044060.
Bonett S, Teixeira da Silva D, Lazar N, et al. Trends in sexually transmitted infection screening during COVID-19 and missed cases among adolescents. Public Health 2022; 213:171–176.
Mayne SL, Hannan C, Davis M, et al. COVID-19 and adolescent depression and suicide risk screening outcomes. Pediatrics 2021; 148:e2021051507.
R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, 2022. Available at: https://www.R-project.org/ . Accessed February 1, 2022.
Henderson JT, Senger CA, Henninger M, et al. Behavioral counseling interventions to prevent sexually transmitted infections: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2020; 324:682–699.
Low N, Heijne JC, Herzog SA, et al. Reinfection by untreated partners of people treated for Chlamydia trachomatis and Neisseria gonorrhoeae : Mathematical modelling study. Sex Transm Infect 2014; 90:254–256.
Anschuetz GL, Beck JN, Asbel L, et al. Determining risk markers for gonorrhea and chlamydial infection and reinfection among adolescents in public high schools. Sex Transm Dis 2009; 36:4–8.
Kovaleski L, Feldman C, Baker S, et al. Gaps in chlamydia treatment within California family planning clinics: Are patients filling prescriptions? Sex Transm Dis 2019; 46:370–374.
Schneider K, Byczkowski T, Reed J. Treatment compliance among asymptomatic adolescents with sexually transmitted infections. JAMA Pediatr 2015; 169:1065–1066.
Sankar MG, Boyle MD, Badolato GM, et al. The adolescent experience of filling prescriptions for the treatment of sexually transmitted infections. J Pediatr Adolesc Gynecol 2022; 35:371–374.
Lindberg C, Lewis-Spruill C, Crownover R. Barriers to sexual and reproductive health care: Urban male adolescents speak out. Issues Compr Pediatr Nurs 2006; 29:73–88.
Fuentes L, Ingerick M, Jones R, et al. Adolescents' and young Adults' reports of barriers to confidential health care and receipt of contraceptive services. J Adolesc Health 2018; 62:36–43.
Llata E, Cuffe KM, Picchetti V, et al. Demographic, behavioral, and clinical characteristics of persons seeking care at sexually transmitted disease clinics—14 sites, STD Surveillance Network, United States, 2010–2018. MMWR Surveill Summ 2021; 70:1–20.
Doll M, Fortenberry JD, Roseland D, et al. Linking HIV-negative youth to prevention services in 12 U.S. cities: Barriers and facilitators to implementing the HIV prevention continuum. J Adolesc Health 2018; 62:424–433.