(P492) Racial and Ethnic Differences in Chlamydia and Gonorrhea Testing Locations among Medicaid-Insured Youth

Background

Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) are the two most common bacterial sexually transmitted infections (STI) in the US. Common barriers to STI care among youth include confidentiality concerns, costs, stigma, and inconvenient services. These barriers disproportionately affect Black and Hispanic youth. To implement accessible and equitable STI services, it is important to know the clinical settings where youth seek and receive CT/GC testing. Our objective was to examine where Medicaid-insured youth, by race and ethnicity, receive CT/GC testing, and whether differences exist in location of care.

Methods

We analyzed IBM Market Scan Medicaid claims data for 2019 to evaluate the number of visits in which a CT/GC test was ordered among 13–21-year-olds. Bivariate regression was used to analyze associations between the health setting in which a CT/GC test was ordered and patient demographics.

Results

There were 418,623 CT/GC tests ordered in our patient population during the study period. Most CT/GC tests (37.6%) were ordered at medical offices regardless of race or ethnicity, although White youth had a greater proportion of tests ordered in medical offices (49.3%) compared with Black (37.6%) and Hispanic (37.3%) youth. Among CT/GC tests for Black youth, 19.6% were ordered in the emergency department (ED), compared to 13.1% and 10.6% for White and Hispanic youth, respectively. In contrast, Federally Qualified Health Centers (FQHCs) were the 2^nd most frequent testing location of CT/GC tests among Hispanic youth, with 19.0% occurring at these locations.

Conclusion

This study highlights differences in CT/GC testing locations among Medicaid-insured youth by race and ethnicity. Our study found significant utilization of EDs for CT/GC testing among Black youth, which may partly explain disparities in this population as prior studies have reported lack of follow up, under-treatment, over-treatment, and racial inequities among youth who receive CT/GC care in EDs. Collaborative interventions with EDs are needed to help Black youth connect to public health clinics, medical offices, or other accessible and longitudinal STI care locations. Additionally, interventions and public health funding that seek to improve STI care among Hispanic youth should prioritize collaborations with FQHCs.