449 - Opt-Out Chlamydia/Gc Testing in a High-Risk Adolescent Population

Chlamydia trachomatis (CT) is the most common sexually transmitted disease (STD) affecting approximately 4 million people in United States. Currently, the highest rates of Chlamydia trachomatis infection occur in females 15-24 years of age. In 2017, a total of 1,708,569 CT infections were reported to the CDC, of those 1,069,111 reported cases of CT infection were among persons aged 15–24 years, representing 62.6% of all reported chlamydia cases in United States. Gonorrhea has a similar profile. CDC estimates that approximately 1.6 million new gonococcal infections occurred in the United States in 2018, and more than half occur among young people aged 15-24.

Objective: Our objective was test the hypothesis was that opt-out testing would increase the total percentage of adolescent adolescents screened for Chlamydia/Gonorrhea compared with traditional opt-in method.

Design/Methods:

All adolescent 12 and older seen in the clinic for a well adolescent/adult visit were provided a urine cup by the triaging nurse. Patients were told by their health care provider that we tested all teenagers for CT/Gc. Each urine collected and sent to the laboratory had a index card completed by the primary care provider that collected basic data on each patient that included; medical record number, name, DOB, gender, ethnicity/race, whether the person was sexually active, reason for opt-out if applicable and CT/Gc test results (to be filled-in later by the researcher). All positives were contacted and treated as per routine clinical protocols.

Results:

Data was collected over 6 months. The median age was 16.8. 58% were male. Forty-Eight percent were Hispanic and 44% where African-American. 34% were sexually active. Interestingly 54% of those under 18 years of age were sexually active while this was only true for 14% of the older group. In the first 3 months of the study there was a 57% increase in the number of teens tested for CT/Gc, while this number was less robust during the 2^nd 4 months of the study with a 21% increase in testing.

Conclusion(s):

Opt-out testing for CT/Gc had a dramatic effect on increasing the number of teens tested in our clinic during the study period. The study effect waned during the 2^nd part of the study, though it was still increased over baseline. This may be due to a fatigue effect upon nursing staff and clinicians. Future work will elucidate, utilizing a PDSA format, how to maintain opt-out testing momentum.