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Professional guidelines and IL state law require screening for sexually transmitted (STI) infection during pregnancy. Our objective was to evaluate adherence to STI screening recommendations during pregnancy and identify factors associated with adherent screening.
Retrospective cohort study of women with singleton gestations who initiated prenatal care in the first or second trimester between 11/2011-2015. Demographic characteristics and STI screening were abstracted from prenatal records. Tests of interest included initial syphilis, HIV, hepatitis B, chlamydia and gonorrhea (GCCT) and repeat (third trimester) syphilis and HIV. All women were eligible for initial screening. Women were considered eligible for repeat screening for syphilis (mandated by state law) and HIV (institutional protocol) if delivered ≥ 32 wks. Adherent screening was defined as performance of all recommended screening; initial and repeat testing were analyzed separately. Factors associated with adherent screening were evaluated using multivariable logistic regression models.
Of 2370 women in the total cohort, 1809 (76.3%) received adherent initial STI screening and 181 (7.6%) received adherent repeat STI screening. Women who received initial screening were more likely to be older, non- Hispanic white, non-smokers who initiated care earlier. After adjusting for covariates, being privately insured (aOR 1.74, 95% CI 1.38-2.21) was significantly associated with adherent initial screening, whereas being non-Hispanic or Hispanic were associated with lower odds of adherent initial screening (Table). Factors associated with adherent repeat STI screening were younger age (aOR 0.95, 95%CI 0.92-0.98), non-Hispanic black race (aOR 2.28, 95% CI 1.85 -4.16), and smoking (aOR 1.67, 95% CI 1.17-2.39). Additionally, private insurance (aOR 0.18, 95% 0.13-0.25) and nulliparity (aOR 0.59, 95% CI 0.44-0.80) were significantly associated with decreased odds of receiving adherent repeat screening (Table).
At this institution, STI screening rates remain suboptimal and multiple disparities exist in performance both of both initial and repeat screening. Results suggest that while women with higher socioeconomic status are more likely to receive adherent initial STI screening, women of lower socioeconomic status are more likely to receive adherent repeat STI screening.