Screening and Treatment of Sexually Transmitted Infections Among Medicaid Populations—A 2-State Analysis

Merrell, Melinda A.; Betley, Charles; Crouch, Elizabeth; Hung, Peiyin; Stockwell, Ian; Middleton, Alice; Pearson, William S.

doi:10.1097/olq.0000000000001365

Cited by 3 publications

(6 citation statements)

References 8 publications

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“…In South Carolina, private health insurance plans administered by managed care organizations provide the majority of Medicaid services and are paid a per-capita dollar amount per enrollee for these services. [ 19 ] We used the two most recent and complete state fiscal years of data available for our study (fiscal year 1: July 2019 to June 2020; fiscal year 2: July 2020 to June 2021). All Medicaid beneficiaries with at least one medical claim during the study period were included in our analysis.…”

Section: Methodsmentioning

confidence: 99%

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

et al. 2022

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Examining the current incidence rates of HIV and STIs among racial and ethnic minority and rural residents is crucial to inform and expand initiatives and outreach efforts to address disparities and minimize the health impact of these diseases. A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period (July 2019-June 2021) in South Carolina. Our main outcomes of interest were claims for chlamydia, gonorrhea, syphilis, and HIV. Any beneficiary with at least one claim for a relevant diagnosis throughout the study period was considered to have one of these diseases. Descriptive analyses and multivariable regression models were used to estimate the association between STIs, HIV, race and ethnicity, and rurality. Overall, 158,731 Medicaid beneficiaries had at least one medical claim during the study period. Most were female (86.6%), resided in urban areas (66.6%), and were of non-Hispanic Black race/ethnicity (42.6%). In total, 6.3% of beneficiaries had at least one encounter for chlamydia, 3.2% for gonorrhea, 0.5% for syphilis, and 0.8% for HIV. In multivariable models, chlamydia, gonorrhea, and HIV claims were significantly associated with non-Hispanic Black or other minority race/ethnicity compared to non-Hispanic white race/ethnicity. Rural residents were more likely to have a claim associated with chlamydia and gonorrhea compared to urban residents. The opposite was observed for syphilis and HIV. Providing updated evidence on disparities in STIs and HIV among racial/ethnic minority and rural populations in a southern state is essential for shaping state Medicaid policies to address health disparities.

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Section: Methodsmentioning

confidence: 99%

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

et al. 2022

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“…25 However, prepandemic costs for STI testing among Medicaid participants in SC were found to be highest overall in emergency department settings. 26 Rates of emergency department visits for STIs have been increasing overall, which leads to inappropriate treatment of these conditions that may contribute to increasing antibiotic resistance. 27 Use and extension of existing levers in the primary care setting, such as the Healthcare Effectiveness Data and Information System measure for chlamydia screening in 15-to 24-year-old sexually active women, may be an opportunity to further incentivize primary care clinics to address STI testing and treatment needs.…”

Section: Discussionmentioning

confidence: 99%

“…Although a Medicaid nonexpansion state, SC provides family planning services—to include STI and HIV testing and treatment—to both men and women that meet income eligibility requirements 25 . However, prepandemic costs for STI testing among Medicaid participants in SC were found to be highest overall in emergency department settings 26 . Rates of emergency department visits for STIs have been increasing overall, which leads to inappropriate treatment of these conditions that may contribute to increasing antibiotic resistance 27 .…”

Section: Discussionmentioning

confidence: 99%

Identifying the Need for and Availability of Evidence-Based Care for Sexually Transmitted Infections in Rural Primary Care Clinics

Merrell,

Crouch,

Harrison

et al. 2023

Sexual Trans Dis

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Background Increasing rates of bacterial sexually transmitted infections (STI) may lead to increased HIV rates, as the STI and HIV epidemics are syndemic. Centers for Disease Control and Prevention (CDC) guidelines recommend including extragenital (i.e., rectal and/or pharyngeal) STI screenings for certain populations at increased risk for STIs and concurrent infections with HIV. Methods A descriptive study was conducted by interviewing staff members from four rural primary care clinics in areas of high need for STI and HIV services in South Carolina. Qualitative data about their clinical practices in 2021 was obtained. The primary outcome was to determine the awareness and availability of health care services associated with STI and HIV care in these locations. Results Clinics in target counties provided limited STI and HIV testing and treatment services, especially for populations at risk of infection, indicating the need for additional clinical training and professional development for all clinic staff. Specifically, only one of four clinics provided extragenital STI testing, and no clinics reported prescribing Pre-Exposure Prophylaxis (PrEP). Conclusions Rural primary care clinics can fill important gaps in the availability of STI and HIV services with appropriate support and incentives. Findings from this study may aid in facilitating policy (state Medicaid agencies) and program (state health department) decisions related to STI and HIV testing and treatment.

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“…These scores summarize each member's total medical morbidity [17]. The DxCG model shares a common development history with the U.S. Department of Health and Human Services' Hierarchical Condition Category (HHS-HCC) models, but is more detailed, employing a comprehensive 394-condition-category classification system [6,18]. The DxCG model yields a relative risk score (RRS) derived from age, sex, and diagnoses recorded in clinician encounters (e.g., ambulatory care visits and hospitalizations).…”

Section: Covariatesmentioning

confidence: 99%

“…Care for STIs is received in various settings, with increasing national utilization trends in emergency departments and urgent care centers [3][4][5]. Recent analyses of sexual health services provided in two state Medicaid programs found large differences in the location of where care was sought [6]. The American Academy of Family Physicians' "Screening for Sexually Transmitted Infections" practice manual suggests that family medicine practitioners and primary care physicians are in an ideal position to deliver routine STI screening and care to prevent transmission and future STI complications [7].…”

Section: Introductionmentioning

confidence: 99%

The role of primary care providers in testing for sexually transmitted infections in the MassHealth Medicaid program

Mick,

Sabatino,

Alcusky

et al. 2023

PLoS ONE

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The objective of this study was to determine the prevalence and predictors of testing for sexually transmitted infections (STIs) under an accountable care model of health care delivery. Data sources were claims and encounter records from the Massachusetts Medicaid and Children’s Health Insurance Program (MassHealth) for enrollees aged 13 to 64 years in 2019. This cross-sectional study examines the one-year prevalence of STI testing and evaluates social determinants of health and other patient characteristics as predictors of such testing in both primary care and other settings. We identified visits with STI testing using procedure codes and primary care settings from provider code types. Among 740,417 members, 55% were female, 11% were homeless or unstably housed, and 15% had some level of disability. While the prevalence of testing in any setting was 20% (N = 151,428), only 57,215 members had testing performed in a primary care setting, resulting in an 8% prevalence of testing by primary care clinicians (PCCs). Members enrolled in a managed care organization (MCO) were significantly less likely to be tested by a primary care provider than those enrolled in accountable care organization (ACO) plans that have specific incentives for primary care practices to coordinate care. Enrollees in a Primary Care ACO had the highest rates of STI testing, both overall and by primary care providers. Massachusetts’ ACO delivery systems may be able to help practices increase STI screening with explicit incentives for STI testing in primary care settings.

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Screening and Treatment of Sexually Transmitted Infections Among Medicaid Populations—A 2-State Analysis

Cited by 3 publications

References 8 publications

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina

Identifying the Need for and Availability of Evidence-Based Care for Sexually Transmitted Infections in Rural Primary Care Clinics

The role of primary care providers in testing for sexually transmitted infections in the MassHealth Medicaid program

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