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BACKGROUND: Iowa’s Community-Based Screening Services (CBSS) funds family planning, STD, and other agencies across Iowa to target disproportionately impacted populations for testing and treatment of chlamydia and gonorrhea. Decreases in funding have resulted in CBSS clinic closures. In 2014, the Centers for Disease Control and Prevention (CDC) implemented the STD AAPPS initiative to leverage opportunities created by the Affordable Care Act to decrease the burden and long-term health effects of STDs. This study’s objective was to evaluate chlamydia and gonorrhea surveillance at CBSS clinics before and after STD AAPPS implementation to determine whether the first year of this new initiative increased chlamydia and gonorrhea screening in high-risk groups in Iowa.
METHODS: CBSS data were used to compare the number of patients screened for chlamydia and gonorrhea from 2010-2014. Iowa Disease Surveillance System (IDSS) data were used to compare chlamydia and gonorrhea diagnoses from 2010-2014. Chi-square tests were used to test differences in the percent screened by sex, age (15-24 years vs. other), and race/ethnicity (non-Hispanic white vs. other) at CBSS clinics from 2010-2013 compared to 2014.
RESULTS: The total number of chlamydia cases reported in IDSS increased from an average of 11,832 cases in 2010-2013 to 11,945 cases in 2014, while the total number of gonorrhea cases decreased from an average of 2,091 cases in 2010-2013 to 1,697 cases in 2014. The number of individuals screened for chlamydia and gonorrhea decreased at CBSS clinics in Iowa. However, the percentage of positive chlamydia diagnoses at CBSS clinics increased from 9.2% in 2010-2013 to 10.5% in 2014, as well as the percentage of positive gonorrhea diagnoses, 1.2% to 1.9%. Additionally, the percentage of racial and ethnic minorities screened for chlamydia and gonorrhea increased from 24.1% to 32.9%, while the percentage of males screened increased from 18.4% to 30.0%. The percentage of young people aged 15-24 screened decreased from 69.3% in 2010-2013 to 60.6% in 2014.
CONCLUSIONS: Despite decreases in CBSS funding, since the implementation of CDC’s STD AAPPS in 2014, the percentage of positive chlamydia and gonorrhea diagnoses has increased at CBSS clinics, as well as the percentage of racial and ethnic minorities and males screened. However, the percentage of young people aged 15-24 screened at CBSS clinics has decreased, which may be due to certain clinics using a non-CBSS affiliated laboratory, but should be investigated further and in future years to ensure this high-risk group is not missed.