{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:43:39Z","timestamp":1777859019080,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T00:00:00Z","timestamp":1640995200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["K23HD099925"],"award-info":[{"award-number":["K23HD099925"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Prim Care Community Health"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Chlamydia trachomatis and Neisseria gonorrhea are the most reported sexually transmitted infections in the United States. Testing rates remain suboptimal and may be subject to implicit bias. We evaluated the effectiveness of an opt-out chlamydia and gonorrhea testing program for adolescents and young adults in improving testing rates and promoting equity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An opt-out testing program that standardized testing to once annually for 14 to 24-year-old patients was implemented across 28 federally qualified health centers spanning 4 specialties. A quasi-experimental design using interrupted time series analyses evaluated testing and infection rates between baseline, intervention, and pandemic-associated test shortage periods. Reduction in testing inequities based on sex, race, ethnicity, insurance, and language preference were also examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 57\u2009452 encounters during the baseline, 17\u2009320 during the intervention, and 26\u2009993 during the test supply shortage periods were included. Testing increased from 66.8% to 81.0% (14.2% absolute increase) between baseline and intervention periods. Pediatric clinics demonstrated the largest improvement compared to other settings (absolute increase 30.9%). We found significant reductions in testing inequities for language preference ( P\u2009&lt;\u2009.001), and un-insured and public insured individuals ( P\u2009&lt;\u2009.001). More cases of chlamydia and gonorrhea were detected in the intervention period (chlamydia-29.7; gonorrhea-7.4 per 1000 patients) than in the baseline period (chlamydia-20.7; gonorrhea-4.4 per 1000 patients; P\u2009&lt;\u2009.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>An opt-out approach increased testing, reduced inequities between some groups and detected more infections than a risk-based approach. Opt-out testing should be considered as an approach to increase detection of chlamydia and gonorrhea and promote equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21501319221131382","type":"journal-article","created":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T05:22:06Z","timestamp":1666848126000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Closing the Equity Gap: An Intervention to Improve Chlamydia and Gonorrhea Testing for Adolescents and Young Adults in Primary Care"],"prefix":"10.1177","volume":"13","author":[{"given":"Margaret M.","family":"Tomcho","sequence":"first","affiliation":[{"name":"Denver Health and Hospital Authority, Denver, CO, USA"},{"name":"University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingbo","family":"Lou","sequence":"additional","affiliation":[{"name":"Denver Health and Hospital Authority, Denver, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonja C.","family":"O\u2019Leary","sequence":"additional","affiliation":[{"name":"Denver Health and Hospital Authority, Denver, CO, USA"},{"name":"University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3002-8875","authenticated-orcid":false,"given":"Deborah J.","family":"Rinehart","sequence":"additional","affiliation":[{"name":"Denver Health and Hospital Authority, Denver, CO, USA"},{"name":"University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara","family":"Thomas-Gale","sequence":"additional","affiliation":[{"name":"Denver Health and Hospital Authority, Denver, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lara","family":"Penny","sequence":"additional","affiliation":[{"name":"Denver Health and Hospital Authority, Denver, CO, USA"},{"name":"University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5419-7476","authenticated-orcid":false,"given":"Holly M.","family":"Frost","sequence":"additional","affiliation":[{"name":"Denver Health and Hospital Authority, Denver, CO, USA"},{"name":"University of Colorado School of Medicine, Aurora, CO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,10,27]]},"reference":[{"key":"bibr1-21501319221131382","unstructured":"Centers for Disease Control and Prevention. New CDC report: STDs continue to rise in the U.S. 2019. Accessed August 6, 2020. https:\/\/www.cdc.gov\/nchhstp\/newsroom\/2019\/2018-STD-surveillance-report-press-release.html"},{"key":"bibr2-21501319221131382","unstructured":"Colorado Department of Public Health and Environment. Sexually transmitted infections in Colorado: 2017 annual report. Colorado Department of Public Health and Environment; 2018. Accessed January 2, 2020. https:\/\/www.colorado.gov\/pacific\/cdphe\/sti-and-hivaids-epidemiology-reports"},{"key":"bibr3-21501319221131382","unstructured":"Denver Public Health. Denver\u2019s rate of STDs continues to climb. 2019. Accessed February 1, 2020. http:\/\/www.denverpublichealth.org\/news\/2019\/04\/rate-of-stds-in-denver-continues-to-climb"},{"key":"bibr4-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1097\/olq.0000000000001302"},{"key":"bibr5-21501319221131382","doi-asserted-by":"publisher","DOI":"10.7326\/m14-1981"},{"key":"bibr6-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1542\/9781610020237"},{"key":"bibr7-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2014.04.009"},{"key":"bibr8-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1080\/07448480209596021"},{"key":"bibr9-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2013.0316"},{"key":"bibr10-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnur.2020.05.002"},{"key":"bibr11-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1363\/4122509"},{"key":"bibr12-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-211"},{"key":"bibr13-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1097\/olq.0b013e31814b86f5"},{"key":"bibr14-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2017.0132"},{"key":"bibr15-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2016.01.007"},{"key":"bibr16-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-2601"},{"key":"bibr17-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjq.2020.03.003"},{"key":"bibr18-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2018.10.004"},{"key":"bibr19-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.22.2846"},{"key":"bibr20-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-1082"},{"key":"bibr21-21501319221131382","doi-asserted-by":"publisher","DOI":"10.5409\/wjcp.v6.i3.154"},{"key":"bibr22-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1097\/olq.0000000000000424"},{"key":"bibr23-21501319221131382","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-027508"},{"key":"bibr24-21501319221131382","unstructured":"Agency for Healthcare Research and Quality. Denver health: how a safety net system maximizes its value. 2019. Updated 2019. Accessed December 28, 2019. https:\/\/www.ahrq.gov\/sites\/default\/files\/wysiwyg\/lhs\/lhs_case_studies_denver_health.pdf"},{"key":"bibr25-21501319221131382","unstructured":"Health Resources and Services Administration. National Health Center Program Uniform Data System (UDS) Awardee Data. 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