1353. Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration

Abstract Background United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans have many risk factors associated with STIs, including high rates of childhood sexual assault, military sexual trauma and intimate partner violence. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans. Methods We performed a retrospective cohort study of all women Veterans in Veterans Health Administration (VHA) care between January 1, 2018 and December 31, 2019 to examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the VHA in 2019. Results Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, predictors of testing in women under age 25 included Black race (aOR: 2.11 CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05 CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (Chlamydia case rate: 265, Gonorrhea case rate: 97/100,000) and those with mental health diagnoses (Chlamydia case rate: 263, Gonorrhea case rate: 72/100,000.) Over a third of chlamydia cases (35.2%) and gonorrhea cases (35.5%) occurred in women who resided in the South Atlantic census division. Chlamydia cases per 100,000 women Veterans seen in VHA (2019) Gonorrhea cases per 100,000 women Veterans seen in VHA (2019) Conclusion Gonorrhea and chlamydia testing remains underutilized among women in the VHA and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates. Disclosures All Authors: No reported disclosures

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Military sexual trauma services for women veterans in the Veterans Health Administration: The patient-care practice environment and perceived organizational support.

Psychological Services ◽

10.1037/1541-1559.4.4.229 ◽

2007 ◽

Vol 4 (4) ◽

pp. 229-238 ◽

Cited By ~ 6

Author(s):

Marcia E. Hall ◽

Ann R. Sedlacek ◽

Jo Ann R. Berenbach ◽

Nathan F. Dieckmann

Keyword(s):

Patient Care ◽

Organizational Support ◽

Perceived Organizational Support ◽

Sexual Trauma ◽

Women Veterans ◽

Veterans Health Administration ◽

Care Practice ◽

Military Sexual Trauma ◽

Veterans Health ◽

Health Administration

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Developing systems that promote veterans’ recovery from military sexual trauma: Recommendations from the Veterans Health Administration national program implementation

Military Psychology ◽

10.1080/08995605.2017.1421818 ◽

2018 ◽

Vol 30 (3) ◽

pp. 270-281 ◽

Cited By ~ 8

Author(s):

Melissa Ming Foynes ◽

Kerry Makin-Byrd ◽

W. Christopher Skidmore ◽

Matthew W. King ◽

Margret E. Bell ◽

...

Keyword(s):

Program Implementation ◽

Sexual Trauma ◽

Veterans Health Administration ◽

Military Sexual Trauma ◽

Veterans Health ◽

Health Administration ◽

National Program

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The Veterans Health Administration and Military Sexual Trauma

American Journal of Public Health ◽

10.2105/ajph.2006.092999 ◽

2007 ◽

Vol 97 (12) ◽

pp. 2160-2166 ◽

Cited By ~ 291

Author(s):

Rachel Kimerling ◽

Kristian Gima ◽

Mark W. Smith ◽

Amy Street ◽

Susan Frayne

Keyword(s):

Sexual Trauma ◽

Veterans Health Administration ◽

Military Sexual Trauma ◽

Veterans Health ◽

Health Administration

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The Veterans Health Administration Response to Military Sexual Trauma

Women at War ◽

10.1093/med/9780199344536.003.0018 ◽

2015 ◽

pp. 321-328 ◽

Cited By ~ 2

Author(s):

Margret E. Bell ◽

Susan J. McCutcheon

Keyword(s):

Sexual Trauma ◽

Veterans Health Administration ◽

Military Sexual Trauma ◽

Veterans Health ◽

Health Administration

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The influence of gender on suicidal ideation following military sexual trauma among Veterans in the Veterans Health Administration

Psychiatry Research ◽

10.1016/j.psychres.2016.07.036 ◽

2016 ◽

Vol 244 ◽

pp. 257-265 ◽

Cited By ~ 20

Author(s):

Lindsey L. Monteith ◽

Nazanin H. Bahraini ◽

Bridget B. Matarazzo ◽

Holly R. Gerber ◽

Kelly A. Soberay ◽

...

Keyword(s):

Suicidal Ideation ◽

Sexual Trauma ◽

Veterans Health Administration ◽

Military Sexual Trauma ◽

Veterans Health ◽

Health Administration

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Posttraumatic Stress Disorder Symptom Severity and Socioeconomic Factors Associated with Veterans Health Administration Use among Women Veterans

Women s Health Issues ◽

10.1016/j.whi.2015.05.003 ◽

2015 ◽

Vol 25 (5) ◽

pp. 535-541 ◽

Cited By ~ 13

Author(s):

Keren Lehavot ◽

Ruth O'Hara ◽

Donna L. Washington ◽

Elizabeth M. Yano ◽

Tracy L. Simpson

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Symptom Severity ◽

Stress Disorder ◽

Women Veterans ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Factors Associated ◽

Disorder Symptom

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Patient Characteristics Associated With the Receipt of Hormone Therapy Among Transgender Patients in the Veterans Health Administration

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1615 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A794-A794

Author(s):

Denise H Wong ◽

Varsha G Vimalananda ◽

Joel I Reisman ◽

Sowmya R Rao ◽

Jillian C Shipherd ◽

...

Keyword(s):

Gender Identity ◽

Hormone Therapy ◽

Sexual Trauma ◽

Patient Characteristics ◽

Veterans Health Administration ◽

Sex Characteristics ◽

Military Sexual Trauma ◽

Veterans Health ◽

Health Administration ◽

Social Stressors

Abstract Background: Many transgender patients experience gender dysphoria as a result of an incongruence between their gender identity and sex assigned at birth. Gender-affirming hormone therapy improves the quality of life for transgender patients seeking to increase alignment of their secondary sex characteristics and gender identity. However, little is known about the patient factors that are associated with receipt of this therapy which is critical to identifying areas for improvement in care for transgender patients. Objective: To evaluate patient characteristics associated with transgender patients’ receipt of hormone therapy from the Veterans Health Administration (VHA). Methods: Inpatient and outpatient data were reviewed for transgender patients, identified through ICD-9/ICD-10 diagnosis codes for gender identity disorder (GID), receiving VHA health care from January 2006 to December 2018. We evaluated receipt of hormone therapy (testosterone or estrogen +/- spironolactone) from the VHA, socio-demographics, comorbidities, social stressors, military sexual trauma, and documented suicide attempts. Adjusted Odds Ratios (aOR) and 95% Confidence Intervals (CI) were obtained from a multivariable logistic regression model used to ascertain the relationship between patient characteristics and hormone therapy. Results: Of 9,406 patients with documented GID, 5,487 (58.3%) received hormone therapy from the VHA. Compared to patients not receiving hormone therapy, a higher proportion of patients receiving hormone therapy were younger (21-29 years: 18.1% vs. 11.6%; 30-39 years: 20.0% vs. 14.6%; 40-49 years: 16.2% vs. 13.6%), had documentation of a positive military sexual trauma screening (22.2% vs. 16.2%; p<0.0001), and a suicide attempt (11.4% vs. 9.9%; p=0.0067). There were significant associations between receipt of hormone therapy and: 1) younger age (aOR: 1.33; 95% CI: 1.29-1.36; p<0.0001); 2) Black non-Hispanic patients (aOR: 0.58; 95% CI: 050-0.68; p<0.0001); 3) increasing number of comorbidities (aOR: 0.86; 95% CI: 0.84-0.88; p<0.0001); and 4) increasing number of social stressors (aOR: 0.86; 95% CI: 0.83-0.90; p<0.0001). Conclusions: Age, race/ethnicity, comorbidities, and social stressors among other factors are associated with receipt of hormone therapy among transgender patients in the VHA. Subsequent efforts should focus on understanding clinician- and site-level determinants to facilitate the design of effective quality improvement measures that optimize gender affirming hormone therapy through VHA for transgender patients.

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