(39) Do adolescents with disabilities have lower rates of STI screening than non-disabled peers?

Background: It is well established that individuals with physical and intellectual disabilities are at increased risk of sexual abuse and experience a higher prevalence of sexually transmitted infections (STIs) compared to individuals without disabilities. Despite this, there is a paucity of data on whether these groups are screened for STIs at the same rate. The aim of this study was to determine whether adolescents and young adults (YA) with disabilities undergo routine screening for gonorrhea and chlamydia at lower rates compared to individuals without disabilities.

Methods: A retrospective chart review was performed at a single academic medical center. IRB exemption was obtained. Patients assigned female at birth aged 16-21 years old who were seen between July 2021-August 2023 by general pediatrics, internal medicine/pediatrics or family medicine were included in the study. Disability status (disability present vs. not) was determined via ICD-10 codes (Table 1), and disabilities were further categorized as intellectual or physical. Information on whether gonorrhea and chlamydia testing was ordered and/or performed was obtained for all patients. Data were analyzed using logistic regression, and odds ratios were calculated by race, ethnicity, age (years), disability status, disability category, and interaction of race/ethnicity and disability.

Results: Of the 6,906 patients meeting inclusion criteria, 90 (1.3%) had an identified disability. Individuals with disabilities were screened for gonorrhea and chlamydia at significantly lower rates than individuals without disabilities (60% vs 77.2%, p< 0.001). There were significantly lower odds of STI screening for individuals with any type of disability (OR 0.38; 95% CI 0.24-0.61, p<.001), a physical disability (OR 0.26, 95% CI 0.09-0.72, p=0.008), or an intellectual disability (OR 0.37, 95% CI 0.21-0.64, p<.001). Among both groups, older teens were more likely to receive STI screening than younger teens (p <.001). Hispanic individuals were more likely to undergo STI screening than non-Hispanic patients (OR 1.38, 95% CI 1.01-1.89, p=.044). Rates of STI screening did not differ significantly by race.

Conclusions: This study identified a significantly lower rate of screening for gonorrhea and chlamydia among adolescents and YA with a physical or intellectual disability compared to those without disabilities. Universal STI screening should be considered so that individuals with a higher risk of STIs are not missed. Further research is indicated to identify and mitigate contributing factors that lead to lower rates of screening, including provider biases and systems issues.