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CDA 20-275 – HSR&D Study

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CDA 20-275
Assessing Trends in STI Screening among Women Veterans in the VHA
Shimrit Keddem PhD MPH
Philadelphia, PA
Funding Period: April 2022 - March 2027


Background: Rates of sexually transmitted infection (STI), especially gonorrhea and chlamydia, have increased dramatically over the past decade. Several factors put women Veterans at higher risk for STIs compared with both non-Veteran women and male Veterans, including substantial rates of exposure to sexual violence (including military sexual trauma), intimate partner violence, and unsafe behavior associated with posttraumatic stress and related substance use. Women are also more vulnerable to STI effects, as infection may be asymptomatic, undetected, and lead to complications. Guideline-recommended STI screening can detect infection and mitigate negative outcomes, but screening is underutilized. Significance/Impact: Women’s health and primary care are priority areas identified by VA/ORD, and the VA Directive 1330.01 states that facilities are required to provide STI screening and counseling in VA women’s health and primary care clinics. However, screening protocols across VA are not well-implemented and screening rates are suboptimal. To improve screening and outcomes, it is necessary to understand the current landscape of STI screening in VA. Innovation: The study is topically innovative because it focuses on a very prevalent but understudied issue that plays a critical role in women’s functioning and well-being. Few studies have examined the epidemiology of STIs in women Veterans and none has assessed health system responses to STIs or examined patterns in rates of STI screening among women Veterans across patient, provider or practice characteristics. Further, there is currently very little structural or informational support for providers screening for STIs. Specific Aims: Use administrative data to examine practice-, provider-, and patient-level correlates of gonorrhea and chlamydia screening in VA (Aim 1); use qualitative interviews to explore practice-, provider-, and patient-level barriers and facilitators to STI screening in VA women’s health and primary care clinics (Aim 2); and use principles of user-centered design to develop a multi-pronged clinical decision support tool to improve gonorrhea and chlamydia screening for women Veterans in women’s health and primary care and pilot test it at VA facilities to assess uptake, usability, and reach (Aim 3). Methodology: With a mixed-methods approach in Aims 1 & 2, employing quantitative electronic health record analyses and subsequent qualitative interviews, this proposed CDA will examine correlates of screening and explore barriers and facilitators to STI screening among women Veterans from both a patient and provider perspective. These findings will inform Aim 3, the development of a clinical decision support tool employing user-centered design, a participatory approach that incorporates multiple rounds of stakeholder feedback. The clinical decision support tool will alert providers to gonorrhea and chlamydia screening needs, support sexual history-taking and documentation, and raise awareness of screening guidelines to enhance STI management for women patients across VA. The final tool will be tested in a small feasibility pilot at two VISN 4 facilities to assess uptake, usability, and reach. Next Steps/ Implementation: Findings from this study will be augmented by an HSR&D investigator-initiated research (IIR) proposal in Year 3 to examine women Veteran’s use of non-VA care for GC/CT and inform an IIR proposal in Year 5 for an effectiveness-implementation trial to test the decision support tool at multiple VA sites.

NIH Reporter Project Information:


Journal Articles

  1. Keddem S, Maier M, Gardella C, Borgerding J, Lowy E, Chartier M, Haskell S, Hauser RG, Beste LA. Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration. Journal of general internal medicine. 2022 Sep 1; 37(Suppl 3):706-713.

DRA: Infectious Diseases, Health Systems
DRE: TRL - Applied/Translational, Epidemiology, Prevention
Keywords: Career Development
MeSH Terms: None at this time.

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