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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Three Years Post-Affordable Care Act Sexually Transmitted Disease Clinics Remain Critical Among Vulnerable Populations

TitleThree Years Post-Affordable Care Act Sexually Transmitted Disease Clinics Remain Critical Among Vulnerable Populations
Publication TypeJournal Article
Year of Publication2018
AuthorsMehtani, NJ, Schumacher, CM, Johnsen, LE, Greenbaum, A, Chaulk, CP, Ghanem, KG, Jennings, JM, Page, KR
JournalAm J Prev Med
Volume55
Pagination111-114
Date PublishedJul
ISBN Number0749-3797
Accession Number29776778
Abstract

INTRODUCTION: The purpose of the study is to examine whether demand for publicly funded sexually transmitted disease clinics changed after Affordable Care Act implementation. METHODS: The percentages of total incident sexually transmitted infections in Baltimore City that occurred at publicly funded sexually transmitted disease clinics were compared between the 3 years prior to and following the 2014 Medicaid and private insurance expansions. Risk factors associated with diagnosis at sexually transmitted disease clinics were identified using log binomial regression. Statistical analyses were conducted in May 2017. RESULTS: Post-Affordable Care Act, the relative proportion of total sexually transmitted infection diagnoses increased among private and hospital-affiliated clinics, remained unchanged at sexually transmitted disease clinics, and decreased at federally qualified health centers and other publicly funded programs (p<0.001). Multivariable analysis controlling for age, sex, race, and ethnicity showed an overall decline in the risk of diagnosis at sexually transmitted disease clinics post-Affordable Care Act compared with prior (adjusted relative risk=0.92, 95% CI=0.89, 0.96), but the risk among black and Latino men aged <25 years persisted (relative risk=1.03, 95% CI=0.96, 1.10). CONCLUSIONS: The Affordable Care Act increased access to traditional health care, reducing burden on publicly funded programs. However, demand for sexually transmitted disease clinics remains substantial among priority patients. In the healthcare reform era, sexually transmitted disease clinic funding remains critical.