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Youth bear a disproportionate burden of sexually transmitted infections (STI). Young people 15-24 years old only make up 27% of the sexually active population, but they account for about 50% of the 26 million new STIs in the United States. Evidence suggests Urgent Care Centers (UCC) are serving as a source of STI care. However, less is known about the availability of youth STI and reproductive services in UCC.
We conducted secondary data analysis of qualitative and checklist-based data collected from a 2017 rapid assessment of 19 UCC in the Atlanta metropolitan area . The data included an assessment of STI, and reproductive services offered at each UCC by population, including youth. We abstracted all data services UCC offered to youth, including qualitative data related to youth services, to contextualize quantitative data. Williams SP, Kinsey J, Carry MG, Terry L, Wells J, Kroeger K. Get In, Get Tested, Get Care: STD Services in Urban Urgent Care Centers. Sex Transm Dis. 2019;46(10):648-653. doi:10.1097/OLQ.0000000000001042
All 19 UCC offered testing for gonorrhea, chlamydia, syphilis, and HIV, with varying protocols for onsite treatment and referrals for youth. Eleven UCC reported conducting sexual histories or risk assessments (SH/RA) with youth when patients had symptoms or diagnoses. An SH/RA was not a standard or typical procedure for any of the UCC. Most UCC did genital (n=15) and pelvic (n=13) exams for youth, with three requiring parental consent. Regarding reproductive services, all UCC offered pregnancy tests to youth. Two UCC indicated testing youth only if accompanied by a parent or in the case of a sexual assault. Five UCC provided PAP/HPV tests to youth, and only two offered HPV vaccination. Four UCC offered emergency contraception to youth, 7 referred patients, and 7 did not offer them at all. Two UCC offered youth long-acting contraception for the 1st month only or a script, then referred youth to a primary health care provider (PHCP). Most UCC referred patients to health departments (HD) or a primary health care provider (PHCP) for services that may require repeat visits or follow-up. All UCC required some form of payment for services, with STI testing ranging between $100 and $500, not including visit fees. Several UCCs mentioned that youth were often reluctant to use insurance if they were on their parent’s policy. Youth unable to pay cash or use insurance for services were referred to the HD.
Varying protocols around parental permission, treatment options (onsite testing, but referred treatment) and costs limits UCC accessibility and use for some youth, especially those with limited economic resources. UCC can serve as an option for STI and reproductive services for youth, offering the ability to access many services confidentially. Interventions to facilitate or deepen UCC partnerships and referrals to collaborating providers might help reduce patient point-of-care costs and link them to other care sources to expand the safety net of STI and reproductive health services for youth.