Abstract：
OBJECTIVE: Contraceptive method type matters to sexually transmitted infection (STI) prevention, but contraceptive counseling often emphasizes method efficacy and the benefits of \"forgettable\" methods, including long-acting reversible contraceptives (LARCs). We aimed to explore associations between prescription method type and annual STI testing and investigated whether these associations relate to annual well-woman visits.
METHODS: We constructed a panel of 20,949 young women (<25) enrolled in Delaware\'s Medicaid program from 2012 through 2019. Conditional logit regressions measured associations between contraceptive method type and annual testing for gonorrhea, chlamydia, or syphilis. We stratified contraceptive methods into LARC, short-acting reversible methods (SARC; pills, patch, ring, and injectable), or no prescription method. We estimated three models examining STI testing in year of method initiation, in years afterwards, and attendance to a well-woman visit as a potential mediator of these associations.
RESULTS: STI testing rates did not differ between LARC versus SARC users in the year of method initiation. In the two years after method initiation, LARC versus SARC users were less likely to be tested (OR = 0.73 to OR = 0.87) and less likely to have a well-woman visit (OR = 0.65 to OR = 0.79). In models controlling for attendance to well-woman visits, the decreased likelihood of STI testing in years after initiating LARC versus SARC is largely eliminated, indicating that well-woman visits mediate the relationship between method type and STI testing.
CONCLUSIONS: LARC use relates to reduced STI testing in years after method initiation due to reduced attendance to well-women visits. These findings can inform clinical practice and STI prevention.
METHODS: We constructed a panel of 20,949 young women (<25) enrolled in Delaware\'s Medicaid program from 2012 through 2019. Conditional logit regressions measured associations between contraceptive method type and annual testing for gonorrhea, chlamydia, or syphilis. We stratified contraceptive methods into LARC, short-acting reversible methods (SARC; pills, patch, ring, and injectable), or no prescription method. We estimated three models examining STI testing in year of method initiation, in years afterwards, and attendance to a well-woman visit as a potential mediator of these associations.
RESULTS: STI testing rates did not differ between LARC versus SARC users in the year of method initiation. In the two years after method initiation, LARC versus SARC users were less likely to be tested (OR = 0.73 to OR = 0.87) and less likely to have a well-woman visit (OR = 0.65 to OR = 0.79). In models controlling for attendance to well-woman visits, the decreased likelihood of STI testing in years after initiating LARC versus SARC is largely eliminated, indicating that well-woman visits mediate the relationship between method type and STI testing.
CONCLUSIONS: LARC use relates to reduced STI testing in years after method initiation due to reduced attendance to well-women visits. These findings can inform clinical practice and STI prevention.
摘要：
目的：避孕方法类型对性传播感染（STI）的预防，但避孕咨询往往强调方法的功效和“难忘”方法的好处，包括长效可逆避孕药（LARCs）。我们旨在探索处方方法类型与年度STI测试之间的关联，并调查这些关联是否与年度女性就诊有关。
方法：我们建立了一个由20,949名年轻女性（<25名）组成的小组，从2012年到2019年参加了特拉华州的医疗补助计划。条件logit回归测量了避孕方法类型与淋病年度测试之间的关联，衣原体,或者梅毒.我们将避孕方法分层为LARC，短效可逆方法(SARC；药丸，补丁,戒指,和可注射)，或者没有处方方法。我们估计了三个模型在方法启动的年份检查STI测试，几年后，并作为这些协会的潜在调解人出席妇女访问。
结果：在方法开始年份，LARC和SARC使用者的STI检测率没有差异。在方法开始后的两年里，LARC与SARC用户不太可能接受测试（OR=0.73至OR=0.87），并且不太可能进行女性健康访问（OR=0.65至OR=0.79）。在控制女性出诊的模型中，在启动LARC与SARC之后的几年中，STI测试的可能性降低已基本消除，表明女性访视调解了方法类型和性传播感染测试之间的关系。
结论：LARC的使用与方法开始后数年内STI检测的减少有关，原因是女性就诊人数减少。这些发现可以为临床实践和性传播感染预防提供信息。
方法：我们建立了一个由20,949名年轻女性（<25名）组成的小组，从2012年到2019年参加了特拉华州的医疗补助计划。条件logit回归测量了避孕方法类型与淋病年度测试之间的关联，衣原体,或者梅毒.我们将避孕方法分层为LARC，短效可逆方法(SARC；药丸，补丁,戒指,和可注射)，或者没有处方方法。我们估计了三个模型在方法启动的年份检查STI测试，几年后，并作为这些协会的潜在调解人出席妇女访问。
结果：在方法开始年份，LARC和SARC使用者的STI检测率没有差异。在方法开始后的两年里，LARC与SARC用户不太可能接受测试（OR=0.73至OR=0.87），并且不太可能进行女性健康访问（OR=0.65至OR=0.79）。在控制女性出诊的模型中，在启动LARC与SARC之后的几年中，STI测试的可能性降低已基本消除，表明女性访视调解了方法类型和性传播感染测试之间的关系。
结论：LARC的使用与方法开始后数年内STI检测的减少有关，原因是女性就诊人数减少。这些发现可以为临床实践和性传播感染预防提供信息。
