# Assessing Trends in STI Screening among Women Veterans in the VHA

> **NIH VA IK2** · PHILADELPHIA VA MEDICAL CENTER · 2024 · —

## Abstract

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 awa...

## Key facts

- **NIH application ID:** 10983285
- **Project number:** 5IK2HX003348-03
- **Recipient organization:** PHILADELPHIA VA MEDICAL CENTER
- **Principal Investigator:** Shimrit Keddem
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-04-01 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10983285

## Citation

> US National Institutes of Health, RePORTER application 10983285, Assessing Trends in STI Screening among Women Veterans in the VHA (5IK2HX003348-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10983285. Licensed CC0.

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