O16.4 Impact of Defunding Family Planning Health Centers on Gonorrhea and Chlamydia Cases in Iowa: A Longitudinal Spatiotemporal Analysis of 2000–2018

Background Family planning health centers (FPHCs) provide low-income individuals in rural areas with essential primary care services, including STD prevention, testing, and treatment. Fifteen states have defunded FPHCs, causing thousands to be left without such services. This has accelerated in the COVID-19 era. We used a longitudinal analysis to examine the impact of FPHC closures in Iowa on gonorrhea and chlamydia incidence at the county level. Methods In 2017, Iowa defunded FPHCs, resulting in four clinic closures. This analysis uses Poisson regression for rates on gonorrhea and chlamydia incidence data from 2000–2018 to investigate if clinic closures were associated with reported gonorrhea and chlamydia cases. Newey-West standard errors are used to adjust for any time-related trends in STI incidence. Given the mid-year policy change, all data from 2017 was removed before running the Poisson regression model. Results We examined 34,479 gonorrhea and 169,660 chlamydia cases. Iowans had 1.99 (95% CI: 1.67, 2.37) times the rate of gonorrhea after clinic closures compared to before closures. In 2018, people in counties with clinic closures were 1.71 (95% CI: 1.01,2.90) times more likely to be diagnosed with gonorrhea than residents in the counties without closures. Iowans had 1.05 (95% CI: 1.03, 1.07) times the rate of chlamydia after clinic closures compared to before closures. People in counties with closures were 1.37 (95% CI: 1.11, 1.69) times more likely to have chlamydia in 2018 as compared to those in counties without closures. Conclusions Despite the fact that many STI diagnoses are made and reported by FPHCs, our data shows that reported gonorrhea and chlamydia cases increased in the year following clinic closures. This is consistent with delayed diagnoses and missed opportunities for providing essential STI services to vulnerable and under-served rural residents. Legislative action is urgently needed to ensure essential STI services for all.