Young people seeking sexual health care but not returning for results

The control of STIs among adolescents is a recognised health priority in France. There are limited data on STI epidemiology among adolescents both across Europe and at the global level. We report a crosssectional study to describe the cascade of care (number tested, diagnosed, treated) for youngsters ( ≤ 18 years) attending Free HIV and STI Information, Screening and Diagnosis Clinics (CeGIDD) in Paris for consultation on STIs. HIV, serology or rapid test, antiHCV, HBsAg, antiHBcorAb, Chlamydia, Gonococci and Mycoplasma specimens for PCR were collected as part of the routine approach at STI diagnosis. Syphilis serology was performed only in patients with more than 10 partners each year, migrants and men who have sex with men. CeGIDD was totally free of charge. The interval between first attendance and availability of test results was up to 7 days. Patients with positive results were systematically called after 1 week to encourage them to come back to get their results and to be treated. This crosssectional study was conducted on a database of patients treated according to standard care under the MR04 methodology; therefore, no ethics approval was necessary according to French law. SPSS V.22.0 was used for statistical analysis. Variables achieving a p value <0.1 in the univariate analysis were entered into a multivariate logistic regression model. In the period between January 2017 and December 2019, among 678 attendees 15–18 years old, 374 (55.2%) were men, 415 (61.2%) were European and 107 (15.8%) were subSaharan African; 624 (92.1%) selfreported heterosexual orientation and 573 (84.5%) had health insurance. The main reasons for consultation of youngsters in CeGIDD were systematic screening (419, 61.8%) and following risktaking (259, 38.2%). HIV tests were performed to 627/678 (92.5%) people; 3 (0.5%) tested positive and of these 2 returned to clinic, started antiretroviral therapy and were retained into care. One person was diagnosed with primary syphilis among 177 tested (0.5%) and was treated with extencilline. Chlamydia infection was found in 46/613 persons (7.5%), of whom 34/46 (73.9%) returned and received doxycycline. Neisseria gonorrhoeae infection was diagnosed in 7/615 people (1.1%), and 6/7 (85.7%) returned and received ceftriaxone. Mycoplasma genitalium was diagnosed and treated with azithromycin in 3/29 persons tested (10.3%). Of 428 people who requested HBV testing, 18 (4.2%) were hepatitis B surface antigen (HBsAg) positive (10/18 of subSaharan African origin), 12/18 (66.7%) returned to clinic and 9/18 (50%) were linked to care, including 4 who met the indication for antiviral therapy. Among 465 people who requested HCV testing, 2 (0.4%) had positive antiHCV but negative HCV RNA. A total of 159/678 young people (23.5%) did not return for their test results. We found that heterosexuals were more likely not to come back for their results (OR 3.00, 95% CI 1.27 to 7.21); the odds of not returning for results were 1.8 times higher among men (OR 1.80, 95% CI 1.25 to 2.70). NonEuropean origin of patient was also associated with the outcome but only in the bivariate analysis. There was no significant difference regarding origin of patient, health insurance coverage, history of STI and reasons for consultation (table 1). Two other studies performed in France in 2014–2015 reported lower rates of failing to return (12% and 14.5%), but in these studies, general populations were investigated and no data were available about youngsters . 6 Additional studies must be done to identify the barriers and improve the return Research Letter