(PL33) PILOT RANDOMIZED CONTROL TRIAL OF A DIGITAL PATIENT DECISION AID TO FACILITATE GONORRHEA AND CHLAMYDIA SCREENING IN THE EMERGENCY DEPARTMENT (STICKER)

Background:
Rising rates of sexually transmitted infections (STIs) among adolescents and young adults (AYA) are concerning. Emergency department (ED) visits offer a unique opportunity to increase STI testing. This study aimed to test the acceptability, feasibility, and potential efficacy of STIckER (STI Check in the ER), a digital patient decision aid facilitating shared decision-making around genitourinary, pharyngeal, and rectal STI testing among AYA ED patients.

Methods:
In this pilot randomized controlled trial (RCT), we enrolled sexually active AYA English-speaking ED patients aged 14-24 years. Enrolled patients were randomized to standard of care (control) versus the STIckER app (intervention), which was developed through a multi-stakeholder, user-design process. Participants and their providers completed post-intervention surveys after each visit. Data analysis included descriptive statistics, bivariable analyses and relative risk estimate of efficacy.

Results:
Between September 2023 and May 2024, we randomized 140 participants with a median age of 19 (IQR 18-22). Majority reported being female (69%), and heterosexual (76%), and Hispanic (83%) or Black (13%). Demographic variables did not differ between arms.  STIckER arm participants reported the app to be “clear” (Likert scale 0-10; median 9, IQR: 7-10) and “helpful” (9, IQR: 7-10). STIckER arm participants rated the ED higher (8 vs 9, p 0.043) and more often recommended the ED (89% vs 100%, p = 0.052).  STIckER recipients were more likely to have had genitourinary testing (24% vs 44%, relative risk (RR) 1.81, 95% Confidence Interval (CI) 1.09 – 3.02), and oral STI testing (1.6% vs 16%, RR: 10.2 (CI: 1.36 -76.2) than the control arm.  Rectal STI, HIV, or syphilis testing did not differ statistically.

Conclusion:
STIckER was acceptable and clear to patients, providing enhanced ED visit satisfaction, and was feasible to implement in the ED setting. STIckER led to a significant increase in genitourinary and pharyngeal STI testing among AYA ED patients.