Karen W Hoover

Centers for Disease Control and Prevention, Atlanta, Michigan, United States

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Publications (40)110.81 Total impact

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    ABSTRACT: To estimate prenatal sexually transmitted disease-human immunodeficiency virus (HIV) screening rates among insured women with prenatal care and the association of chlamydia and gonorrhea screening with Pap testing. We estimated prenatal screening rates for syphilis, hepatitis B, HIV, chlamydia, and gonorrhea among women aged 15-44 years using a 2009-2010 U.S. administrative claims database that captures information for health services provided for both Medicaid- and commercially insured persons. Procedural and diagnostic codes were used to identify pregnant women with a live birth in 2010 with continuous insurance coverage at least 210 days before delivery and at least one typical prenatal blood test. Strengths of association between chlamydia and gonorrhea screening and Pap testing were measured using a χ test of independence. Among 98,709 Medicaid-insured pregnant women, 95,064 (96.3%) were screened for syphilis, 95,082 (96.3%) for hepatitis B, 81,339 (82.4%) for HIV, 82,047 (83.1%) for chlamydia, and 73,799 (74.8%) for gonorrhea. Among 266,012 commercially insured women, 260,079 (97.8%) were screened for syphilis, 257,675 (96.8%) for hepatitis B, 227,276 (85.4%) for HIV, 187,071 (70.3%) for chlamydia, and 182,400 (68.6%) for gonorrhea. Prenatal screening for chlamydia and gonorrhea among both groups of women was more likely to be performed if a Pap test was also done (P<.001). Prenatal screening for syphilis and hepatitis B was nearly universal among Medicaid- and commercially insured women; HIV screening rates were much lower and varied by insurance type and demographic characteristics. Chlamydia screening was suboptimal and most often occurred with Pap testing. III.
    Obstetrics and Gynecology 05/2015; 125(5):1211-1216. DOI:10.1097/AOG.0000000000000756 · 4.37 Impact Factor
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    ABSTRACT: BACKGROUND: Male circumcision confers protection against HIV, sexually transmitted infections, and urinary tract infections. Compared with circumcision of postneonates (>28 days), circumcision of neonates is associated with fewer complications and usually performed with local rather than general anesthesia. We assessed circumcision of commercially insured males during the neonatal or postneonatal period. METHODS: We analyzed 2010 MarketScan claims data from commercial health plans, using procedural codes to identify circumcisions performed on males aged 0 to 18 years, and diagnostic codes to assess clinical indications for the procedure. Among circumcisions performed in the first year of life, we estimated rates for neonates and postneonates. We estimated the percentage of circumcisions by age among males who had circumcisions in 2010, and the mean payment for neonatal and postneonatal procedures. RESULTS: We found that 156 247 circumcisions were performed, with 146 213 (93.6%) in neonates and 10 034 (6.4%) in postneonates. The neonatal circumcision rate was 65.7%, and 6.1% of uncircumcised neonates were circumcised by their first birthday. Among postneonatal circumcisions, 46.6% were performed in males younger than 1 year and 25.1% were for nonmedical indications. The mean payment was $285 for a neonatal and $1885 for a postneonatal circumcision. CONCLUSIONS: The large number of nonmedical postneonatal circumcisions suggests that neonatal circumcision might be a missed opportunity for these boys. Delay of nonmedical circumcision results in greater risk for the child, and a more costly procedure. Discussions with parents early in pregnancy might help them make an informed decision about circumcision of their child.
    Pediatrics 10/2014; 134(5). DOI:10.1542/peds.2014-1007 · 5.30 Impact Factor
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    ABSTRACT: Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. Chlamydia is the most commonly reported notifiable disease in the United States, with 1.4 million cases reported in 2012. Chlamydia is usually asymptomatic in both men and women, and as a result, infections often are undiagnosed. Approximately 3 million new infections are estimated to occur each year. Among sexually active females aged 14-19 years, chlamydia prevalence has been estimated to be 6.8%. In a recent study involving approximately 1 million tests conducted among both privately insured and Medicaid-insured females aged 15-21 years, chlamydia positivity ranged from 6.9% to 10.7% among those with chlamydial symptoms and from 6.1% to 9.6% among those who were asymptomatic.
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    ABSTRACT: In the United States, chlamydia screening has been recommended for all pregnant women by the Centers for Disease Control and Prevention (CDC) but only for pregnant women who are at increased risk by the US Preventive Services Task Force (USPSTF). Very limited evidence, such as age-specific chlamydia positivity in pregnant women, has been used to develop these recommendations.
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    ABSTRACT: The Affordable Care Act of 2010 (ACA) contains a provision requiring private insurers issuing or renewing plans on or after September 23, 2010, to provide, without cost sharing, preventive services recommended by US Preventive Services Task Force (grades A and B), among other recommending bodies. As a grade A recommendation, chlamydia screening for sexually active young women 24 years and younger and older women at risk for chlamydia falls under this requirement. This article examines the potential effect on chlamydia screening among this population across private and public health plans and identifies lingering barriers not addressed by this legislation. Examination of the impact on women with private insurance touches upon the distinction between coverage under grandfathered plans, where the requirement does not apply, and nongrandfathered plans, where the requirement does apply. Acquisition of private health insurance through health insurance Marketplaces is also discussed. For public health plans, coverage of preventive services without cost sharing differs for individuals enrolled in standard Medicaid, covered under the Medicaid expansion included in the ACA, or those enrolled under the Children's Health Insurance Program or who fall under Early, Periodic, Screening, Diagnosis and Treatment criteria. The discussion of lingering barriers not addressed by the ACA includes the uninsured, physician reimbursement, cost sharing, confidentiality, low rates of appropriate sexual history taking by providers, and disclosures of sensitive information. In addition, the role of safety net programs that provide health care to individuals regardless of ability to pay is examined in light of the expectation that they also remain a payer of last resort.
    Sex Transm Dis 09/2014; 41(9):538-44. DOI:10.1097/OLQ.0000000000000170 · 2.75 Impact Factor
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    ABSTRACT: To examine rates of ectopic pregnancy (EP) among American Indian and Alaska Native (AI/AN) women aged 15-44 years seeking care at Indian Health Service (IHS), Tribal, and urban Indian health facilities during 2002-2009. We used 2002-2009 inpatient and outpatient data from the IHS National Patient Information Reporting System to identify EP-associated visits and obtain the number of pregnancies among AI/AN women. Repeat visits for the same EP were determined by calculating the interval between visits; if more than 90 days between visits, the visit was considered related to a new EP. We identified 229,986 pregnancies among AI/AN women 15-44 years receiving care at IHS-affiliated facilities during 2002-2009. Of these, 2,406 (1.05 %) were coded as EPs, corresponding to an average annual rate of 10.5 per 1,000 pregnancies. The EP rate among AI/AN women was lowest in the 15-19 years age group (5.5 EPs per 1,000 pregnancies) and highest among 35-39 year olds (18.7 EPs per 1,000 pregnancies). EP rates varied by geographic region, ranging between 6.9 and 24.4 per 1,000 pregnancies in the Northern Plains East and the East region, respectively. The percentage of ectopic pregnancies found among AI/AN women is within the national 1-2 % range. We found relatively stable annual rates of EP among AI/AN women receiving care at IHS-affiliated facilities during 2002-2009, but considerable variation by age group and geographic region. Coupling timely diagnosis and management with public health interventions focused on tobacco use and sexually transmitted diseases may provide opportunities for reducing EP and EP-associated complications among AI/AN women.
    Maternal and Child Health Journal 07/2014; 19(4). DOI:10.1007/s10995-014-1558-0 · 2.24 Impact Factor
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    ABSTRACT: Background: CDC sexually transmitted disease (STD) treatment guidelines recommend that all persons presenting with a genital, anal or perianal ulcer (GUD) be tested for herpes simplex virus (HSV), syphilis, and HIV and receive empiric treatment while awaiting diagnostic tests. It is unknown what proportion of patients with GUD are appropriately managed according to these guidelines. Methods: We analyzed administrative claims data from the 2011 MarketScan database. The database included enrollment and claims data for inpatient and outpatient encounters and prescription services for approximately 15 million privately insured persons in the United States. We included all initial encounters with an ICD-9 code for genital herpes, primary or secondary syphilis, or unspecified genital, anal, or perianal ulcer. We used CPT and NDC codes to identify laboratory testing and prescribed pharmacotherapy, respectively. We defined appropriate management as testing for syphilis and HIV, and testing for HSV or provision of antivirals, within 30 days of initial presentation. Either testing or provision of antivirals was considered appropriate management for HSV because it can recur. Results: Among initial encounters by 84,919 patients with GUD, 78.3% were for HSV, 20.8% for unspecified ulcers, and 0.9% for syphilis; 0.1% were for both HSV and syphilis. Among all GUD patients, only 5.3% (n=4520) were tested for syphilis and managed for HSV, and only 0.2% (n=174) were also tested for HIV. The percentage of patients receiving appropriate management for HSV and syphilis was not significantly different by sex (both 5.3%, p=0.89). When considering HIV testing, men were significantly more likely to be managed appropriately than women (0.32% v. 0.16%, respectively, p≤0.0001). Conclusions: Despite CDC GUD management guidelines, few patients with GUD received appropriate care. Patients with GUD have an increased risk of HIV transmission and acquisition. Interventions are needed to assure high quality healthcare services for patients with GUD.
    National STD Prevention Conference 2014 Centers for Disease Control and Prevention; 06/2014
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    ABSTRACT: HIV-infected men who have sex with men (MSM) are at increased risk for transmitting and acquiring sexually transmitted diseases (STDs). Guidelines recommend at least annual screening of HIV-infected MSM for syphilis and for chlamydia and gonorrhea at exposed anatomical sites, to protect their health and their sexual partners' health. Despite these guidelines, STD screening has been suboptimal, with very low nongenital chlamydia and gonorrhea testing rates. Our objective was to better understand barriers encountered by HIV care providers in adhering to STD screening guidelines for HIV-infected MSM. We conducted 40 individual semistructured interviews with health care providers (physicians, midlevel providers, nurses, and health educators) of HIV-infected MSM at 8 large HIV clinics in 6 US cities. Providers were asked about their STD screening practices and barriers to conducting sexual risk assessments of their patients. Emerging themes were identified by qualitative data analysis. Although most health care providers reported routine syphilis screening, screening for chlamydia and gonorrhea at exposed anatomical sites was less frequent. Obstacles that prevented routine chlamydia and gonorrhea screening included time constraints, difficulty obtaining a sexual history, language and cultural barriers, and patient confidentiality concerns. Providers reported many obstacles to routine chlamydia and gonorrhea screening. Interventions are needed to help to mitigate barriers to STD screening, such as structural and patient-directed health services models that might facilitate increased testing coverage of these important preventive services.
    Sexually transmitted diseases 02/2014; 41(2):137-42. DOI:10.1097/OLQ.0000000000000067 · 2.75 Impact Factor
  • Contraception 09/2013; 88(3):454. DOI:10.1016/j.contraception.2013.05.093 · 2.93 Impact Factor
  • Sexually Transmitted Infections 07/2013; 89(Suppl 1):A268-A269. DOI:10.1136/sextrans-2013-051184.0835 · 3.08 Impact Factor
  • Sexually Transmitted Infections 07/2013; 89(Suppl 1):A284-A284. DOI:10.1136/sextrans-2013-051184.0885 · 3.08 Impact Factor
  • Guoyu Tao, Karen W Hoover
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    ABSTRACT: Background: Men who have sex with men (MSM) experience disparities in access to healthcare and have specific healthcare needs. Methods: We analysed data from the 2006-10 National Survey of Family Growth (NSFG) to examine differences in access to healthcare and HIV and sexually transmissible infection (STI) related health services by MSM and non-MSM among men in the United States aged 15-44 years who have ever had sex. MSM and sexually active MSM were identified in the NSFG as men who had ever had oral or anal sex with another man, or who had sex in the past 12 months with another man, respectively. Access was measured by the type of health insurance, having a usual place for receiving healthcare and type of usual place. Results: Of men aged 15-44 years who have ever had sex, there were no significant differences between MSM and non-MSM in the three access measures. MSM were more likely than non-MSM to receive HIV counselling (22.5% v. 8.3%) and STI testing (26.2% v. 15.6%) in the past 12 months, or to ever have had HIV testing (67.8% v. 44.6%). STI testing in the past 12 months was reported by 38.7% of sexually active MSM. Conclusion: Our findings show no significant differences in access to healthcare between MSM and non-MSM. MSM were more likely to receive HIV- and STI-related preventive services than non-MSM. However, the low STI testing rate among MSM highlights the need for interventions to increase STI testing, and HIV and STI counselling for MSM.
    Sexual Health 06/2013; 10(4). DOI:10.1071/SH13017 · 1.58 Impact Factor
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    ABSTRACT: Background. Chlamydia is prevalent among young persons in the United States. Infected persons have a high prevalence of infection several months later, most likely from reinfection. Retesting of all men and women with a positive test is recommended 3 months after treatment. A test-of-cure is recommended for pregnant women 3-4 weeks after treatment.Methods. We analyzed 2008-2010 chlamydia testing data from a large US laboratory to estimate test positivity by patient demographic characteristics and diagnoses, and patterns of repeat testing of men and nonpregnant women with a positive test and tests-of-cures of pregnant women with a positive test.Results. During the study period, 7.0% of 0.40 million tests performed in men and 4.0% of 2.92 million tests performed in women were positive. Among young women, positivity rates were highest among those aged 15-19 years, ranging from 8.5% to 10.0%. Retesting rates of persons with a positive test were suboptimal, with 22.3% of men and 38.0% of nonpregnant women retested. Although 60.1% of pregnant women with a positive test were retested, only 22.0% received a test-of-cure within the 4-week recommended time frame. Repeat tests were positive in 15.9% of men, 14.2% of nonpregnant women, and 15.4% of pregnant women.Conclusions. Analyses of laboratory testing data provided important insights into chlamydia testing, retesting, and positivity among a diverse US population of men and women. Too few persons were retested as recommended, and interventions are needed to increase both healthcare provider and patient adherence to recommendations for retesting men and women with positive tests.
    Clinical Infectious Diseases 10/2012; 56(1). DOI:10.1093/cid/cis771 · 9.42 Impact Factor
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    ABSTRACT: Using the 2006-2008 National Survey of Family Growth, we estimated a 37.9% annual chlamydia testing rate for sexually active US women aged 15 to 25 years, defined as having ≥ 1 sex partner in the past year. Our results highlight the need for increased testing among sexually active young women.
    Sexually transmitted diseases 08/2012; 39(8):605-7. DOI:10.1097/OLQ.0b013e318254c837 · 2.75 Impact Factor
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    ABSTRACT: To assess chlamydia testing in women in community health centers, we analyzed data from national surveys of ambulatory health care. Women with chlamydial symptoms were tested at 16% of visits, and 65% of symptomatic women were tested if another reproductive health care service (pelvic examination, Papanicolaou test, or urinalysis) was performed. Community health centers serve populations with high sexually transmitted disease rates and fill gaps in the provision of sexual and reproductive health care services as health departments face budget cuts that threaten support of sexually transmitted disease clinics.
    American Journal of Public Health 06/2012; 102(8):e26-9. DOI:10.2105/AJPH.2012.300744 · 4.23 Impact Factor
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    ABSTRACT: HIV-infected men who have sex with men (MSM) are at increased risk of viral hepatitis because of similar behavioral risk factors for acquisition of these infections. Our objective was to estimate adherence to HIV management guidelines that recommend screening HIV-infected persons for hepatitis A, B, and C infection, and vaccinating for hepatitis A and B if susceptible. We evaluated hepatitis prevention services received by a random sample of HIV-infected MSM in 8 HIV clinics in 6 US cities. We abstracted medical records of all visits made by the patients to the clinic during the period from 2004 to 2007, to estimate hepatitis screening and vaccination rates overall and by clinic site. Medical records of 1329 patients who had 14,831 visits from 2004 to 2006 were abstracted. Screening rates for hepatitis A, B, and C were 47%, 52%, and 54%, respectively. Among patients who were screened and found to be susceptible, 29% were vaccinated for hepatitis A and 25% for hepatitis B. The percentage of patients screened and vaccinated varied significantly by clinic. Awareness of hepatitis susceptibility and hepatitis coinfection status in HIV-infected patients is essential for optimal clinical management. Despite recommendations for hepatitis screening and vaccination of HIV-infected MSM, rates were suboptimal at all clinic sites. These low rates highlight the importance of routine review of adherence to recommended clinical services. Such reviews can prompt the development and implementation of simple and sustainable interventions to improve the quality of care.
    Sexually transmitted diseases 05/2012; 39(5):349-53. DOI:10.1097/OLQ.0b013e318244a923 · 2.75 Impact Factor
  • Guoyu Tao, Karen W Hoover, Charlotte K Kent
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    ABSTRACT: Annual chlamydia screening for sexually active women aged ≤25 years is recommended, and chlamydia testing rates have continuously increased. However, several studies have shown that many providers screen all women of reproductive age in public settings. To examine chlamydia testing patterns in private settings for women and young women aged 15-44 years (hereafter referred to as women). A large commercial claims database was used to estimate the chlamydia testing rate for women aged 15-44 years who had reproductive health services in 2008. Such services and tests were identified using diagnostic and procedural codes in 2008. Of 3.2 million women aged 15-44 years who had reproductive health services in 2008, 19.2% had at least a claim for a sexually transmitted disease (STD), 29.3% for pregnancy, and 81.2% for a gynecologic exam. Of those 3.2 million, 22.3% had chlamydia testing: 34.2% aged 15-25 years vs 18.3% aged 26-44 years. Of the 0.7 million who were tested, 65% were aged 26-44 years, and the reason for the healthcare visit in which their first chlamydia test was performed was an STD for 22.7% and pregnancy for 33.5%. In this population of insured women, young women are undertested and older women are overtested for chlamydia. Efforts to improve screening practices should be evaluated.
    American journal of preventive medicine 04/2012; 42(4):337-41. DOI:10.1016/j.amepre.2011.11.013 · 4.28 Impact Factor
  • R. Guzmn-Pereira, Karen W. Hoover
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    ABSTRACT: Background: The number of single fathers has been increasing over recent years, and the man’s role in the family has been changing. A father’s health behaviors can serve as a role model for his children. Objectives: To compare sexual health and risk behaviors of fathers with a partner and fathers without a partner. Methods: We analyzed data from the 2006-2008 National Survey of Family Growth, a nationally representative survey that included men aged 15-44 years. We defined a “father” as any male who reported children ≤ 18 years, and a “partner” as a reported female spouse or cohabitation partner. For fathers with a partner vs. fathers without a partner, we compared the proportions with > 1 female sexual partners; who used a condom or other contraception; had an STD test or diagnosis in the past year; was ever incarcerated; and who used marijuana. We determined if differences were significant using the Chi-squared test. Results: Compared to fathers with a partner, those without a partner were more likely to have > 1 sexual partner (8% vs. 49%, p<0.01); less likely to use a condom for only pregnancy prevention (73% vs. 22%, p<0.01), more likely to use a condom for both pregnancy prevention and disease prevention (17% vs. 62%, p<0.01), more likely to use marijuana (14% vs. 33%, p<0.01), and more likely to use STD services (11% vs. 24%, p<0.01). A similar proportion of men in each group reported having an STD. Conclusions: Fathers with a partner and fathers without a partner had different patterns of risk behavior. Implications for Programs, Policy, and Research: Interventions are needed to promote sexual health among men, and to assure the provision of quality sexual healthcare services for men. Further studies are needed to understand factors that influence condom and contraception use.
    National STD Prevention Conference 2012 Centers for Disease Control and Prevention; 03/2012
  • toria Beltran, Guoyu Tao, Karen W. Hoover
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    ABSTRACT: Background: HIV-infected MSM are at greater risk of acquiring STDs, and if infected with a STD, transmitting HIV and STDs to partners. National guidelines recommend annual asymptomatic STD screening of sexually active HIV-infected persons. Objectives: To estimate the frequency of HIV-infected MSM who reported high risk behaviors that were tested for STDs. Methods: Data were analyzed from a survey of sexually active HIV-infected MSM receiving medical care in eight HIV clinics in six U.S. cities in 2007. We estimated the testing rates of self-reported chlamydia, gonorrhea, and syphilis, and the positivity rates among those who reported that they were tested, by risk behaviors during the year prior to the survey. Results: Among 505 patients, 80.6% reported having more than one sex partner, 58.6% having clinicians who provided risk counseling, and 25% having not using a condom during the most recent receptive anal sex encounter in the past year. Of those 505 patients, 42% reported that they were tested for chlamydia and gonorrhea, and 52.7% for syphilis. Among those tested, 7.7% reported that they had been diagnosed with chlamydia or gonorrhea, and 8.9% with syphilis. After adjusting for independent variables such as demographic variables and symptom status, our logistic regressions found that patients were significantly more likely to be tested for chlamydia and gonorrhea if they had more than one sex partner, did not use condoms during their last receptive anal sex encounter, and had clinicians who provided risk counseling in the past year. Conclusions: With a high proportion of men reporting STDs and suboptimal testing rates for these STDs, our findings suggests that providers need to better adhere to national guidelines that recommend annual STD screening of HIV-infected MSM. Implications for Programs, Policy, and Research: Comprehensive HIV and STD prevention interventions targeting HIV-infected MSM should also include strategies to reduce high risk behaviors.
    National STD Prevention Conference 2012 Centers for Disease Control and Prevention; 03/2012
  • Source
    Karen W Hoover, Justin D Radolf
    The Journal of Infectious Diseases 09/2011; 204(9):1295-6. DOI:10.1093/infdis/jir528 · 5.78 Impact Factor