Integrating Chlamydia and Gonorrhea Testing into a Community-Based Cohort of Latine Young Adults: Patterns and Predictors of Uptake

BACKGROUND: We examined STI testing behaviors in a community-based study that removed access and cost barriers by offering in-person and mail-in testing. METHODS: A Crecer is a prospective cohort study of adolescents and young adults in an agricultural, majority Latine community (2015-2025). STI testing was offered at three annual visits in emerging adulthood (2022-2025). Participants provided biospecimens for chlamydia/gonorrhea testing, either in-person or via mailed self-collection kit, and completed questionnaires. We examined associations between individual, relationship, and environmental factors and STI testing using Poisson regression with generalized estimating equations. RESULTS: Participants (N=389, 56% female sex at birth, 95% Latine) had a mean age of 20 (range 18-22). Sixty-three percent tested at the first visit in early adulthood, decreasing to 44% and 33% in subsequent annual visits. Initial uptake was higher among those completing in-person versus remote visits (84% vs. 25%). Chlamydia prevalence was 8% at the first visit in early adulthood, and positivity was 5% and 2% at subsequent visits. Testing did not vary by sex. In multivariable analysis, uptake was higher among those experiencing intimate partner violence (adjusted Relative Risk (aRR): 1.3; 95% CI: 1.1, 1.4, p<0.001), and among those reporting sex without a condom in the prior 12 months (aRR: 1.2; CI: 1.0, 1.4, p=0.03). Receipt of sexual health services outside the study was not associated with testing uptake. CONCLUSIONS: While many tested based on perceived STI risk, uptake fell short of public health recommendations. Low uptake of mail-in testing highlights the need for testing models that better align with Latine young adults' preferences and circumstances. Findings underscore the importance of understanding testing barriers and normalizing STI screening as routine preventive care.