A Cluster Randomized Stepped-Wedge Effectiveness-Implementation Trial of a Patient Decision Aid to Increase Sexually Transmitted Infection Testing in the Emergency Department: The STIckER Trial

About This Grant

ABSTRACT Sexually transmitted infections (STIs) remain a significant public health challenge in the United States, disproportionately affecting adolescents and young adults aged 15–24. Comprehensive STI screening— including extra-genital and blood testing—remains underutilized, particularly in emergency departments (EDs), where over 19 million adolescents and young adults receive care annually. Barriers such as time constraints, provider discomfort, and workflow challenges contribute to missed opportunities for STI detection. Even when STI testing occurs, patients are rarely linked to ongoing sexual health services, including STI treatment completion and HIV preventive care, leading to high rates of reinfection and continued disease transmission. Innovative interventions that fit efficiently within the ED workflow and maximize appropriate STI testing are needed. Our multi-disciplinary team developed STIckER (STI ChecK in the ER), a user-informed, theory-based digital patient decision aid designed to facilitate shared decision-making and increase STI testing rates in EDs. In a randomized controlled trial, STIckER significantly increased STI testing rates, improved patient-provider communication, and enhanced ED experience ratings. However, real-world effectiveness and implementation across diverse ED settings remain unexplored. This multi-center R01 study will evaluate STIckER’s effectiveness and implementation across 13 pediatric and adult EDs using a cluster-randomized stepped wedge hybrid type 2 trial. The specific aims of the proposal are: (1) to evaluate the effectiveness of STIckER on STI testing (clinical outcomes) among adolescent and young adult ED patients in a cluster-randomized stepped wedge trial; (2) to measure implementation outcomes across ED sites among key stakeholders, and (3) to evaluate STIckER’s impact on follow-up and linkage to outpatient sexual healthcare services. By integrating scalable, digital, patient- centered approaches into routine ED workflows, STIckER has the potential to transform STI screening and improve long-term sexual health outcomes for adolescents and young adults nationwide.