Public health funding and chlamydia and gonorrhea rates among adolescents during the COVID-19 pandemic in Ontario, Canada: An interrupted time series study.

Publication date: Jul 03, 2025

We estimated the association between local public health infectious and communicable diseases (ICD) funding and chlamydia and gonorrhea trends before and during the COVID-19 pandemic among adolescents aged 13-19 in Ontario, Canada. Quasi-experimental, interrupted time series. We conducted a population-based analysis using repeated cross-sectional data of chlamydia and gonorrhea incidence among adolescents across Ontario’s 34 regional public health units from January 2015 to October 2022. We used negative binomial-regression to estimate changes in chlamydia and gonorrhea incidence before and during the COVID-19 pandemic, and whether these changes differed by 2019 ICD per capita public health funding. During the study period, there were 51,230 adolescent cases of chlamydia and 5256 of gonorrhea with most cases in females and older adolescents (age 18-19). Pre-pandemic, chlamydia rates increased over time (Risk ratio (RR) = 1. 01, 95 % confidence interval (CI): 1. 01-1. 01, per month). There was an immediate decrease in chlamydia rates post-pandemic onset (RR = 0. 26, 95 % CI: 0. 12-0. 53) though higher rates were observed with increasing 2019 ICD per capita funding (RR = 1. 11, 95 % CI: 1. 05-1. 17, per dollar of ICD per capita funding, post-pandemic onset). Similar trends were observed for gonorrhea, but estimates had lower precision. Higher pre-pandemic 2019 ICD per capita funding may have allowed greater sexual health screening services during the COVID-19 pandemic, potentially mitigating a larger drop in STI detection. Results suggest that higher public health funding may allow for greater resilience of sexual health services during public health emergencies.

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