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Zani B, Luckett B, Thurman TR. COVID-19 pandemic stressors, familial discord, and anxiety among adolescents living with HIV in South Africa: pathways to non-adherence. AIDS Care 2024:1-8. [PMID: 38301123 DOI: 10.1080/09540121.2024.2308025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
Adolescents living with HIV (ALHIV) have poorer adherence to antiretroviral treatment (ART). This study investigates the interconnectivity of stressors induced by the COVID-19 pandemic, anxiety and family dynamics on adolescents' adherence to ART. A telephone survey was conducted among 196 South African ALHIV previously enrolled in support groups. Generalized structural equations modeling was used to understand how pandemic-related stressors affected ART adherence. Respondents reported experiencing life stressors since the implementation of COVID-19 restrictions, including doing worse at school (32%), loss of household income (44%) and less food available (38%). Forty-two percent reported greater verbal aggression from adults at home and 60% experienced anxiety. The structural equations model demonstrated a direct path from experiencing life stressors to increased verbal aggression from caregivers, which led to anxiety and ultimately, poorer ART adherence. Each stressor experienced increased the odds of experiencing verbal aggression by 51% (OR=1.51, 95%CI=1.14-2.00) which, in turn, increased the odds of having anxiety four-fold (OR=4.1, 95%C =2.16-7.76). Anxiety was associated with a 74% reduction in the odds of being fully ART adherent (OR=0.26, 95%CI=0.08-0.81). COVID-19-induced stressors exacerbated the mental and physical vulnerability of ALHIV. Findings elucidate how both discord at home and anxiety can result in poorer ART adherence.
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Affiliation(s)
- Babalwa Zani
- Tulane International, Cape Town, South Africa
- Highly Vulnerable Children Research Center, Cape Town, South Africa
| | - Brian Luckett
- Tulane International, Cape Town, South Africa
- Highly Vulnerable Children Research Center, Cape Town, South Africa
- School of Public Health and Tropical Medicine, Department of International Health and Sustainable Development, Tulane University, New Orleans, LA, USA
| | - Tonya R Thurman
- Tulane International, Cape Town, South Africa
- Highly Vulnerable Children Research Center, Cape Town, South Africa
- School of Public Health and Tropical Medicine, Department of International Health and Sustainable Development, Tulane University, New Orleans, LA, USA
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Toska E, Zhou S, Laurenzi CA, Saal W, Rudgard W, Wittesaele C, Langwenya N, Jochim J, Banougnin BH, Gulaid L, Armstrong A, Sherman G, Edun O, Sherr L, Cluver L. Healthcare provisions associated with multiple HIV-related outcomes among adolescent girls and young women living with HIV in South Africa: a cross-sectional study. J Int AIDS Soc 2024; 27:e26212. [PMID: 38332518 PMCID: PMC10853575 DOI: 10.1002/jia2.26212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) living with HIV experience poor HIV outcomes and high rates of unintended pregnancy. Little is known about which healthcare provisions can optimize their HIV-related outcomes, particularly among AGYW mothers. METHODS Eligible 12- to 24-year-old AGYW living with HIV from 61 health facilities in a South African district completed a survey in 2018-2019 (90% recruited). Analysing surveys and medical records from n = 774 participants, we investigated associations of multiple HIV-related outcomes (past-week adherence, consistent clinic attendance, uninterrupted treatment, no tuberculosis [TB] and viral suppression) with seven healthcare provisions: no antiretroviral therapy (ART) stockouts, kind and respectful providers, support groups, short travel time, short waiting time, confidentiality, and safe and affordable facilities. Further, we compared HIV-related outcomes and healthcare provisions between mothers (n = 336) and nulliparous participants (n = 438). Analyses used multivariable regression models, accounting for multiple outcomes. RESULTS HIV-related outcomes were poor, especially among mothers. In multivariable analyses, two healthcare provisions were "accelerators," associated with multiple improved outcomes, with similar results among mothers. Safe and affordable facilities, and kind and respectful staff were associated with higher predicted probabilities of HIV-related outcomes (p<0.001): past-week adherence (62% when neither accelerator was reported to 87% with both accelerators reported), clinic attendance (71%-89%), uninterrupted ART treatment (57%-85%), no TB symptoms (49%-70%) and viral suppression (60%-77%). CONCLUSIONS Accessible and adolescent-responsive healthcare is critical to improving HIV-related outcomes, reducing morbidity, mortality and onward HIV transmission among AGYW. Combining these provisions can maximize benefits, especially for AGYW mothers.
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Affiliation(s)
- Elona Toska
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Siyanai Zhou
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Division of Social and Behavioural SciencesFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Christina A. Laurenzi
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Wylene Saal
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
| | - William Rudgard
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Camille Wittesaele
- Department of Infectious Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | | | - Janina Jochim
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | | | - Laurie Gulaid
- UNICEF Eastern and Southern Africa Office (UNICEF‐ESARO)NairobiKenya
| | - Alice Armstrong
- UNICEF Eastern and Southern Africa Office (UNICEF‐ESARO)NairobiKenya
| | - Gayle Sherman
- National Institute for Communicable DiseasesJohannesburgSouth Africa
- Department of Paediatrics and Child HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Olanrewaju Edun
- MRC Centre for Global Infectious Disease AnalysisSchool of Public HealthImperial College LondonLondonUK
| | - Lorraine Sherr
- Institute for Global HealthUniversity College LondonLondonUK
| | - Lucie Cluver
- Division of Social and Behavioural SciencesFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
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Mude W, Mwenyango H, Preston R, O'Mullan C, Vaughan G, Jones G. HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review. AIDS Behav 2024; 28:186-200. [PMID: 37548796 PMCID: PMC10803448 DOI: 10.1007/s10461-023-04139-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/08/2023]
Abstract
Access to treatment and care in safe clinical settings improves people's lives with HIV. The COVID-19 pandemic disrupted vital HIV programs and services, increasing the risk of adverse health outcomes for people with HIV and HIV transmission rates in the community. This systematic literature review provides a meta-analysis of HIV testing disruptions and a synthesis of HIV/AIDS services adapted during COVID-19. We searched scholarly databases from 01 January 2020 to 30 June 2022 using key terms on HIV testing rates and services during the COVID-19 pandemic. The process of how the included articles were identified, selected, appraised, and synthesised was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 17 articles that reported changes in HIV testing during the COVID-19 pandemic and 22 that reported adaptations in HIV/AIDS services. We found that HIV testing decreased by 37% during the search period because of the COVID-19 pandemic. Service providers adopted novel strategies to support remote service delivery by expanding community antiretroviral therapy dispensing, setting up primary care outreach points, and instituting multi-month dispensing services to sustain client care. Therefore, service providers and policymakers should explore alternative strategies to increase HIV testing rates impacted by COVID-19 and leverage funding to continue providing the identified adapted services.
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Affiliation(s)
- William Mude
- School of Health Medical and Applied Sciences, Central Queensland University, Cairns Campus, 42-52 Abbott Street & Shields Street, Cairns, QLD, 4870, Australia.
| | - Hadijah Mwenyango
- School of Health & Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, UK
| | - Robyn Preston
- School of Health Medical and Applied Sciences, Central Queensland University, Townsville Campus, Townsville, Australia
| | - Catherine O'Mullan
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg Campus, Bundaberg, Australia
| | - Geraldine Vaughan
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, Australia
| | - Gary Jones
- Cohort Doctoral Studies Program, James Cook University, Cairns, Australia
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Brault MA, Linnander EL, Ginindza TM, Mabuza K, Christie S, Canavan ME, Jones A, Desai MM. Assessing changes in adolescent girls' and young women's sexual and reproductive health service utilisation following a COVID-19 lockdown in eSwatini. Glob Health Action 2023; 16:2243760. [PMID: 37565704 PMCID: PMC10424588 DOI: 10.1080/16549716.2023.2243760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
The effects of COVID-19-associated restrictions on youth sexual and reproductive health (SRH) care during the pandemic remain unclear, particularly in sub-Saharan Africa. This study uses interrupted time series analyses to assess changes in SRH care utilisation (including visits for HIV testing and treatment, family planning, and antenatal care) adolescent girls' and young women's (AGYW; aged 15-24 years old) in eSwatini following COVID-19 lockdown beginning in March 2020. SRH utilisation data from 32 clinics in the Manzini region that remained open throughout the 2020 COVID-19 period were extracted from eSwatini's electronic health record system. We tabulated and graphed monthly visits (both overall and by visit type) by AGYW during the two-year period between January 2019 and December 2020. Despite the March to September 2020 lockdown, we did not detect significant changes in monthly visit trends from 2019 to 2020. Our findings suggest little change to AGYW's SRH utilisation in eSwatini during the 2020 COVID-19 lockdown period.
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Affiliation(s)
- Marie A. Brault
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, San Antonio, TX, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Erika L. Linnander
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
- Department of Health Policy & Management, Yale School of Public Health, New Haven, CT, USA
| | - Thokozani M. Ginindza
- Health Management Information Systems (HMIS), eSwatini Ministry of Health, Mbabane, eSwatini
| | | | - Sarah Christie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- School of Public Health, University of the Western Cape, Bellville, Republic of South Africa
| | - Maureen E. Canavan
- Yale School of Medicine, Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
| | - Anastasia Jones
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, San Antonio, TX, USA
| | - Mayur M. Desai
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Laurenzi CA, Toska E, Tallarico R, Sherr L, Steventon Roberts KJ, Hansen M, Tolmay J, Jochim J, Ameyan W, Yates R. Key normative, legal, and policy considerations for supporting pregnant and postpartum adolescents in high HIV-burden settings: a critical analysis. Sex Reprod Health Matters 2023; 31:2249696. [PMID: 37712411 PMCID: PMC10506436 DOI: 10.1080/26410397.2023.2249696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Rates of adolescent pregnancy within sub-Saharan Africa are increasing. Adolescent mothers ages 10-19 years face a distinct set of risks to their own and their children's health, compounded by many economic, social, and epidemiological challenges, such as living with HIV. In navigating this complex developmental period, many adolescent mothers face structural barriers impeding safe transitions to adulthood and motherhood. Drawing on existing literature and emerging data, we outline three normative, legal, and policy issues - violence and gender inequity, access to sexual and reproductive health services, and access to social and structural supports - which affect the health, wellbeing and development of adolescent mothers and their children. We also highlight emergent evidence about programming and policy changes that can better support adolescent mothers and their children. These key proposed responses include removing barriers to SRH and HIV service integration; ensuring implementation of return-to-school policies; and extending social protection systems to cater for adolescent mothers. Despite ongoing global crises and shifts in funding priorities, these normative, legal, and policy considerations remain critical to safeguard the health and wellbeing of adolescent mothers and their children.
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Affiliation(s)
- Christina A. Laurenzi
- Senior Researcher, Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Elona Toska
- Associate Professor, Centre for Social Science Research, Department of Sociology, University of Cape Town, Rondebosch, South Africa; Co-director, Accelerate Hub, University of Cape Town, Rondebosch, South Africa; Associate Professor, Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom
| | - Renata Tallarico
- Youth Team Lead and SYP Regional Coordinator, United Nations Population Fund, Eastern and Southern Regional Office, Johannesburg, South Africa
| | - Lorraine Sherr
- Professor, Clinical and Health Psychology, University College London, London, United Kingdom
| | - Kathryn J. Steventon Roberts
- Postdoctoral Researcher, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Postgraduate Researcher, Institute for Global Health, University College London, London, United Kingdom
| | - Maja Hansen
- Technical Advisor, Gender Equality, United Nations Population Fund, Dar es Salaam, Tanzania
| | - Janke Tolmay
- Quantitative Research Assistant, Accelerate Hub, Centre for Social Science Research, University of Cape Town, Rondebosch, South Africa
| | - Janina Jochim
- Postdoctoral Research Officer, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Wole Ameyan
- Technical Officer, Adolescent HIV, Global HIV Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Yates
- Strategic Advocacy Lead, Accelerate Hub, University of Oxford, Oxford, United Kingdom
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Mayman YR, van Wyk B. The impact of COVID-19 on HIV treatment of adolescents in sub-Saharan Africa: A scoping review. Health SA 2023; 28:2226. [PMID: 37795154 PMCID: PMC10546235 DOI: 10.4102/hsag.v28i0.2226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background Adolescents living with HIV are a key population who are susceptible to poor health. The global coronavirus disease 2019 pandemic and widespread national COVID-19 restrictions has disrupted health service delivery and HIV support services, affecting treatment adherence among adolescents with HIV. Aim This study aimed to review the available literature on the impact of the COVID-19 pandemic on the HIV treatment of adolescents in sub-Saharan Africa. Method Seven online databases were searched for articles published between 2020 and 2022 that focused on the impact of COVID-19 on adolescents living with HIV on antiretroviral therapy. A data charting extraction form and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA) flowchart were used for screening and reporting the articles in this review. A narrative synthesis was conducted. Results Five overarching themes emerged from the articles in this review, which highlighted the mental, social, and economic impacts of the COVID-19 pandemic, as well as the impact of the reallocation of healthcare services and challenges to accessing HIV care services on the antiretroviral therapy (ART) adherence of adolescents living with HIV. Conclusion The global COVID-19 pandemic affected adolescents living with HIV in sub-Saharan Africa in many ways, but very little research has been done to describe the various ways in which the physical and mental well-being of adolescents were impacted. Contribution The findings of this review can be used to further inform policies and interventions aimed at the care and well-being of adolescents on antiretroviral therapy within sub-Saharan Africa.
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Affiliation(s)
- Yolanda R Mayman
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Brian van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Subramanian S, Namusoke-Magongo E, Edwards P, Atujuna M, Chimulwa T, Dow D, Jalil E, Torbunde N, Agot K, Arinaitwe I, Beizer J, Chelwa N, Mbalinda SN, Miti S, Mwangwa F. Integrated Health Care Delivery for Adolescents Living with and at Risk of HIV Infection: A Review of Models and Actions for Implementation. AIDS Behav 2023; 27:50-63. [PMID: 35841465 PMCID: PMC9287816 DOI: 10.1007/s10461-022-03787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 11/02/2022]
Abstract
Integrated service delivery, providing coordinated services in a convenient manner, is important in HIV prevention and treatment for adolescents as they have interconnected health care needs related to HIV care, sexual and reproductive health and disease prevention. This review aimed to (1) identify key components of adolescent-responsive integrated service delivery in low and middle-income countries, (2) describe projects that have implemented integrated models of HIV care for adolescents, and (3) develop action steps to support the implementation of sustainable integrated models. We developed an implementation science-informed conceptual framework for integrated delivery of HIV care to adolescents and applied the framework to summarize key data elements in ten studies or programs across seven countries. Key pillars of the framework included (1) the socioecological perspective, (2) community and health care system linkages, and (3) components of adolescent-focused care. The conceptual framework and action steps outlined can catalyze design, implementation, and optimization of HIV care for adolescents.
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Affiliation(s)
- Sujha Subramanian
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA.
| | | | - Patrick Edwards
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | - Millicent Atujuna
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | | | - Dorothy Dow
- Duke Global Health Institute, Durham, NC, USA
| | | | | | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | | | - Jenny Beizer
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709, USA
| | | | | | - Sam Miti
- Copperbelt University School of Medicine, Ndola, Zambia
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Ciccacci F, Ismael F, Chume V, Ruth L, Mbula P, Orlando S, Majid NA, Marazzi MC. Enhancing retention in care in HIV-infected adolescents during COVID-19 in Mozambique: results from the DREAM program. Int J Adolesc Med Health 2023; 35:227-231. [PMID: 36708359 DOI: 10.1515/ijamh-2022-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Around 1,7 million adolescents aged 10-19 years worldwide are infected with HIV, 84% of them living in Sub-Saharan Africa. Mozambique is one of the countries with the highest prevalence of HIV in the world. According to UNAIDS, HIV services for adolescents should be tailored and specifically designed for them. METHODS We aimed to evaluate a package of activities to enhance the retention of HIV-infected adolescent in Mozambique. We retrospectively reviewed routine data from 7 health centers involved in 26 months, from March 2020 to May 2022. A package of tailored interventions was implemented in all the sites. We reviewed activity data from the included centers. RESULTS The median number of patients per center was 343 (IQR: 289-466) at the beginning of the period and 395 (IQR: 322-453) at the end. The median overall retention in care and rate of lost to follow-up at the beginning and the end of the period were respectively: 94.2% (IQR 91.9-97.3%) to 99.0% (IQR 96.8-99.5%), 1.5% (IQR 1-3.2%) to 0% (IQR 0.0-0.3%). The total number of deaths increased reaching a plateau after September 2021. All the indicators improved after the beginning of the intervention, also during COVID-19 pandemic. CONCLUSIONS Our data support the idea that enhancing retention in care for HIV positive adolescents need tailored interventions, based on deep rooting in the specific social context. Tailored intervention can resist external shock such as COVID-19.
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Affiliation(s)
- Fausto Ciccacci
- UniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Flavio Ismael
- DREAM program, Community of Sant'Egidio, Maputo, Mozambique
| | - Veronica Chume
- DREAM program, Community of Sant'Egidio, Maputo, Mozambique
| | - Lina Ruth
- DREAM program, Community of Sant'Egidio, Maputo, Mozambique
| | - Pedro Mbula
- DREAM program, Community of Sant'Egidio, Beira, Mozambique
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Torvergata, Rome, Italy
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Baker V, Mulwa S, Khanyile D, Sarrassat S, O'Donnell D, Piot S, Diogo Y, Arnold G, Cousens S, Cawood C, Birdthistle I. Young people's access to sexual and reproductive health prevention services in South Africa during the COVID-19 pandemic: an online questionnaire. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001500. [PMID: 36693683 PMCID: PMC9884573 DOI: 10.1136/bmjpo-2022-001500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/01/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The South African government responded swiftly to the first wave of novel coronavirus (SARS-CoV-2) with a nationwide lockdown. Initial restrictions from March-July 2020 required people to stay at home unless accessing essential, life-saving services. We sought to understand how the COVID-19 pandemic and resulting lockdowns affected young people's access to sexual and reproductive health services in a high-prevalence HIV setting. METHODS We analysed data from a cross-sectional web-based questionnaire conducted with 15-24 year-olds from September-December 2020 in Eastern Cape, South Africa. The questionnaire was promoted through social media platforms. Participants were asked whether and how the COVID-19 pandemic and related restrictions affected their access to sexual and reproductive health services, through closed-ended and open-ended questions. Descriptive statistics using proportions were used to summarise responses, and open text was analysed using thematic analysis. RESULTS Of 3431 respondents, the proportions reporting 'more difficulty' accessing HIV testing services, HIV self-screening kits, condoms, pre-exposure prophylaxis and antiretroviral treatment since the COVID-19 pandemic were 16.8%, 13.7%, 13.9%, 11% and 7%, respectively. In 796 open-text responses, participants described challenges accessing HIV services due to clinics being overwhelmed and prioritising patients with COVID-19, resulting in young people being turned away. Some were afraid of contracting COVID-19 at or en route to clinics. Others were unable to reach clinics because of restricted transport or financial insecurity. DISCUSSION Young people in Eastern Cape rely on local clinics for services, and large proportions of young males and females faced difficulties or fears accessing clinics during the COVID-19 lockdown. Clinics became overwhelmed or inaccessible, limiting young people's access to sexual and reproductive health services. In high HIV risk contexts, prevention services and tools must be more accessible to young people, outside of clinics and within the communities and spaces that young people can access without fear or cost.
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Affiliation(s)
- Venetia Baker
- Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Mulwa
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sophie Sarrassat
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sara Piot
- MTV Staying Alive Foundation, London, UK
| | | | | | - Simon Cousens
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Isolde Birdthistle
- Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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10
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Tucker JD, Marley G, Marks M, Mabey D. Prioritizing syphilis control: Now is the time for action. Front Med (Lausanne) 2022; 9:899200. [PMID: 36072951 PMCID: PMC9441663 DOI: 10.3389/fmed.2022.899200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Syphilis control programs and research received fewer resources and attention compared to HIV and other sexually transmitted infections (STIs) in the pre-pandemic era. The neglect of syphilis within comprehensive STI control efforts may be related to diagnostic (poor diagnostics), historical (legacies of racism in research), public health (limited partner services), and social problems (limited public engagement). At the same time, there are increasingly compelling reasons to prioritize syphilis control programs and research by harnessing lessons learned and advances during COVID-19. The closure of many STI facilities has accelerated new syphilis diagnostic pathways (e.g., syphilis self-testing), providing new ways for people to be screened outside of clinics. COVID-19 has underlined health inequities that fuel syphilis transmission, providing an opportunity to reckon with the historical legacy of racism that is linked to syphilis research. COVID-19 partner tracing efforts have also contributed to additional resources for partner services which may enhance syphilis control efforts. Finally, COVID-19 has demonstrated the importance of public engagement, making the case for greater public involvement in syphilis control and prevention programs. Urgent action is needed to prioritize syphilis control in a wide range of settings.
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Affiliation(s)
- Joseph D. Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- SESH Global, Guangzhou, China
- *Correspondence: Joseph D. Tucker
| | - Gifty Marley
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- SESH Global, Guangzhou, China
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London, London, United Kingdom
| | - David Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London, London, United Kingdom
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11
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Escosa-García L, Sainz T. Editorial: HIV and ART in children. Front Pediatr 2022; 10:1074684. [PMID: 36619525 PMCID: PMC9812436 DOI: 10.3389/fped.2022.1074684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Luis Escosa-García
- Servicio de Pediatría Hospitalaria, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz and IdiPAZ, Madrid, Spain.,RITIP (Red de Investigación Translacional en Infectología Pediátrica), Madrid, Spain.,Área de Enfermedades Infecciosas del Centro de Investigación Biomédica en Red del Instituto de Salud Carlos III (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Talía Sainz
- Servicio de Pediatría Hospitalaria, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz and IdiPAZ, Madrid, Spain.,RITIP (Red de Investigación Translacional en Infectología Pediátrica), Madrid, Spain.,Área de Enfermedades Infecciosas del Centro de Investigación Biomédica en Red del Instituto de Salud Carlos III (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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