Safeguarding gains in the sexual and reproductive health and AIDS response amidst COVID-19: The role of African civil society

Assessing changes in adolescent girls' and young women's sexual and reproductive health service utilisation following a COVID-19 lockdown in eSwatini

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.

The role of civil society organizations (CSOs) in the COVID-19 response across the Global South: A multinational, qualitative study

Despite receiving less attention than high-income countries, low- and middle-income countries (LMICs) experienced more than 85% of global excess deaths during the first two years of the COVID-19 pandemic. Due to the unprecedented speed and scale of the COVID-19 pandemic, which placed large demands on government capacity, many LMICs relied on civil society organizations (CSOs) to assist in implementing COVID-19 response programs. Yet few studies have examined the critical role CSOs played in mitigating the effects of the COVID-19 pandemic in low resource settings. This study explored the CSO response to COVID-19 in five of the most heavily impacted LMICs in the Global South. Interviews were conducted from May to August 2021 with a purposive sample of CSO key informants within each of the five countries. A total of 52 CSOs were selected from which 53 key informants were interviewed either via Zoom or by phone. Interviews were coded and analyzed using NVivo or MAXQDA2020. Out of the 52 CSOs selected, 24 were national organizations, 8 were regional, and 20 were local. CSOs fell into six categories: community-based organizations, non-governmental organizations, unions/professional organizations, campaigns/social movements, research organizations/think tanks, and networks/coalitions. CSOs across all five countries adapted their missions, stretched their resources, and performed a wide range of activities that fit into five programmatic areas: food security and livelihood support, public health and medical care, cash transfer programs, risk communication and community education, and needs assessment. This qualitative analysis demonstrates the critical role CSOs played in supplementing government emergency aid response by delivering necessary resources and supporting highly vulnerable populations during the COVID-19 pandemic, as well as the primary challenges they faced in doing so. Given the generally weak state of public capacity in the LMICs studied, this role was vital to responding to the pandemic.

Estimating the economic impact of COVID-19 disruption on access to sexual and reproductive health and rights in Eastern and Southern Africa

Background

The Coronavirus disease 2019 (COVID-19) resulted in the disruption of Sexual and Reproductive Health Rights (SRHR) services in the Eastern and Southern Africa region. To date, studies estimating the impact of COVID-19 disruptions have mainly focused on SRHR services without estimating the economic implication.

Method

We used national service coverage data on the effectiveness of interventions from the lives saved tool (LiST), a mathematical modeling tool that estimates the effects of service coverage change in mortality. We computed years lost due to COVID-19 disruption on SRHR using life expectancy at birth, number of years of life lost due to child mortality, and life expectancy at average maternal death. We calculated the economic value of the lives saved, using the values of statistical life year for each of the countries, comparing 2019 (pre-COVID-19) to 2020 (COVID-19 era).

Findings

The total life-years lost were 1,335,663, with 1,056,174 life-years lost attributed to child mortality and 279,249 linked to maternal mortalities, with high case-fatality rates in the Democratic Republic of Congo, Burundi, and Tanzania. The findings show COVID-19 disruptions on SRHR services between 2019 and 2020 resulted in US$ 3.6 billion losses, with the highest losses in Angola (USD 777 million), South Africa (USD 539 million), and Democratic Republic of Congo (USD 361 million).

Conclusion

The monetized value of disability adjusted life years can be used as evidence for advocacy, increased investment, and appropriate mitigation strategies. Countries should strengthen their health systems functionality, incorporating and transforming lessons learned from shock events.

Impacts of COVID-19 on contraceptive and abortion services in low- and middle-income countries: a scoping review

The COVID-19 pandemic has disproportionate effects on people living in low- and middle-income countries (LMICs), exacerbating weak health systems. We conducted a scoping review to identify, map, and synthesise studies in LMICs that measured the impact of COVID-19 on demand for, provision of, and access to contraceptive and abortion-related services, and reproductive outcomes of these impacts. Using a pre-established protocol, we searched bibliographic databases (December 2019-February 2021) and key grey literature sources (December 2019-April 2021). Of 71 studies included, the majority (61%) were not peer-reviewed, and 42% were based in Africa, 35% in Asia, 17% were multi-region, and 6% were in Latin America and the Caribbean. Most studies were based on data through June 2020. The magnitude of contraceptive service-related impacts varied widely across 55 studies (24 of which also included information on abortion). Nearly all studies assessing changes over time to contraceptive service provision noted declines of varying magnitude, but severe disruptions were relatively uncommon or of limited duration. Twenty-six studies addressed the impacts of COVID-19 on abortion and postabortion care (PAC). Overall, studies found increases in demand, reductions in provision and increases in barriers to accessing these services. The use of abortion services declined, but the use of PAC was more mixed with some studies finding increases compared to pre-COVID-19 levels. The impacts of COVID-19 varied substantially, including the country context, health service, and population studied. Continued monitoring is needed to assess impacts on these key health services, as the COVID-19 pandemic evolves.

Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda

Background

The spread of COVID-19 exposed the inadequacies inherent in the health care systems of many countries. COVID-19 and the attendant demands for emergency treatment and management put a significant strain on countries' health care systems, including hitherto strong health systems. In Uganda, as the government strived to contain COVID-19, other essential health care services were either disrupted or completely crowded out. Balancing the provision of COVID-19 treatment and management services and at the same time offering sexual and reproductive health and rights services (SRHR) proved to be a considerable challenge in these circumstances. COVID-19 prevention-related travel restrictions and border closures had far-reaching negative consequences on the mobility of individuals to access essential health services in Uganda. The situation may have been worse for cross-border communities that sometimes access services across the borders.

Methods

Using quantitative data from 1521 respondents and qualitative data (20 key informant interviews and 12 focus group discussions), we investigate the disruption in accessing SRHR services for border communities in Uganda during COVID-19.

Results

Results indicate that females (adjusted odds ratio (aOR) = 1.3; 95% confidence interval CI = 1.08-1.79), those with primary education (aOR = 1.47; 95% CI = 1.61-2.57), currently employed (aOR = 2.03; 95% CI = 1.61-2.57) and those with the intention to leave current residence (aOR = 2.09; 95% CI = 1.23-3.55) were more likely to have experienced a disruption in accessing SRHR services. However, respondents aged 35 years, or more were less likely to have experienced a disruption compared to their younger counterparts.

Conclusions

Results shed light on the disruption of access toSRHR services during pandemics such as COVID-19 among a highly mobile population. There is a need to invest in building strong and resilient health care systems that can guarantee continuous access to essential health services including SRHR provisions among mobile populations during pandemics.

Protecting HIV service delivery for key populations in southern Africa in the context of the COVID-19 pandemic

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The 2025 UNAIDS targets prioritize reaching all subpopulations living with HIV

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The COVID-19 pandemic has resulted in a setback in terms of confronting HIV

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National HIV control programs must focus on key populations

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Strategies for addressing fundamental structural barriers are proposed

The 2025 UNAIDS targets prioritize reaching all subpopulations living with HIV and those at risk for HIV as the only pathway to achieving control of the HIV epidemic. This has brought to the fore the importance of addressing the needs of key marginalized groups and placing such communities at the center of HIV response strategies. However, the COVID-19 pandemic has resulted in a setback in terms of confronting HIV. With this in mind, it is important not only to protect services within HIV responses among key populations, but also to expand such services to meet the UNAIDS 2025 targets. Without this, gains in controlling COVID-19 may be achieved at the expense of losses in controlling the spread of HIV, which had been achieved after sustained and resource-intensive actions.

Understanding the local and international stakeholders in rheumatic heart disease field in Tanzania and Uganda: A systematic stakeholder mapping

BACKGROUND

Our study aimed to systematically identify RHD stakeholders and categories of stakeholders to consider when developing a scorecard that reflects a broad stakeholder input.

METHOD

We used the Schiller et al.(2013) framework to identify RHD stakeholders and stakeholder categories in Tanzania and Uganda. The process involved identifying stakeholders by searching literature related to incidence, prevalence, morbidity, mortality, health services, or health outcomes of Group A streptococcus, acute rheumatic fever, or rheumatic heart disease in these countries. The strategy was completed for two electronic databases in 2016 and in 2020 to update the results. We also engaged known stakeholders to obtain practice-based insight. We then categorised and visually represented the identified stakeholders.

RESULTS

We identified 139 stakeholders in Uganda, with 68% being from 15 different countries across 31 locations. In comparison, local Ugandan stakeholders were dispersed in six locations across the country. In Tanzania, we identified 128 stakeholders, with 66% being locally based and dispersed in seven locations across the country and stakeholders from different countries were situated in 18 countries across 28 locations. We categorised all identified stakeholders into one or more of five categories 1) Civil Society and General Public, 2) Education Sector, 3) Research, Training and Capacity Building, 4) Healthcare service delivery, and 5) Health Policy and Administration.

CONCLUSION

The stakeholder categories identified include multiple sectors and stakeholders from multiple countries, this reflects the complexities of RHD. This also highlights the need for collaboration and partnership as a critical action for preventing and controlling RHD.

Adolescent Sexual and Reproductive Health During the COVID-19 Pandemic: A Mini Review

This mini review explores the impact of the COVID-19 pandemic on adolescent sexual and reproductive health. We conducted a rapid review of the literature across three databases, with a particular focus on the African continent. Few studies have specifically focused on adolescents in Africa and this paper contributes to this paucity of research. Findings revealed the unintended consequences of the pandemic. Studies across several countries showed that the respective lockdown measures restricted adolescents' access to sexual and reproductive health services. The literature also showed increases in adolescent pregnancies during the lockdown, along with increases in reports of sexual violence against adolescents. We conclude this paper by offering recommendations to address these unintended consequences and potentially improve adolescent sexual and reproductive health in African communities.

Understanding the Sexual and Reproductive Health Experiences of Refugee and Host Community Adolescents and Youth in Rwanda During COVID-19: Needs, Barriers, and Opportunities

Background

COVID-19 has exacerbated the sexual and reproductive health (SRH) needs of those affected by humanitarian emergencies, particularly affecting adolescents and youth, whose needs are often neglected during crises. In Rwanda, the situation for refugees in Mahama Refugee Camp has worsened, as COVID-19 lockdown measures have increased needs while restricting access to basic services. Few assessments have been conducted on the SRH needs of refugees in Mahama camp, including adolescents and youth, since COVID-19. To address this gap, Save the Children (SC) undertook research utilizing SenseMaker to collect data on the SRH needs of adolescents and youth in Mahama camp, as well as in the surrounding host community.

Methodology

SC used SenseMaker to collect 745 data entries from adolescents and youth in Mahama camp and the surrounding host community. The application was pretested with adolescents and youth in Mahama camp before initiating the research. SenseMaker asks participants to share their stories in response to a prompt; our prompt asked participants to describe their experience seeking help with their health during COVID-19. The research team analyzed the data using simultaneous coding to examine key themes. The results were discussed with SC staff to validate the coding analysis results before conducting four focus group discussions to further clarify results and propose action steps in response to the findings.

Results

Many adolescents and youth reported significant difficulties accessing SRH information and services, including stigmatization among service providers. Provider biases and negative attitudes were repeatedly cited as barriers. Stories collected during COVID-19 show how these biases and judgmental attitudes continue to adversely affect access and use of SRH services for young people. Coercive, non-consensual, and transactional sexual incidents were reported from adolescents and youth. They cited reduced time in education spaces as a source of distress as well as increasing their level of sexual activity and associated risks. Limited data exists for SRH needs among adolescents and youth during COVID-19 in humanitarian settings. This study adds to the evidence, making the case for increased SRH prioritization for adolescents and youth in humanitarian settings, particularly when facing overlapping crises like during the COVID-19 pandemic.

Differences in COVID-19 Preventive Behavior and Food Insecurity by HIV Status in Nigeria

The aim of the study was to assess if there were significant differences in the adoption of COVID-19 risk preventive behaviors and experience of food insecurity by people living with and without HIV in Nigeria. This was a cross-sectional study that recruited a convenience sample of 4471 (20.5% HIV positive) adults in Nigeria. Binary logistic regression analysis was conducted to test the associations between the explanatory variable (HIV positive and non-positive status) and the outcome variables-COVID-19 related behavior changes (physical distancing, isolation/quarantine, working remotely) and food insecurity (hungry but did not eat, cut the size of meals/skip meals) controlling for age, sex at birth, COVID-19 status, and medical status of respondents. Significantly fewer people living with HIV (PLWH) reported a positive COVID-19 test result; and had lower odds of practicing COVID-19 risk preventive behaviors. In comparison with those living without HIV, PLWH had higher odds of cutting meal sizes as a food security measure (AOR: 3.18; 95% CI 2.60-3.88) and lower odds of being hungry and not eating (AOR: 0.24; 95% CI 0.20-0.30). In conclusion, associations between HIV status, COVID-19 preventive behaviors and food security are highly complex and warrant further in-depth to unravel the incongruities identified.

Responding to the Essential Sexual and Reproductive Health Needs for Women During the COVID-19 Pandemic: A Literature Review

The pandemic and its consequences have been shown to have a negative impact on the availability and accessibility of the basic services, including sexual and reproductive health (SRH) needs. The aim of this study was to investigate the responses to the essential SRH needs for women during the COVID-19 pandemic. This narrative review was conducted based on the Scale for Assessing Narrative Review Articles (SANRA), in order to present key activities for responding to the important SRH needs of women in the current COVID-19 pandemic. The literature search was performed through English databases of Cochrane Library, PubMed, Scopus and ScienceDirect, as well as Persian databases including Magiran and Scientific Information Database (SID). In addition, the World Health Organization (WHO), the Joint United Nations Programme on HIV and AIDS (UNAIDS) and the reports of Center for Disease Control and Prevention (CDC) were searched. The search was carried out from December 2019 up to 10 January 2021. Essential reproductive healthcare services for women during the COVID-19 pandemic were divided into six categories including access to contraception, safe abortion and post-abortion care, sexual health and sexually transmitted disease (STD) prevention, cervical cancer screening and prevention, maternity services and also addressing violence against women and girls. These essential needs should be considered as a priority by governments as well as public and private stakeholders. It seems that the implementation of the shifted strategies, active participation of public and private stakeholders, consideration of human rights and ethical issues, ensuring access to vulnerable populations, regular contact with individuals and the increased cooperation of individuals for responding to the SRH needs during the COVID-19 outbreak, are necessary.

Adaptation and Resilience: Lessons Learned From Implementing a Combination Health and Education Intervention for Adolescent Girls and Young Women in South Africa During the COVID-19 Pandemic

The COVID-19 pandemic has been associated with reduced access to health services and worsening health outcomes for HIV and sexual and reproductive health (SRH). Through the analysis of data from an evaluation study of a combination intervention for adolescent girls and young women (AGYW) in South Africa, we sought to examine the way in which implementation and service provision were impacted by the COVID-19 pandemic and related restrictions, describing the adaptation implementers made to respond to this context. The intervention was implemented from 2019 in South African districts identified as high priority, given the high rates of HIV and teenage pregnancy amongst AGYW. The South African government introduced the first COVID-19 lockdown in March 2020. We conducted in-depth interviews with 38 intervention implementers in the period from November 2020 to March 2021. Respondents described various ways in which the COVID-19 pandemic and related restrictions had limited their ability to implement the intervention and provide services as planned. As a result, AGYW intervention beneficiary access to SRH and psychosocial services was disrupted. Implementers described several ways in which they attempted to adapt to the pandemic context, such as offering services remotely or door-to-door. Despite attempts to respond to the context and adapt services, overall COVID-19 negatively affected implementation and service provision, and heightened issues around community acceptability of the programs. Our findings can help to inform efforts to reduce health service disruption, increase health system resilience, and ensure continuous SRH service provision to AGYW in times of pandemics and other crises.

Brain drain: An ever-present; significant challenge to the Zimbabwean public health sector

The COVID-19 pandemic has seen developed countries relax immigration procedures for health workers seeking new work opportunities elsewhere. Our letter outlines the risks to the HIV & TB program of health workers' outward migration from Zimbabwe, a country with one of the worst morbidity and mortality rates in the world from these two diseases. We discuss the recent legal changes in immigration to the United Kingdom (UK), which facilitate easier relocation of appropriately trained and experienced health professionals to that country. Additionally, we discuss key issues health workers in Zimbabwe face on a daily basis and why the UK is a naturally fertile ground for their migration.

COVID-19 Vaccine Roll-Out in South Africa and Zimbabwe: Urgent Need to Address Community Preparedness, Fears and Hesitancy

South Africa became one of the first African countries to receive the COVID-19 vaccine. As the rest of Africa prepares to receive COVID-19 vaccines, most countries in Africa have set up national-level coordination committees for developing national vaccination deployment plans. While the main focus of these committees has been on setting up strategies that facilitate the swift distribution of COVID-19 vaccines once they are available, the role of effective public health awareness should not be ignored. Countries must devise strategies on how best to enhance public understanding and curb misinformation about the vaccines. With this viewpoint, we unpack the threat of COVID-19 vaccine hesitancy and offer recommendations for COVID-19 vaccine communication strategies in the South African and Zimbabwean contexts.

The paradox of re-opening schools in Zimbabwe in the COVID-19 era

The easing of COVID-19 restrictions in southern Africa, including Zimbabwe, has seen most countries reopening schools for face-to-face learning. In this letter we discuss the paradox of reopening schools in the COVID-19 era and proffer recommendations for safe learning environments.