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Min J, Bonett S, Tam V, Makeneni S, Goldstein ND, Wood S. Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19. Am J Prev Med 2024; 67:210-219. [PMID: 38417592 PMCID: PMC11260531 DOI: 10.1016/j.amepre.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Early in the COVID-19 pandemic, routine sexually transmitted infection (STI) screenings decreased, and test positivity rates increased due to limited screening appointments, national-level STI testing supply shortages, and social distancing mandates. It is unclear if adolescent preventive STI screening has returned to pre-pandemic levels and if pre-existing disparities worsened in late-pandemic. METHODS This cross-sectional study examined 22,974 primary care visits by 13-19-year-olds in the Philadelphia metropolitan area undergoing screening for gonorrhea and chlamydia in a 31-clinic pediatric primary care network during 2018-2022. Using interrupted-time-series analysis and logistic regression, pandemic-related changes in the asymptomatic STI screening rate and test positivity were tracked across patient demographics. Neighborhood moderation was investigated by census-tract-level Child Opportunity Index in 2023. RESULTS The asymptomatic STI screening rate dropped by 27.8 percentage points (pp) and 13.5pp when the pandemic and national STI test supply shortage began, respectively, but returned to pre-pandemic levels after supply availability was restored in early 2021. Non-Hispanic-Black adolescents had a significant pandemic drop in STI screening rate, and it did not return to prep-andemic levels (-3.6 pp in the late-pandemic period, p<0.01). This decrease was more pronounced in socioeconomically and educationally disadvantaged neighborhoods (7.5 pp and 9.9 pp lower, respectively) than in advantaged neighborhoods (both p<0.001), controlling for sex, age, insurance type and clinic characteristics. CONCLUSIONS Neighborhood socioeconomic and educational disadvantage amplified racial-ethnic disparities in STI screening during the pandemic. Future interventions should focus on improving primary care utilization of non-Hispanic-Black adolescents to increase routine STI screening and preventive care utilization.
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Affiliation(s)
- Jungwon Min
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Spandana Makeneni
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Neal D Goldstein
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Sarah Wood
- Clinical Futures and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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da Silva TPR, Schreck RSC, de Oliveira DCB, Mascarenhas LV, Luvisaro BMO, Camargo BTS, Martins EF, de Freitas GL, Matozinhos FP. Spatial and trend analysis of gestational syphilis cases in Brazil from 2011 to 2020: an ecological study. BMC Public Health 2024; 24:1859. [PMID: 38992653 PMCID: PMC11241899 DOI: 10.1186/s12889-024-19286-z] [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] [Received: 01/11/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES To analyze the rate of gestational syphilis (GS) based on temporal trends over 11 years, as well as the spatial distribution of GS in Brazil, based on the identification of spatial clusters. METHODOLOGY An ecological, using Brazil and its regions as an analysis unit, based on gestational syphilis data reported in the Notifiable Diseases Information System (SINAN), from 2011 to 2020. Thematic maps were built for spatial data analysis, and the Prais-Winsten autoregressive model was used to verify the trend. Spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of distribution of GS across Brazilian municipalities, using a 5% significance level. RESULTS Gestational syphilis experienced a considerable increase in cases during the studied period, with a peak of 37,436 cases in 2018. The spatial distribution of the disease is heterogeneous in the country. A growing trend was observed in all states of Brazil, except for Espírito Santo, where it remained stationary, with a monthly variation of 10.32%. CONCLUSION The spatial and temporal trend analysis point to syphilis as an important public health problem. The numbers are alarming and show the urgent need for measures to prevent and control syphilis during pregnancy.
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Affiliation(s)
- Thales Philipe Rodrigues da Silva
- Department of Women's Health Nursing, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
- Graduate Nursing Program, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rafaela Siqueira Costa Schreck
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, CEP: 30130-100, Brazil
| | | | | | | | | | - Eunice Francisca Martins
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, CEP: 30130-100, Brazil
| | - Giselle Lima de Freitas
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, CEP: 30130-100, Brazil
| | - Fernanda Penido Matozinhos
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, CEP: 30130-100, Brazil.
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Fenelon HT, Berzkalns A, Amiya RM, Barbee LA, Dombrowski JC, Golden MR, Kerani RP. Sexually Transmitted Infection Partner Services Outcomes Before and During the SARS-CoV-2 Pandemic in King County, WA. Sex Transm Dis 2024; 51:445-451. [PMID: 38403296 DOI: 10.1097/olq.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND SARS-CoV-2 pandemic mitigation efforts resulted in reallocation of public health personnel, likely impacting provision of timely sexually transmitted infection partner services (PS). We describe PS outcomes before and during the pandemic in King County, WA. METHODS We examined PS outcomes for syphilis and gonorrhea cases diagnosed in 2019 and 3 periods in 2020 (pre-lockdown: January 1, 2020-March 23, 2020; lockdown: March 24, 2020-June 5, 2020; post-lockdown: June 6, 2020-December 31, 2020). We described changes over time in 3 PS outcomes: cases initiated, interviewed, and with named sex partners. We calculated adjusted prevalence ratios (aPRs) with Poisson regression comparing these outcomes in the 2020 periods with 2019. RESULTS Reported gonorrhea (4611 vs. 4179) and syphilis (665 vs. 586) cases declined from 2019 to 2020. In 2019, 60.7% of cases were initiated, compared with 42.1% before lockdown (aPR, 0.74; 95% confidence interval [CI], 0.70%-0.78%), 41.7% during lockdown (aPR, 0.79; 95% CI, 0.73-0.85), and 41.7% after lockdown (aPR, 0.81; 95% CI, 0.77-0.85). Among initiated cases, the proportion interviewed also seemed to drop in the 3 lockdown periods (52.4%, 41.0%, 44.1%) compared with 2019 (55.7%). However, in adjusted analyses, the prevalence of interview among case patients was only lower pre-lockdown (aPR, 0.91; 95% CI, 0.85-0.99), and higher during (aPR, 1.10; 95% CI, 1.01-1.20) and after (aPR, 1.12; 95% CI, 1.06-1.19). Interviewed patients named partners more often during (21.4%; aPR, 1.35; 95% CI, 1.05-1.74) and less often after lockdown (16.0%; aPR, 0.63; 95% CI, 0.51-0.79), compared with 2019 (26.6%). CONCLUSIONS These results underscore the need for a trained public health worker reserve, and plans for deployment of existing workers and prioritization of cases to continue essential sexually transmitted infection public health activities during public health crises.
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Loosier PS, Ogale YP, Smith RC, Kachur R, Nicolae L, Heumann C. Sexual Behavior and Sexual Decision-Making Among Gay, Bisexual, and Other Men Who Have Sex with Men During the COVID-19 Pandemic: Observations from a Rapid Ethnographic Assessment in Marion County, Indiana, October-November 2021. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:871-877. [PMID: 38253741 DOI: 10.1007/s10508-023-02795-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
From 2020 to 2021, Marion County, Indiana, USA, saw an increase in early syphilis diagnoses, primarily among gay, bisexual, and other men who have sex with men (GBMSM). This rapid ethnographic assessment combines survey data from GBMSM with data from key informant interviews with multiple groups of stakeholders, including GBMSM, to describe how COVID-19 impacted sexual behaviors, sexual decision-making, and access to sexually transmitted disease (STD) services among GBMSM in Marion County, Indiana. A total of 62 virtual, semi-structured qualitative interviews with 72 key respondents including health department staff, medical providers, community-based organization staff, and GBMSM were conducted from October 14 to November 22, 2021. Modifications to partner-seeking and sexual behaviors attributable to the pandemic were associated with the way in which individuals reacted to the pandemic in general. Some GBMSM adopted mitigation strategies to avoid COVID-19 when meeting sex partners, such as creating a "sex pod." Effects on mental health included increased loneliness, heightened anxiety, and a sense of hopelessness regarding the perceived inevitability of acquiring COVID-19. For some, the latter prompted decreased engagement in preventive measures when engaging in sexual activity. The pandemic decreased access to STD services and significantly curtailed public health outreach efforts, which may have limited access to needed STD treatment and care. Efforts focusing on ongoing public health concerns during extreme health events like COVID-19 may want to consider the many ways these events affect ancillary behaviors, such sexual decision-making and sexual behaviors. The role of mental health is key; messaging and guidance may benefit from a trauma-informed approach.
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Affiliation(s)
- Penny S Loosier
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA.
| | - Yasmin P Ogale
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Clark Smith
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA
| | - Rachel Kachur
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA
| | - Lavinia Nicolae
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA
| | - Christine Heumann
- Marion County Public Health Department, Bell Flower Clinic and STD Control Program, Indianapolis, IN, USA
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
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Jewell M, Jampel SM, Casagrande MG, Ásbjörnsdóttir K, Littman AJ. Self-reported condom use among Washington State residents prior to and during the COVID-19 pandemic: a cross-sectional analysis of BRFSS data. BMJ Open 2023; 13:e075877. [PMID: 38128941 DOI: 10.1136/bmjopen-2023-075877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES COVID-19 significantly impacted healthcare access and sexual behaviour, but little is known about how COVID-19 affected condom use. This study aimed to investigate whether self-reported condom use and sex in Washington State changed during pandemic restrictions compared with prepandemic. DESIGN Cross-sectional survey data from the Behavioral Risk Factor Surveillance System. SETTING Washington State. PARTICIPANTS 11 684 participants aged 18-65. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was changes in the prevalence of condom use by time of interview pre-COVID-19, before the Washington State lockdown (1 January 2019 to 23 March 2020, n=7708) and during COVID-19, after the first state lockdown (24 March 2020 to 31 December 2020, n=3976). The secondary outcome was changes in the prevalence of reported sex during the same periods. We assessed whether associations differed by rurality and HIV risk behaviour. RESULTS Condom use was similar during COVID-19 (37.3%) compared with pre-COVID-19 (37.8%) (adjusted prevalence ratio (PR): 0.98, 95% CI 0.89, 1.01). Associations did not differ by rurality or HIV risk behaviour. Compared with pre-COVID-19 (83.0%), a smaller proportion of respondents reported having sex in the last 12 months during COVID-19 (80.5%), a relative decrease of 3% (PR: 0.97, 95% CI 0.96, 0.99; p<0.001). CONCLUSIONS The prevalence of reported sex declined during COVID-19, but condom use remained steady in Washington. As our reproductive health system faces increased challenges, these results may inform future sexual health services.
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Affiliation(s)
- Mary Jewell
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Sonya M Jampel
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Mary Grace Casagrande
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Kristjana Ásbjörnsdóttir
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
- University of Iceland, Reykjavík, Iceland
| | - Alyson J Littman
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
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Wang X, Ouyang Z, Liu E, Han M. Sexually transmitted infections and associated risk factors among sexual minority women in China. Sci Rep 2023; 13:21583. [PMID: 38062127 PMCID: PMC10703893 DOI: 10.1038/s41598-023-48745-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
There is a potential for transmission of sexually transmitted infections (STIs) within sexual minority women (SMW) in China. However, research specifically focused on STIs among SMW in China is severely limited. This study aims to evaluate the prevalence of STIs and identify associated risk factors among SMW in Beijing, China. This study comprised a baseline assessment followed by a follow-up evaluation. Consistent questionnaire interviews and STI tests were administered during both stages. Participants were recruited online in Beijing between 2020 and 2021 and factors associated with STIs were analyzed using logistic and Cox regression models. The baseline included 219 SMW, and 58.9% (129/219) of these individuals participated in the follow-up. During the baseline assessment, 4.1% (9/219) tested positive for chlamydia infection, while 5.0% (11/219) were HSV-2 seropositive. At the follow-up, the incidence of HSV-2 was 3.7 cases per 100 person-years. Notably, engaging in sexual activity with men and having an increased number of sexual partners were both identified as factors associated with a higher risk of STIs. The findings suggest that SMW in Beijing may face a significant risk of contracting STIs. As a preventive measure, there should be a concerted effort to promote STI testing within the SMW community.
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Affiliation(s)
- Xiaofang Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Zhaohui Ouyang
- Jinsong Community Hospital, Chaoyang District, Beijing, China
| | - Enwu Liu
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Mengjie Han
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China
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Luigi R, Stefania S, Francesca I, Federica R, Fiore BD, Annalisa S, Francesco DG, Eugenio M, Mandorino M, Adriana M, Eleonora S, Carmela DC, Lucia N, Enrica R, Michele M, Maria Teresa M, Raffaele DP. HPV and Covid-19 Era: effects of nonpharmaceutical interventions on HPV transmission. Pathog Glob Health 2023; 117:735-743. [PMID: 37533358 PMCID: PMC10614711 DOI: 10.1080/20477724.2023.2239052] [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: 08/04/2023] Open
Abstract
Human papillomavirus (HPV) is considered the commonest viral cause of sexually transmitted infections. The impact of social distance measures due to Covid-19 pandemic on HPV spread is unknown. Therefore, this study has analyzed the seven-year trend of HPV prevalence in all patients tested for HPV DNA at the Microbiology and Virology Unit at Bari Policlinico. Moreover, the HPV prevalence in 2020 has been compared with the previous year ones in order to evaluate the consequences of lockdown and social distancing measures on transmission risks. From 2013 to 2020, we retrospectively analyzed 64 anal swabs, 418 biopsies, 5925 cervical-vaginal swabs, 512 cervical swabs, 104 gland swabs, 154 oral swabs, 21 seminal fluids and 503 urethral swabs. HPV DNA detection was initially performed using nested-polymerase chain reaction (PCR) and subsequently multiplex real-time PCR assay. All statistical tests were carried out by the open-source environment R 4.0.3 (R Core Team). The data were analyzed according to yearly positivity rates, temporal trend and prevalence of HPV genotypes (HPV-6, HPV-11, HPV-16, HPV-18, high risk and low risk) by age category and sex. The number of patients increased steadily from 2016 to 2019 and then decreased in 2020. There were significant differences in prevalence between females and males for HPV-6 (6.16% in females Vs 30.80% in males), HPV-11 (0.82% Vs 7.16%) and HPV-16 (7.77% Vs 5.01%). The prevalence of HPV-6 and HPV-11 significantly increased in 2020 compared to 2013-2019 (15.72% Vs 8.52 and 3.18% Vs 1.44%). On the contrary, the overall prevalence of HPV DNA remained constant in 2020 (52.84% Vs 48.44%). Over time, the prevalence of HPV DNA (Coefficient=-0.020, p-value = 0.036) and particularly high-risk genotypes (Coefficient=-0.030, p-value = 0.005) decreased in females, while low-risk genotypes (Coefficient = 0.141, p-value= < 0.001) and the prevalence of HPV DNA increased in males (Coefficient = 0.068, p-value = 0.008). During the pandemic, the number of screened patients declined, although HPV prevalence compared to 2013-2019 remained constant or increased as in the case of low-risk genotypes. It can be assumed that the reduction of the screening coverage favored the emerging of the more symptomatic low-risk infections. In conclusion, nonpharmaceutical interventions due to Covid-19 pandemic did not reduce the risk of HPV infection but it likely caused a decrease in access to health services resulting in an increased risk of undiagnosed HPV.
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Affiliation(s)
- Ronga Luigi
- Microbiology and Virology, UOC, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | - Stolfa Stefania
- Microbiology Section, Medicine Interdisciplinary Department, Medicine School, Bari “Aldo Moro” University, Bari, Italy
| | - Indraccolo Francesca
- Microbiology Section, Medicine Interdisciplinary Department, Medicine School, Bari “Aldo Moro” University, Bari, Italy
| | - Romanelli Federica
- Microbiology Section, Medicine Interdisciplinary Department, Medicine School, Bari “Aldo Moro” University, Bari, Italy
| | - Bavaro Davide Fiore
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, Bari “Aldo Moro” University, Bari, Italy
| | - Saracino Annalisa
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, Bari “Aldo Moro” University, Bari, Italy
| | - Di Gennaro Francesco
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, Bari “Aldo Moro” University, Bari, Italy
| | - Milano Eugenio
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, Bari “Aldo Moro” University, Bari, Italy
| | - Manuela Mandorino
- Microbiology Section, Medicine Interdisciplinary Department, Medicine School, Bari “Aldo Moro” University, Bari, Italy
| | - Mosca Adriana
- Microbiology Section, Medicine Interdisciplinary Department, Medicine School, Bari “Aldo Moro” University, Bari, Italy
| | - Sparapano Eleonora
- Microbiology and Virology, UOC, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | - De Carlo Carmela
- Microbiology and Virology, UOC, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | - Nisi Lucia
- Microbiology and Virology, UOC, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | - Ranieri Enrica
- Microbiology Section, Medicine Interdisciplinary Department, Medicine School, Bari “Aldo Moro” University, Bari, Italy
| | - Mastria Michele
- Microbiology Section, Medicine Interdisciplinary Department, Medicine School, Bari “Aldo Moro” University, Bari, Italy
| | - Montagna Maria Teresa
- Hygiene Section, Medicine Interdisciplinary Department, Medicine School, Bari “Aldo Moro” University, Bari, Italy
| | - Del Prete Raffaele
- Microbiology Section, Medicine Interdisciplinary Department, Medicine School, Bari “Aldo Moro” University, Bari, Italy
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Dalmau M, Ware R, Field E, Sanguineti E, Si D, Lambert S. Effect of COVID-19 pandemic restrictions on chlamydia and gonorrhoea notifications and testing in Queensland, Australia: an interrupted time series analysis. Sex Transm Infect 2023; 99:447-454. [PMID: 36823113 DOI: 10.1136/sextrans-2022-055656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To investigate trends in testing and notifications of chlamydia and gonorrhoea during the COVID-19 pandemic in Queensland, Australia. METHODS Statewide disease notification and testing data between 1 January 2015 and 31 December 2021 were modelled using interrupted time series. A segmented regression model estimated the pre-pandemic trend and observed effect of the COVID-19 pandemic response on weekly chlamydia notifications, monthly gonorrhoea notifications and monthly testing figures. The intervention time point was 29 March 2020, when key COVID-19 public health restrictions were introduced. RESULTS There were 158 064 chlamydia and 33 404 gonorrhoea notifications and 2 107 057 combined chlamydia and gonorrhoea tests across the 72-month study period. All three studied outcomes were increasing prior to the COVID-19 pandemic. Immediate declines were observed for all studied outcomes. Directly after COVID-19 restrictions were introduced, declines were observed for all chlamydia notifications (mean decrease 48.4 notifications/week, 95% CI -77.1 to -19.6), gonorrhoea notifications among males (mean decrease 39.1 notifications/month, 95% CI -73.9 to -4.3) and combined testing (mean decrease 4262 tests/month, 95% CI -6646 to -1877). The immediate decline was more pronounced among males for both conditions. By the end of the study period, only monthly gonorrhoea notifications showed a continuing decline (mean decrease 3.3 notifications/month, p<0.001). CONCLUSION There is a difference between the immediate and sustained impact of the COVID-19 pandemic on reported chlamydia and gonorrhoea notifications and testing in Queensland, Australia. This prompts considerations for disease surveillance and management in future pandemics. Possible explanations for our findings are an interruption or change to healthcare services during the pandemic, reduced or changed sexual practices or changed disease transmission patterns due to international travel restrictions. As pandemic priorities shift, STIs remain an important public health priority to be addressed.
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Affiliation(s)
- Marguerite Dalmau
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane, Queensland, Australia
- National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia
| | - Robert Ware
- Menzies Health Institute, Griffith University, Nathan, Queensland, Australia
| | - Emma Field
- National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia
| | - Emma Sanguineti
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane, Queensland, Australia
| | - Damin Si
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane, Queensland, Australia
| | - Stephen Lambert
- Communicable Diseases Branch, Department of Health, Queensland Health, Brisbane, Queensland, Australia
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
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Llata E, Schumacher C, Grigorov I, Danforth B, Pathela P, Asbel L, Nguyen TQ, Berzkalns A, Kreisel KM. Trends in Patient's Use of Sexual Health Services During COVID-19 in a Network of STD Clinics, STD Surveillance Network, 2019 to 2021. Sex Transm Dis 2023; 50:692-698. [PMID: 37255255 PMCID: PMC11201968 DOI: 10.1097/olq.0000000000001837] [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] [Indexed: 06/01/2023]
Abstract
BACKGROUND The initial years of the COVID-19 pandemic disrupted sexual health care clinic's services. We describe use patterns by patient characteristics, and the use of telehealth (TH) services among a network of sexually transmitted disease (STD) clinics. METHODS Data were collected using a survey to assess the impact of COVID-19 from March to December 2020 among 7 jurisdictions who contribute STD visit-level data as part of the STD Surveillance Network. As a complement to the survey, retrospective data from January 2019 to December 2021 from these 7 STD clinics in the same 7 jurisdictions were examined for monthly utilization trends by overall visits, patient characteristics, and TH visits. RESULTS Survey results indicated 7 clinics prioritized patients for in-person visits and 4 jurisdictions reported urgent care centers were the most common referral location. In April 2020 (relative to April 2019) clinic visits and unique patients decreased by 68.0% and 75.8%, respectively. Telehealth were documented in 4 clinics, beginning in March 2020, peaking in December 2020, and tapering until December 2021. We observed the number of clinic visits (-12.2%) and unique patients presenting for care (-27.2%) in December 2021 had yet to return to levels to that seen in December 2019. CONCLUSIONS Sexually transmitted disease clinics showed fragility and resiliency in their adjustment to the pandemic; allowing for the continuation of services. Overall patient census has been slow to return to prepandemic levels, and many patients may still not be seeking timely care. This could result in missed opportunities to screen and treat STIs and increasing the possibility of harmful sequelae.
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Affiliation(s)
- Eloisa Llata
- Centers for Disease Control and Prevention, Surveillance and Data Science Branch, Division of STD Prevention (NCHHSTP)
| | - Christina Schumacher
- Johns Hopkins University School of Medicine and Baltimore City Health Department, Baltimore, MD
| | | | | | - Preeti Pathela
- New York City Department of Health & Mental Hygiene, New York City, NY
| | - Lenore Asbel
- Philadelphia Department of Public Health, Philadelphia, PA
| | | | | | - Kristen M. Kreisel
- Centers for Disease Control and Prevention, Surveillance and Data Science Branch, Division of STD Prevention (NCHHSTP)
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Liu M, Zhou J, Lan Y, Zhang H, Wu M, Zhang X, Leng L, Mi X, Li J. A Neglected Narrative in the COVID-19 Pandemic: Epidemiological and Clinical Impacts of the COVID-19 Outbreak on Syphilis. Clin Cosmet Investig Dermatol 2023; 16:2485-2496. [PMID: 37719933 PMCID: PMC10505047 DOI: 10.2147/ccid.s417522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/11/2023] [Indexed: 09/19/2023]
Abstract
The COVID-19 pandemic has profoundly changed our lives. While healthcare resources were redistributed and mobilized to focus on dealing with the COVID-19 crisis, there have been unmet medical needs of patients with other diseases such as syphilis, weaving an integral but neglected component of the pandemic story. In different countries, the epidemiology of newly reported syphilis underwent diverse changes during the COVID-19 pandemic. Asymptomatic cases experienced the largest decline in number. From the perspective of transmission, on one hand, the implementation of lockdown measures led to a higher degree of abstinence and sex distancing in many countries, thereby reducing the transmission of syphilis. On the other hand, vertical transmission was reported to have increased significantly during COVID-19. Meanwhile, the volume of STI clinic capacity declined, and STI staff were redeployed to facilitate the contact tracing of COVID-19. As a result, many STI centers converted traditional in-person clinical services to telemedicine and self-testing. However, syphilis testing and clinical treatment cannot fully adapt to this conversion. In syphilis diagnosis, COVID-19 infection and vaccination were reported to cause false positivity in syphilis serological tests. Diverse cutaneous manifestations of COVID-19 could resemble the skin lesions in syphilis patients, requiring differential diagnosis from clinicians. As for the post-pandemic years, consequent to service interruptions and diagnosis delays, a surge in the number of confirmed cases of syphilis is expected. The COVID-19 pandemic has also been a meaningful lesson for the control and prevention of infectious diseases. The experience in combating COVID-19 has underscored the importance of maintaining a robust and well-supported medical system for the provision of sexual health services and better healthcare equality even during eras of crisis, not least for syphilis patients.
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Affiliation(s)
- Mingjuan Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- 4+4 M.D. Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Jia Zhou
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Yining Lan
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Mengyin Wu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyi Zhang
- Departments of Internal Medicine and Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Ling Leng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xia Mi
- Department of Dermatology, Strategic Support Force Medical Center, Beijing, People’s Republic of China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
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11
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Manabe YC. The impact of COVID-19 pandemic on technologic and process innovation in point-of-care diagnostics for sexually transmitted infections. Clin Biochem 2023; 117:75-83. [PMID: 34808115 PMCID: PMC8604101 DOI: 10.1016/j.clinbiochem.2021.11.003] [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] [Received: 08/29/2021] [Revised: 09/23/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
The STI diagnostic landscape of FDA cleared tests for use at point-of-care (POC), as well as those emergency use authorized for COVID-19 are reviewed; some of these COVID-19 diagnostics may have platform potential as STI diagnostics. Finally, process innovation is described with self-collection and hub-and-spoke mail-in to reference lab models. Movement of Clinical Laboratory Improvement Amendments (CLIA)-waived POC tests to over-the-counter formats will make tests more accessible to consumers. Together with public health messaging, these measures could accelerate STI and COVID-19 syndemic diagnostic solutions.
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Affiliation(s)
- Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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12
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Manca E, Van der Pol B, Exten C, Pinto CN. A Review of the Scope of Direct-to-Consumer Sexually Transmitted Infection Testing Services Offered on the Internet. Sex Transm Dis 2023; 50:323-328. [PMID: 36807311 DOI: 10.1097/olq.0000000000001783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND The prevalence of sexually transmitted infections (STIs) is at an all-time high. Direct-to-consumer STI testing services may help alleviate this undue health burden. These products are sold online and rarely require interaction with a health care professional (HCP). Vendors offer STI self-collection kits or prescriptions for HCP specimen collection. The objective was to understand the scope of direct-to-consumer STI testing services offered and provide recommendations for consumers and industry. METHODS Seven volunteers searched for "STD tests" on Google from February 1 through March 31, 2021 and shared their top 3 results. The study team extracted data from consumer-facing information on each website. Descriptive statistics and thematic qualitative analyses were performed. RESULTS Twenty vendors were identified. Most vendors (95%) used Clinical Laboratory Improvement Amendments (CLIA)-certified or College of American Pathologists (CAP) accredited laboratories. Analyses distinguished between STI self-collection kits (n = 9) using independent laboratories and HCP specimen collection (n = 10), which used commercial laboratories (n = 1 offered both). The STI self-collection kits were cheaper per test and bundle on average (eg, $79.00 vs. $106.50 for chlamydia/gonorrhea), and more closely aligned with clinical recommendations compared with the HCP specimen collection options. Websites often contained inaccurate or misleading information (n = 13), often promoting testing outside of the recommendations. CONCLUSIONS Direct-to-consumer STI testing services are part of an emerging market lacking regulation. Consumers should select vendors offering prescriptions for HCP specimen collection at CAP accredited and CLIA-certified laboratories. Vendors should provide a screening tool to assess individual patient risk prior to test purchase.
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Affiliation(s)
- Ellie Manca
- From the Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA
| | - Barbara Van der Pol
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Cara Exten
- Ross & Carol Nese College of Nursing, The Pennsylvania State University, Hershey, PA
| | - Casey N Pinto
- From the Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA
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13
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Coen ME, Williford SL, Muvva R, Genberg B, Greenbaum A, Schumacher CM. Characteristics of Reported Gonorrhea Diagnoses During The COVID-19 Pandemic Compared With Pre-COVID-19 Pandemic, Baltimore City, Maryland. Sex Transm Dis 2023; 50:215-223. [PMID: 36473236 PMCID: PMC10009801 DOI: 10.1097/olq.0000000000001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sexual health service disruptions due to COVID-19 mitigation measures may have decreased gonorrhea screening and biased case-ascertainment toward symptomatic individuals. We assessed changes in reported symptoms and other characteristics among reported gonorrhea cases during pandemic versus prepandemic periods in 1 city with persistent gonorrhea transmission. METHODS Enhanced surveillance data collected on a random sample of gonorrhea cases reported to the Baltimore City Health Department between March 2018 and September 2021 was used. Logistic regression assessed differences in case characteristics by diagnosis period (during pandemic: March 2020-September 2021; prepandemic: March 2018-September 2019). RESULTS Analyses included 2750 (1090 during pandemic, 1660 prepandemic) gonorrhea cases, representing 11,904 reported cases. During pandemic versus prepandemic, proportionally fewer cases were reported by sexual health clinics (8.8% vs 23.2%), and more frequently reported by emergency departments/urgent care centers (23.3% vs 11.9%). Adjusting for diagnosing provider, fewer cases who were men with urethral infections (adjusted odds ratio [aOR], 0.65; 95% confidence interval [CI], 0.55-0.77), aged <18 years (aOR, 0.64; 95% CI, 0.47-0.89), and women (aOR, 0.84; 95% CI, 0.71-0.99) were reported, and cases with insurance (aOR, 1.85; 95% CI, 1.40-2.45), living with human immunodeficiency virus (aOR, 1.43; 95% CI, 1.12-1.83), or recent (≤12 months) gonorrhea history (aOR, 1.25; 95% CI, 1.02-1.53) were more frequently reported during pandemic versus prepandemic. Reported symptoms and same-day/empiric treatment did not differ across periods. CONCLUSIONS We observed no changes in reported symptoms among cases diagnosed during pandemic versus prepandemic. Increased frequency of reported diagnoses who were insured, living with human immunodeficiency virus, or with recent gonorrhea history are suggestive of differences in care access and care-seeking behaviors among populations with high gonorrhea transmission during the pandemic.
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Affiliation(s)
- Michelle E. Coen
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sarah L. Williford
- Center for Child and Community Health Research, Johns Hopkins School of Medicine
- Baltimore City Health Department, Baltimore, MD
| | | | - Becky Genberg
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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14
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Wang L, Zhao N, Wang Y, Sun K, Wang Y, Huang S, Yao F, Guo X, Yang Y, Ma C, Liu S. Impact of the COVID-19 pandemic and the dynamic COVID-zero strategy on HIV incidence and mortality in China. BMC Public Health 2023; 23:361. [PMID: 36800946 PMCID: PMC9938685 DOI: 10.1186/s12889-023-15268-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/13/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND In response to the coronavirus disease 2019 (COVID-19) pandemic, the Chinese government implemented the dynamic COVID-zero strategy. We hypothesized that pandemic mitigation measures might have reduced the incidence, mortality rates, and case fatality ratios (CFRs) of the human immunodeficiency virus (HIV) in 2020-2022. METHOD We collected HIV incidence and mortality data from the website of the National Health Commission of the People's Republic of China from January 2015 to December 2022. We compared the observed and predicted HIV values in 2020-2022 with those in 2015-2019 using a two-ratio Z-test. RESULTS From January 1, 2015, to December 31, 2022, a total of 480,747 HIV incident cases were reported in mainland China, of which 60,906 (per year) and 58,739 (per year) were reported in 2015-2019 (pre-COVID-19 stage) and 2020-2022 (post-COVID-19 stage), respectively. The average yearly HIV incidence decreased by 5.2450% (from 4.4143 to 4.1827 per 100,000 people, p < 0.001) in 2020-2022 compared with that in 2015-2019. However, the average yearly HIV mortality rates and CFRs increased by 14.1076 and 20.4238%, respectively (all p < 0.001), in 2020-2022 compared with those in 2015-2019. During the emergency phase in January 2020 to April 2020, the monthly incidence was significantly lower (23.7158%) than that during the corresponding period in 2015-2019, while the incidence during the routine stage in May 2020-December 2022 increased by 27.4334%, (all p < 0.001). The observed incidence and mortality rates for HIV decreased by 16.55 and 18.1052% in 2020, by 25.1274 and 20.2136% in 2021, and by 39.7921 and 31.7535% in 2022, respectively, compared with the predicted values, (all p < 0.001). CONCLUSIONS The findings suggest that China's dynamic COVID-zero strategy may have partly disrupted HIV transmission and further slowed down its growth. Without China's dynamic COVID-zero strategy, HIV incidence and deaths in the country would have likely remained high in 2020-2022. There is an urgent need to expand and improve HIV prevention, care, and treatment, as well as surveillance in the future.
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Affiliation(s)
- Lan Wang
- Department of Geriatrics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Key Laboratory of Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou, 310003, China
| | - Na Zhao
- School of Ecology and Environment, Anhui Normal University, Wuhu, 241002, Anhui Province, China
| | - Yuliang Wang
- Department of Immunology, Basic Medical School, Nanjing Medical University, Nanjing, 211166, China
| | - Kaili Sun
- College of Statistics and Data Science, Faculty of Science, Beijing University of Technology, Beijing, 100124, China
| | - Yike Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510315, Guangdong Province, China
| | - Shufang Huang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510315, Guangdong Province, China
| | - Feng Yao
- Peking University Health Science Center, Beijing, 100191, China
| | - Xiangyu Guo
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Yunmei Yang
- Department of Geriatrics, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
- Key Laboratory of Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou, 310003, China.
| | - Chenjin Ma
- College of Statistics and Data Science, Faculty of Science, Beijing University of Technology, Beijing, 100124, China.
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, Zhejiang Province, China.
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15
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Steiner RJ, Zapata LB, Curtis KM, Whiteman MK, Carvalho Guimarães MA, Fasula AM, Tromble EE, Brittain AW, Nguyen A. Is the COVID-19 Pandemic Continuing to Impact Sexual and Reproductive Health Services for Adolescents? Findings From a 2021 Survey of US Physicians. J Adolesc Health 2023; 72:696-702. [PMID: 36775748 PMCID: PMC9916602 DOI: 10.1016/j.jadohealth.2022.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE We examined the impact of the COVID-19 pandemic in Fall 2021 on sexual and reproductive health (SRH) services among physicians whose practice provided these services to adolescents just before the pandemic. METHODS Data were from the DocStyles online panel survey administered September-November 2021 to US physicians who reported their practice provided SRH services to adolescent patients before the pandemic (n = 948). We calculated prevalence of service delivery challenges (e.g., limited long-acting reversible contraception services) and use of strategies to support access (e.g., telehealth) in the month prior to survey completion, compared these estimates with prevalence "at any point during the COVID-19 pandemic", and examined differences by physician specialty and adolescent patient volume. RESULTS Fewer physicians reported their practice experienced service delivery challenges in the month prior to survey completion than at any point during the pandemic. About 10% indicated limited long-acting reversible contraception and sexually transmitted infection testing services in the prior month overall; prevalence varied by physician specialty (e.g., 26% and 17%, respectively by service, among internists). Overall, about 25% of physicians reported reductions in walk-in hours, weekend/evening hours, and adolescents seeking care in the prior month. While most practices that initiated strategies supporting access to services during the pandemic used such strategies in the prior month, some practices (22%-37% depending on the strategy) did not. DISCUSSION Findings suggest some physicians who serve adolescents continued to experience challenges providing SRH services in the Fall 2021, and some discontinued strategies to support access that had been initiated during the pandemic.
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Affiliation(s)
- Riley J. Steiner
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia,Address correspondence to: Riley J. Steiner, M.P.H., Ph.D., Senior Director, Research and Evaluation, Power to Decide
| | - Lauren B. Zapata
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Kathryn M. Curtis
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Maura K. Whiteman
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | | | - Amy M. Fasula
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Erin E. Tromble
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia
| | - Anna W. Brittain
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Antoinette Nguyen
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
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16
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Goodreau SM, Delaney KP, Zhu W, Smith DK, Mann LM, Sanchez TH, Hamilton DT, Hoover KW. Impacts of COVID-19 on sexual behaviors, HIV prevention and care among men who have sex with men: A comparison of New York City and Metropolitan Atlanta. PLoS One 2023; 18:e0282503. [PMID: 36943832 PMCID: PMC10030006 DOI: 10.1371/journal.pone.0282503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 03/23/2023] Open
Abstract
The COVID-19 pandemic has disrupted HIV prevention, care, and transmission opportunities. This likely varies by geography, given differences in COVID-19 burden and mandates over time, and by age, given different likelihoods of severe COVID-19 consequences. We consider changes in sexual behavior, HIV testing, pre-exposure prophylaxis (PrEP) use and antiretroviral therapy (ART) use among men who have sex with men (MSM) over the first year of the COVID-19 epidemic, comparing the Atlanta metropolitan area and New York City (NYC). We use two continuous time-series datasets and one panel dataset, assessing changes over time within city and comparing across cities, and disaggregate major findings by age. For clinical results, ART use showed by far the smallest reductions, and testing the largest. Disruptions occurred concurrently between cities, despite the major wave of COVID-19, and government mandates, occurring later in Atlanta. Test positivity increased in NYC only. In both cities, younger MSM saw the greatest reductions in testing and PrEP use, but the smallest in sexual behavior. Reduced clinical service usage would be unconcerning if stemming solely from reductions in exposure; however, the patterns for young MSM suggest that the COVID-19 epidemic likely generated new conditions for increased HIV transmission, especially in this cohort.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington, United States of America
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | - Kevin P Delaney
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Weiming Zhu
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dawn K Smith
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura M Mann
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | - Karen W Hoover
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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17
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Pyra M, Schafer T, Rusie L, Houlberg M, Thompson HM, Hazra A. Temporary changes in STI & HIV testing & diagnoses across different phases of the COVID-19 pandemic, Chicago IL. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1072700. [PMID: 37206577 PMCID: PMC10188963 DOI: 10.3389/frph.2023.1072700] [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: 10/17/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction While the U.S. has seen a sustained rise in STI cases over the past decade, the impact of the COVID-19 on STIs and HIV is unclear. Methods To examine the short- and medium-term impacts of COVID-19 and HIV and STI testing and diagnosis, we compared pre-pandemic trends to three periods of the pandemic: early- pandemic, March-May 2020; mid-pandemic June 2020-May 2021; and late-pandemic, June 2021-May 2022. We compared average number of monthly tests and diagnoses, overall and by gender, as well as the monthly change (slope) in testing and diagnoses. Results We find that after decreases in average monthly STI and HIV testing and diagnoses during the early- and mid-pandemic, cases were largely back to pre-pandemic levels by the late-pandemic, with some variation by gender. Conclusion Changes in testing and diagnoses varied by phase of the pandemic. Some key populations may require additional outreach efforts to attain pre-pandemic testing levels.
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Affiliation(s)
- Maria Pyra
- Department of Data, Evaluation, & Epidemiology, Howard Brown Health, Chicago, IL, United States
- Institute for Sexual & Gender Minority Health & Wellbeing, Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Correspondence: Maria Pyra
| | - Tommy Schafer
- Department of Data, Evaluation, & Epidemiology, Howard Brown Health, Chicago, IL, United States
| | - Laura Rusie
- Department of Data, Evaluation, & Epidemiology, Howard Brown Health, Chicago, IL, United States
| | - Magda Houlberg
- Department of Data, Evaluation, & Epidemiology, Howard Brown Health, Chicago, IL, United States
| | - Hale M. Thompson
- Department of Data, Evaluation, & Epidemiology, Howard Brown Health, Chicago, IL, United States
| | - Anu Hazra
- Department of Data, Evaluation, & Epidemiology, Howard Brown Health, Chicago, IL, United States
- Division of Infectious Diseases, Department of Medicine, University of Chicago, Chicago, IL, United States
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18
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Beste LA, Keddem S, Borgerding J, Lowy E, Gardella C, McFarland L, Comstock E, Fonseca GA, Van Epps P, Ohl M, Hauser RG, Ross D, Maier MM. Sexually Transmitted Infection Testing in the National Veterans Health Administration Patient Cohort During the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2022; 9:ofac433. [PMID: 36514443 PMCID: PMC9452156 DOI: 10.1093/ofid/ofac433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background We performed a retrospective study of chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV) testing in the Veterans Health Administration (VHA) during 2019-2021. Methods We determined the annual number of chlamydia, gonorrhea, syphilis, and HIV tests from 2019 through 2021 using electronic health record data. We calculated rates by age, birth sex, race, census region, rurality, HIV status, and use of preexposure prophylaxis. Results The VHA system experienced a 24% drop in chlamydia/gonorrhea testing, a 25% drop in syphilis testing, and a 29% drop in HIV testing in 2020 versus 2019. By the conclusion of 2021, testing rates had recovered to 90% of baseline for chlamydia/gonorrhea, 91% for syphilis, and 88% for HIV. Declines and subsequent improvements in sexually transmitted infection (STI) testing occurred unequally across age, sex, race, and geographic groups. Testing for all 4 STIs in 2021 remained below baseline in rural Veterans. Excluding those aged <25 years, women experienced a steeper decline and slower recovery in chlamydia/gonorrhea testing relative to men, but quicker recovery in HIV testing. Asian Americans and Hawaiian/Pacific Islanders had a steeper decline and a slower recovery in testing for chlamydia/gonorrhea. Black and White Veterans had slower recovery in HIV testing compared with other race groups. People living with HIV experienced a smaller drop in testing for syphilis compared with people without HIV, followed by a near-total recovery of testing by 2021. Conclusions After dramatic reductions from 2019 to 2020, STI testing rates returned to near-baseline in 2021. Testing recovery lagged in rural, female, Asian American, Hawaiian/Pacific Islander, and Black Veterans.
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Affiliation(s)
- Lauren A Beste
- Correspondence: Lauren A. Beste, MD, MSc, VA Puget Sound Health Care System,1660 S Columbian Way, Seattle, WA 98108 ()
| | - Shimrit Keddem
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joleen Borgerding
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | - Elliott Lowy
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Carolyn Gardella
- Gynecology Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lorenzo McFarland
- Office of Specialty Care Services, Veterans Health Administration, Washington, District of Columbia, USA
| | - Emily Comstock
- Department of Infectious Diseases, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Giuseppe Allan Fonseca
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Puja Van Epps
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Veterans Affairs Northeast Ohio Healthcare System,Cleveland, Ohio, USA
| | - Michael Ohl
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs, Iowa City, Iowa, USA
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ronald G Hauser
- Pathology and Laboratory Medicine Department, Veterans Affairs Connecticut Healthcare, New Haven, Connecticut, USA
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Ross
- Office of Specialty Care Services, Veterans Health Administration, Washington, District of Columbia, USA
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19
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Chang JJ, Chen Q, Dionne-Odom J, Hechter RC, Bruxvoort KJ. Changes in Testing and Diagnoses of Sexually Transmitted Infections and HIV During the COVID-19 Pandemic. Sex Transm Dis 2022; 49:851-854. [PMID: 35470350 PMCID: PMC9668362 DOI: 10.1097/olq.0000000000001639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/16/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT We evaluated changes in rates of testing and diagnoses of sexually transmitted infections during the 2017-2020 period at Kaiser Permanente Southern California. During the COVID-19 pandemic period, we observed profound reductions in testing and fewer diagnoses of chlamydia, gonorrhea, and HIV compared with prepandemic periods, but syphilis diagnoses rates increased by 32%.
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Affiliation(s)
- Jennifer J. Chang
- From the Department of Infectious Diseases, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles
| | - Qiaoling Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jodie Dionne-Odom
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Rulin C. Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Katia J. Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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20
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Bonett S, Teixeira da Silva D, Lazar N, Makeneni S, Wood S. Trends in sexually transmitted infection screening during COVID-19 and missed cases among adolescents. Public Health 2022; 213:171-176. [PMID: 36423495 PMCID: PMC9576220 DOI: 10.1016/j.puhe.2022.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The COVID-19 pandemic disrupted sexual health services for young people, with potential consequences of decreasing preventive screening and increasing undiagnosed sexually transmitted infections (STIs). This study aimed to assess trends in asymptomatic screening among patients receiving STI testing and to estimate the number of STI cases that were missed during the early months of the pandemic. STUDY DESIGN A cross-sectional study of electronic health records for chlamydia, gonorrhea, and trichomonas testing encounters from six pediatric primary care clinics in Philadelphia, July 2014 to November 2020. METHODS A total of 35,548 testing encounters were analyzed, including 2958 during the pandemic. We assessed whether testing at each encounter was performed as asymptomatic screening, risk-based testing, or symptomatic testing. We evaluated screening trends over time and estimated the number of missed STI cases during the pandemic. RESULTS The mean monthly testing encounters decreased from 479 per month prepandemic to 329 per month during the pandemic. The percent of tests performed as asymptomatic screening dropped from 72.5% prepandemic to a nadir of 54.5% in April 2020. We estimate that this decrease in asymptomatic screening would represent 159 missed cases (23.8% of expected cases) based on patient volume from the previous year. CONCLUSIONS During the pandemic, the total volume of STI testing encounters and the proportion of tests performed as asymptomatic screening decreased, potentially resulting in missed diagnoses. Undiagnosed STIs can result in severe sequelae and contribute to community transmission of STIs. Efforts are needed to re-establish and sustain access to STI services for adolescents in response to disruptions caused by the pandemic.
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Affiliation(s)
- S. Bonett
- School of Nursing, University of Pennsylvania, USA,Corresponding author. School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA. Tel.: +215-573-4299
| | | | - N. Lazar
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA
| | - S. Makeneni
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - S.M. Wood
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA,PolicyLab, Children's Hospital of Philadelphia, USA
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21
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Rezaeian A, Ahmadi Pishkuhi M, Oliveira Reis L, Aghamir SMK. Sexuality Transmitted Infection in the COVID-19 Pandemic and Non-Pandemic Time. Am J Mens Health 2022; 16:15579883221134900. [PMID: 36412243 PMCID: PMC9692181 DOI: 10.1177/15579883221134900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
On March 11, 2020, the World Health Organization recognized the SARS-CoV-2 infection as a pandemic. The pandemic itself in addition to its containment measures affects individuals' lifestyles and welfare including their sexual behaviors. Thus, we hypothesized that sexually transmitted infection (STI) incidence may be changed and so we evaluate urethritis incidence as the most common STI in men and some other related factors. Two cross-sectional surveys during the first 6 months of 2019 and 2020 were undertaken and data were collected from 11 urology offices located in different parts of the capital city. In total, 34,611 male participants were included in our study, and 191 (.55%) patients' clinical diagnoses were urethritis. The urethritis incidence significantly decreased from 149 of 17,950 (.83%) to 42 of 16,661 (.25%) individuals in the same period of the years 2019 and 2020, respectively (p-value < .001). There was a higher percentage of single (p-value = .049) and older (p-value < .001) urethritis patients in the first 6 months of the year 2020 compared with 2019. Our survey provided urethritis incidence, demographics, symptoms, and treatment characterization. As our results show, the proportion of urethritis patients in all populations admitted to urologist offices had dramatically decreased during the COVID-19 pandemic compared with prior. The indirect effects of the pandemic and its containment measures on people's sexual health should be noticed and an appropriate reaction and policy-making are recommended to manage issues properly in different aspects of sexual health.
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Affiliation(s)
- AhmadReza Rezaeian
- Faculty of Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
- Urology Research Center, Tehran
University of Medical Sciences, Tehran, Iran
| | - Mahin Ahmadi Pishkuhi
- Urology Research Center, Tehran
University of Medical Sciences, Tehran, Iran
- Pars Advanced & Minimally Invasive
Medical Manners Research Center, Pars General Hospital, Iran University of Medical
Sciences, Tehran, Iran
| | - Leonardo Oliveira Reis
- UroScience and Department of Surgery
(Urology), School of Medical Sciences, University of Campinas, Unicamp, and
Pontifical Catholic University of Campinas (PUC-Campinas), Campinas, Brazil
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22
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Muacevic A, Adler JR, Holland-Hall C, Bonny AE. Impact of Early Stages of the COVID-19 Pandemic on Sexually Transmitted Infection Screening Claims Among Adolescent Females in a Pediatric Accountable Care Organization in Ohio, United States. Cureus 2022; 14:e32070. [PMID: 36600869 PMCID: PMC9803362 DOI: 10.7759/cureus.32070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Testing for sexually transmitted infections (STIs) decreased during the early months of the coronavirus disease 2019 (COVID-19) pandemic. Less is known about the extent to which screening of asymptomatic adolescents for STIs was specifically affected. Our aim was to describe the impacts of early stages of the COVID-19 pandemic on asymptomatic STI screening and overall STI testing among adolescent females aged 13 to 19. We hypothesized that screening would decrease more than overall testing. Methods We evaluated claims data from a pediatric accountable care organization responsible for approximately 40,000 adolescent females. We assessed rates of asymptomatic screening and overall testing for chlamydia and gonorrhea in this population, comparing the early pandemic to pre-pandemic levels. Results Both STI screening and overall STI testing were found to be significantly decreased during the early period of the COVID-19 pandemic compared to pre-pandemic levels. The proportion of tests billed as screening was 70% of tests for April to August 2020 (early pandemic), compared to 67% for October 2019 to February 2020 and 64% for April to August 2019, contrary to our hypothesis. Conclusion Asymptomatic screening represented a similar proportion of STI testing among this population of adolescent females during the early COVID-19 pandemic compared to pre-pandemic testing. More work is needed to understand how asymptomatic screening was proportionally maintained despite COVID-19 pandemic restrictions.
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23
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Nyitray AG, Quinn KG, John SA, Walsh JL, Schim van der Loeff MF, Wu R, Eastwood D, McAuliffe TL. Sexually Transmitted Infections Diagnosed Among Sexual and Gender Minority Communities During the First 11 Months of the COVID-19 Pandemic in Midwest and Southern Cities in the United States. Sex Transm Dis 2022; 49:687-694. [PMID: 35858473 PMCID: PMC9477706 DOI: 10.1097/olq.0000000000001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected sexual health services. Given the burden of sexually transmitted infections (STIs) on sexual and gender minorities (SGMs), we estimated incidence of self-reported STI diagnoses and factors associated with STI diagnoses among SGMs during the pandemic's first year. METHODS A cohort of 426 SGM persons, 25 years or older, recruited in Chicago, Milwaukee, Detroit, Minneapolis, and Houston completed 5 online surveys from April 2020 to February 2021. Persons self-reported on each survey all health care provider STI diagnoses. Kaplan-Meier was used to estimate the cumulative risk of STI diagnoses, stratified by human immunodeficiency virus (HIV) status. Factors associated with STI diagnoses were assessed with a longitudinal negative binomial regression. RESULTS Median age was 37 years, and 27.0% were persons living with HIV (PLH). Participants reported 63 STIs for a cumulative incidence for PLH and HIV-negative persons of 0.19 (95% confidence interval [CI], 0.13-0.29) and 0.12 (95% CI, 0.09-0.17), respectively. Regardless of HIV, a younger age and changes in health care use were associated with STI diagnoses. Among HIV-negative persons, the rate of STI diagnoses was higher in Houston than the Midwest cities (adjusted relative risk, 2.37; 95% CI, 1.08-5.20). Among PLH, a decrease in health care use was also associated with STI diagnoses (adjusted relative risk, 3.53; 95% CI, 1.01-12.32 vs no change in health care services), as was Hispanic ethnicity and using a dating app to meet a sex partner. CONCLUSIONS Factors associated with STI diagnoses during the COVID-19 pandemic generally reflected factors associated with STI incidence before the pandemic like geography, HIV, age, and ethnicity.
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Affiliation(s)
- Alan G. Nyitray
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Katherine G. Quinn
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
| | - Steven A. John
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
| | - Jennifer L. Walsh
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
| | - Maarten F. Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam Institute for Infection and Immunity
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ruizhe Wu
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Daniel Eastwood
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy L. McAuliffe
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
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24
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Schumacher CM, Thornton N, Wagner J, Tilchin C, Ghanem KG, Hamill MM, Latkin C, Rompalo A, Ruhs S, Greenbaum A, Jennings JM. Sexually Transmitted Infection Transmission Dynamics During the Coronavirus Disease 2019 (COVID-19) Pandemic Among Urban Gay, Bisexual, and Other Men Who Have Sex With Men. Clin Infect Dis 2022; 75:e1137-e1144. [PMID: 35169833 PMCID: PMC8903324 DOI: 10.1093/cid/ciab1053] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) mitigation measures on sexually transmitted infection (STI) transmission and racial disparities remains unknown. Our objectives were to compare sex and drug risk behaviors, access to sexual health services, and STI positivity overall and by race during the COVID-19 pandemic compared with pre-pandemic among urban sexual minority men (MSM). METHODS Sexually active MSM aged 18-45 years were administered a behavioral survey and STI testing every 3-months. Participants who completed at least 1 during-pandemic (April 2020-December 2020) and 1 pre-pandemic study visit (before 13 March 2020) that occurred less than 6 months apart were included. Regression models were used to compare during- and pre-pandemic visit outcomes. RESULTS Overall, among 231 MSM, reports of more than 3 sex partners declined(pandemic-1: adjusted prevalence ratio 0.68; 95% confidence interval: .54-.86; pandemic-2: 0.65, .51-.84; pandemic-3: 0.57, .43-.75), substance use decreased (pandemic-1: 0.75, .61-.75; pandemic-2: 0.62, .50-.78; pandemic-3: 0.61, .47-.80), and human immunodeficiency virus/preexposure prophylaxis care engagement (pandemic-1: 1.20, 1.07-1.34; pandemic-2: 1.24, 1.11-1.39; pandemic-3: 1.30, 1.16-1.47) increased. STI testing decreased (pandemic-1: 0.68, .57-.81; pandemic-2: 0.78, .67-.92), then rebounded (pandemic-3: 1.01, .87-1.18). Nei-ther Chlamydia (pandemic-2: 1.62, .75-3.46; pandemic-3: 1.13, .24-1.27) nor gonorrhea (pandemic-2: 0.87, .46 1.62; pandemic-3: 0.56, .24-1.27) positivity significantly changed during vs pre-pandemic. Trends were mostly similar among Black vs. non-Black MSM. CONCLUSIONS We observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared with pre-pandemic. Our findings underscore the need for novel STI prevention strategies that can be delivered without in-person interactions.
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Affiliation(s)
- Christina M Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicole Thornton
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jessica Wagner
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Carla Tilchin
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Matthew M Hamill
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- STI/HIV Program, Baltimore City Health Department, Baltimore, Maryland, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne Rompalo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Adena Greenbaum
- STI/HIV Program, Baltimore City Health Department, Baltimore, Maryland, USA
| | - Jacky M Jennings
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Chase Brexton Health Services, Baltimore, Maryland, USA
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25
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Liu H, Yao Q, Li D, Zhao Z, Li Y. Impact of COVID-19 Outbreak on the Gynecological Outpatients HPV Infection Rate in Wuhan, China: A Retrospective Observational Study. Front Med (Lausanne) 2022; 9:799736. [PMID: 35479933 PMCID: PMC9035827 DOI: 10.3389/fmed.2022.799736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background The recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has caused millions of deaths and greatly influenced the timely diagnosis and treatment of other diseases. Throughout the pandemic, there was a dramatic reduction in the prevalence of several sexually transmitted infections. However, the impact of the ongoing pandemic on human papillomavirus (HPV) infection rates has not been investigated thus far. Materials and Methods We retrospectively collected data regarding HPV and cervical cancer screening results of outpatients from gynecological clinics of a tertiary hospital from 1 December 2018 to 31 December 2020 in Wuhan. Based on the timeline of the SARS-CoV-2 pandemic in Wuhan, we divided this period into four relatively independent stages to compare the HPV screening visit numbers and infection rates. Results There was a 50% drop in HPV screening visits and a 10% drop in HPV infection rates throughout the pandemic when compared with the numbers collected before the pandemic. Strict lockdown measures greatly decreased the HPV infection rate (17.03 vs. 8.29, P = 0.003). During the pandemic, the most prevalent HPV genotypes were HPV 16, 52, 58, and 53. After the pandemic, the HPV infection rate recovered quickly, but it was still slightly lower than the infection rate found before the outbreak (23.3 vs. 21.2%). Conclusion During coronavirus disease 2019 (COVID-19) pandemic, cervical cancer screening visits and HPV infection rates have decreased dramatically. The HPV transmission has also decreased after strict lockdown. Effective HPV and cervical cancer screening programs should be strengthened immediately to reduce the transmission of HPV during and after the pandemic.
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Affiliation(s)
- Hang Liu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Yao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Di Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhiming Zhao
- Department of Geratology, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Zhiming Zhao
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
- Yan Li
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26
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Yan X, Wang X, Zhang X, Wang L, Zhang B, Jia Z. The Epidemic of Sexually Transmitted Diseases Under the Influence of COVID-19 in China. Front Public Health 2022; 9:737817. [PMID: 34976912 PMCID: PMC8716580 DOI: 10.3389/fpubh.2021.737817] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/15/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Prevention and control of HIV/AIDS and other sexually transmitted diseases (STDs) are major public health priorities in China, but are influenced by the COVID-19 epidemic. In this study, we aimed to quantitatively explore the impact of the COVID-19 epidemic and its control measures on five major STD epidemics in China. Methods: A monthly number of newly reported cases of HIV/AIDS, hepatitis B and C, gonorrhea, and syphilis from January 2010 to December 2020 were extracted to establish autoregressive integrated moving average (ARIMA) models. Each month's absolute percentage error (APE) between the actual value and model-predicted value of each STD in 2020 was calculated to evaluate the influence of the COVID-19 epidemic on the STDs. Pearson correlation analysis was conducted to explore the confirmed COVID-19 case numbers and the COVID-19 control measures' correlations with the case numbers and the APEs of five STDs in 2020. Results: The actual number of five STDs in China was more than 50% lower than the predicted number in the early days of the COVID-19 epidemic, especially in February. Among them, the actual number of cases of hepatitis C, gonorrhea, and syphilis in February 2020 was more than 100% lower than the predicted number (APE was −102.3, −109.0, and −100.4%, respectively). After the sharply declines of STDs' reported cases in early 2020, the case numbers recovered quickly after March. The epidemic of STDs was negatively associated with the COVID-19 epidemic and its control measures, especially for restrictions on gathering size, close public transport, and stay-at-home requirements (p < 0.05). Conclusion: COVID-19 had a significant but temporary influence on the STD epidemic in China. The effective control of COVID-19 is vital for STD prevention. STD services need to be improved to prevent STDs from becoming a secluded corner in the shadow of COVID-19.
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Affiliation(s)
- Xiangyu Yan
- School of Public Health, Peking University, Beijing, China
| | - Xuechun Wang
- School of Public Health, Peking University, Beijing, China
| | - Xiangyu Zhang
- School of Public Health, Peking University, Beijing, China
| | - Lei Wang
- Taiyuan Center for Disease Control and Prevention, Taiyuan, China
| | - Bo Zhang
- School of Public Health, Peking University, Beijing, China
| | - Zhongwei Jia
- School of Public Health, Peking University, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China.,Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China
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27
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Ronga L, Stolfa S, Romanelli F, Bavaro DF, Saracino A, Mosca A, Sparapano E, De Carlo C, Montagna MT, Diella G, Nisi L, Del Prete R. Trend of sexually transmitted infections during the Covid-19 age. What was the impact of the pandemic and the social distancing measures? J Eur Acad Dermatol Venereol 2021; 36:e190-e192. [PMID: 34862991 DOI: 10.1111/jdv.17853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- L Ronga
- UOC Microbiologia e Virologia, Azienda Ospedaliero-Universitaria, Bari, Italy
| | - S Stolfa
- Section of Microbiology, Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - F Romanelli
- Section of Microbiology, Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - D F Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - A Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - A Mosca
- UOC Microbiologia e Virologia, Azienda Ospedaliero-Universitaria, Bari, Italy.,Section of Microbiology, Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - E Sparapano
- UOC Microbiologia e Virologia, Azienda Ospedaliero-Universitaria, Bari, Italy
| | - C De Carlo
- UOC Microbiologia e Virologia, Azienda Ospedaliero-Universitaria, Bari, Italy
| | - M T Montagna
- Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - G Diella
- Hygiene Section, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - L Nisi
- Section of Microbiology, Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - R Del Prete
- UOC Microbiologia e Virologia, Azienda Ospedaliero-Universitaria, Bari, Italy.,Section of Microbiology, Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
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28
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Pagaoa M, Grey J, Torrone E, Kreisel K, Stenger M, Weinstock H. Trends in Nationally Notifiable Sexually Transmitted Disease Case Reports During the US COVID-19 Pandemic, January to December 2020. Sex Transm Dis 2021; 48:798-804. [PMID: 34224523 PMCID: PMC8459909 DOI: 10.1097/olq.0000000000001506] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To describe changes in reported sexually transmitted diseases (STDs) during the US coronavirus disease 2019 pandemic, we compared the weekly number of reported nationally notifiable STDs in 2020 to 2019. METHODS We reviewed cases of chlamydia, gonorrhea, and primary and secondary (P&S) syphilis reported to the US National Notifiable Disease Surveillance System in 2020. For each STD, we compare the number of 2020 cases reported for a given Morbidity and Mortality Weekly Report (MMWR) week to the number of 2019 cases reported in the same week, expressing 2020 cases as a percentage of 2019 cases. We also calculated the percent difference between 2020 and 2019 cumulative case totals as of MMWR week 50 (week of December 9). RESULTS During MMWR weeks 1 to 11 (week of December 29, 2019-March 11, 2020), the weekly number of cases of STDs reported in 2020 as a percentage of the cases in the same week in 2019 was similar. However, 2020 numbers were much lower than 2019 numbers in week 15 (week of April 8; chlamydia, 49.8%; gonorrhea, 71.2%; and P&S syphilis, 63.7%). As of week 50, the 2020 cumulative totals compared with 2019 were 14.0% lower for chlamydia, 7.1% higher for gonorrhea, and 0.9% lower for P&S syphilis. CONCLUSIONS During March-April 2020, national case reporting for STDs dramatically decreased compared with 2019. However, resurgence in reported gonorrhea and syphilis cases later in the year suggests STD reporting may have increased in 2020, underscoring the importance of continued STD prevention and care activities.
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29
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Sentís A, Prats-Uribe A, López-Corbeto E, Montoro-Fernandez M, Nomah DK, de Olalla PG, Mercuriali L, Borrell N, Guadalupe-Fernández V, Reyes-Urueña J, Casabona J. The impact of the COVID-19 pandemic on Sexually Transmitted Infections surveillance data: incidence drop or artefact? BMC Public Health 2021; 21:1637. [PMID: 34493244 PMCID: PMC8423330 DOI: 10.1186/s12889-021-11630-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 08/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Before the COVID-19 pandemic, Sexually transmitted infections (STIs) were increasing in Europe, and Spain and Catalonia were not an exception. Catalonia has been one of the regions with the highest number of COVID-19 confirmed cases in Spain. The objective of this study was to estimate the magnitude of the decline, due to the COVID-19 pandemic, in the number of STI confirmed cases in Catalonia during the lockdown and de-escalation phases. METHODS Interrupted time series analysis was performed to estimate the magnitude of decline in the number of STI reported confirmed cases - chlamydia, gonorrhoea, syphilis, and lymphogranuloma venereum- in Catalonia since lockdown with historical data, from March 13th to August 1st 2020, comparing the observed with the expected values. RESULTS We found that since the start of COVID-19 pandemic the number of STI reported cases was 51% less than expected, reaching an average of 56% during lockdown (50% and 45% during de-escalation and new normality) with a maximum decrease of 72% for chlamydia and minimum of 22% for syphilis. Our results indicate that fewer STIs were reported in females, people living in more deprived areas, people with no previous STI episodes during the last three years, and in the HIV negative. CONCLUSIONS The STI notification sharp decline was maintained almost five months after lockdown started, well into the new normality. This fact can hardly be explained without significant underdiagnosis and underreporting. There is an urgent need to strengthen STI/HIV diagnostic programs and services, as well as surveillance, as the pandemic could be concealing the real size of the already described re-emergence of STIs in most of the European countries.
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Affiliation(s)
- Alexis Sentís
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalonia (CEEISCAT). Department of Health. Generalitat of Catalonia, Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
- Epiconcept, Epidemiology Department, Paris, France
| | - Albert Prats-Uribe
- Centre for Statistics in Medicine, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Evelin López-Corbeto
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalonia (CEEISCAT). Department of Health. Generalitat of Catalonia, Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marcos Montoro-Fernandez
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalonia (CEEISCAT). Department of Health. Generalitat of Catalonia, Badalona, Spain
| | - Daniel Kwakye Nomah
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalonia (CEEISCAT). Department of Health. Generalitat of Catalonia, Badalona, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autónoma de Barcelona, Badalona, Spain
| | - Patrícia Garcia de Olalla
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiological Service of Public Health Agency of Barcelona, Barcelona, Spain
| | - Lilas Mercuriali
- Epidemiological Service of Public Health Agency of Barcelona, Barcelona, Spain
| | - Núria Borrell
- Epidemiological Surveillance and Response to Public Health Emergencies Service in Tarragona Camp, Agency of Public Health of Catalonia, Generalitat of Catalonia, Tarragona, Spain
| | - Víctor Guadalupe-Fernández
- Epidemiological Surveillance and Response to Public Health Emergencies Service in Central Catalonia, Agency of Public Health of Catalonia, Generalitat of Catalonia, Manresa, Spain
| | - Juliana Reyes-Urueña
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalonia (CEEISCAT). Department of Health. Generalitat of Catalonia, Badalona, Spain.
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
| | - Jordi Casabona
- Centre of epidemiological studies on sexually transmitted infections and AIDS of Catalonia (CEEISCAT). Department of Health. Generalitat of Catalonia, Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine, Universitat Autónoma de Barcelona, Badalona, Spain
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Raphael BH, Haderxhanaj L, Bowen VB. 2020 STD Prevention Conference: Disrupting Epidemics and Dismantling Disparities in the Time of COVID-19. Sex Transm Dis 2021; 48:S1-S3. [PMID: 33967234 DOI: 10.1097/olq.0000000000001448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Brian H Raphael
- From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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