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Shanley A, O’Donnell K, Weatherburn P, Gilmore J, Witzel TC. Understanding sexual health service access for gay, bisexual and other men who have sex with men in Ireland during the COVID-19 crisis: Findings from the EMERGE survey. PLoS One 2024; 19:e0306280. [PMID: 38950031 PMCID: PMC11216565 DOI: 10.1371/journal.pone.0306280] [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: 08/30/2023] [Accepted: 06/12/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND In the Republic of Ireland, the COVID-19 crisis led to sexual health service closures while clinical staff were redeployed to the pandemic response. Gay, bisexual and other men who have sex with men (gbMSM) face pre-existing sexual health inequalities which may have been exacerbated. The aim of this study is to understand sexual health service accessibility for gbMSM in Ireland during the COVID-19 crisis. METHODS EMERGE recruited 980 gbMSM in Ireland (June-July 2021) to an anonymous online survey investigating well-being and service access through geo-location sexual networking apps (Grindr/Growlr), social media (Facebook/Instagram/Twitter) and collaborators. We fit multiple regression models reporting odds ratios (ORs) to understand how demographic and behavioural characteristics (age, sexual orientation, HIV testing history/status, region of residence, region of birth and education) were associated with ability to access services. RESULTS Of the respondents, 410 gbMSM accessed sexual health services with some or no difficulty and 176 attempted but were unable to access services during the COVID-19 crisis. A further 382 gbMSM did not attempt to access services and were excluded from this sample and analysis. Baseline: mean age 35.4 years, 88% gay, 83% previously tested for HIV, 69% Dublin-based, 71% born in Ireland and 74% with high level of education. In multiple regression, gbMSM aged 56+ years (aOR = 0.38, 95%CI:0.16, 0.88), not previously tested for HIV (aOR = 0.46, 95%CI:0.23, 0.93) and with medium and low education (aOR = 0.55 95%CI:0.35, 0.85) had lowest odds of successfully accessing services. GbMSM with HIV were most likely to be able to access services successfully (aOR = 2.68 95%CI:1.83, 6.08). Most disrupted services were: STI testing, HIV testing and PrEP. CONCLUSIONS Service access difficulties were found to largely map onto pre-existing sexual health inequalities for gbMSM. Future service development efforts should prioritise (re)engaging older gbMSM, those who have not previously tested for HIV and those without high levels of education.
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Affiliation(s)
| | - Kate O’Donnell
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Peter Weatherburn
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - T. Charles Witzel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- University College London, London, United Kingdom
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Adelekan B, Ikuteyijo L, Goldson E, Abubakar Z, Adepoju O, Oyedun O, Adebayo G, Dasogot A, Mueller U, Fatusi AO. When one door closes: a qualitative exploration of women's experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria. BMC Public Health 2024; 24:1124. [PMID: 38654297 DOI: 10.1186/s12889-023-15848-9] [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: 06/23/2022] [Accepted: 05/08/2023] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources. METHODS The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software. RESULTS Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women's SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies. CONCLUSION COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.
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Affiliation(s)
| | - Lanre Ikuteyijo
- Department of Sociology and Anthropology, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Erika Goldson
- United Nations Population Fund (UNFPA) Country Office, Abuja, Nigeria
| | - Zubaida Abubakar
- United Nations Population Fund (UNFPA) Country Office, Abuja, Nigeria
| | | | - Olaitan Oyedun
- Academy for Health Development (AHEAD), Ile-Ife, Nigeria
| | | | - Andat Dasogot
- United Nations Population Fund (UNFPA) Country Office, Abuja, Nigeria
| | - Ulla Mueller
- United Nations Population Fund (UNFPA) Country Office, Abuja, Nigeria
| | - Adesegun O Fatusi
- Academy for Health Development (AHEAD), Ile-Ife, Nigeria.
- Centre for Adolescent Health and Development, School of Public Health, University of Medical Sciences, Ondo, Nigeria.
- Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
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Begum T, Cullen E, Moffat M, Rankin J. Contraception prescribing in England during the COVID-19 pandemic. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024; 50:76-82. [PMID: 37852734 DOI: 10.1136/bmjsrh-2023-201856] [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: 03/07/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND National lockdowns in England due to COVID-19 resulted in rapid shifts in healthcare provision, including in primary care where most contraceptive prescriptions are issued. This study aimed to investigate contraception prescribing trends in primary care during the pandemic and the impact of socioeconomic deprivation. METHODS Prescribing data were accessed from the English Prescribing Dataset for the first year of the COVID-19 pandemic (1 March 2020-28 February 2021) and the year prior (1 March 2019-29 February 2020). Data were analysed by geographical region (London, Midlands and East of England, North of England, South of England) and contraceptive type (progestogen-only pill (POP), combined oral contraception (COC), emergency hormonal contraception (EHC) and contraceptive injections). Differences in prescribing rates were calculated using Poisson regression. Pearson correlation coefficients were calculated for the Index of Multiple Deprivation (IMD) scores for each Clinical Commissioning Group (CCG) in the North East and North Cumbria (NENC). RESULTS Contraception prescribing rates decreased overall during the COVID-19 pandemic in England (Poisson regression coefficient (β)=-0.035), with a statistically significant (p<0.01) decrease in all four regions. Prescriptions decreased for COC (β=-0.978), contraceptive injections (β=-0.161) and EHC (β=-0.2005), while POP (β=0.050) prescribing rates increased. There was a weak positive correlation between IMD and prescribing rates in NENC (p>0.05). CONCLUSIONS Contraception provision was impacted by COVID-19 with an overall decrease in prescribing rates. The deprivation results suggest that this may not be a significant contributing factor to this decrease. Further research is recommended to better understand these changes, and to ensure that services respond appropriately to population needs.
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Affiliation(s)
- Tanha Begum
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Emer Cullen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Malcolm Moffat
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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McMillan L, Gadsby E, Howell R, Ussher M, Hunt K, Ford A. Understanding the impact of COVID-19 on women's access to and experiences of contraceptive services in England: a qualitative study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2024:bmjsrh-2023-202206. [PMID: 38503471 DOI: 10.1136/bmjsrh-2023-202206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/28/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND The COVID-19 pandemic response prompted rapid changes to how contraceptive services were delivered in England. Our aim was to examine women's experiences of accessing contraceptive services since March 2020 and to understand any inequalities of access. METHODS We conducted telephone interviews with 31 women aged 17-54 years who had accessed contraceptive services in England since March 2020. The sample was skewed to include participants with lower educational attainment and higher deprivation. Interview transcripts were thematically analysed using inductive and deductive approaches. RESULTS Few differences were found regarding educational attainment. Participants using contraceptive injections (all living in areas in the most deprived quintile) reported the greatest access challenges. Some switched method or stopped using contraception as a result. More general barriers reported by participants included service closures, unclear booking processes, and lack of appointment availability. Many participants welcomed the flexibility and convenience of remote contraceptive services. However, telephone appointments posed challenges for those at school or living with parents, and some described them as rushed and inconducive to asking questions or raising concerns. Those accessing contraception for the first time or nearing menopause felt they were unable to access sufficient support and guidance during the pandemic. Some participants voiced concerns around the lasting effects of COVID-19 on appointment availability and inadequate service delivery. CONCLUSIONS Women's experiences of accessing contraceptive services in England since March 2020 are diverse. While remote services were suitable for some, COVID-19 restrictions unequally impacted women depending on their method of contraception and life stage.
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Affiliation(s)
- Lauren McMillan
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Erica Gadsby
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Rebecca Howell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- Population Health Research Institute, St George's University of London, London, UK
| | - Kate Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Allison Ford
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Baxter AJ, Geary RS, Dema E, Bosó Pérez R, Riddell J, Willis M, Conolly A, Oakley LL, Copas AJ, Gibbs J, Bonell C, Sonnenberg P, Mercer CH, Clifton S, Field N, Mitchell K. Contraceptive use and pregnancy planning in Britain during the first year of the COVID-19 pandemic: findings from a large, quasi-representative survey (Natsal-COVID). BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:260-273. [PMID: 36958823 PMCID: PMC10579517 DOI: 10.1136/bmjsrh-2022-201763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Contraceptive services were significantly disrupted during the COVID-19 pandemic in Britain. We investigated contraception-related health inequalities in the first year of the pandemic. METHODS Natsal-COVID Wave 2 surveyed 6658 adults aged 18-59 years between March and April 2021, using quotas and weighting to achieve quasi-representativeness. Our analysis included sexually active participants aged 18-44 years, described as female at birth. We analysed contraception use, contraceptive switching due to the pandemic, contraceptive service access, and pregnancy plannedness. RESULTS Of 1488 participants, 1619 were at risk of unplanned pregnancy, of whom 54.1% (51.0%-57.1%) reported routinely using effective contraception in the past year. Among all participants, 14.3% (12.5%-16.3%) reported switching or stopping contraception due to the pandemic. 3.2% (2.0%-5.1%) of those using effective methods pre-pandemic switched to less effective methods, while 3.8% (2.5%-5.9%) stopped. 29.3% (26.9%-31.8%) of at-risk participants reported seeking contraceptive services, of whom 16.4% (13.0%-20.4%) reported difficulty accessing services. Clinic closures and cancelled appointments were commonly reported pandemic-related reasons for difficulty accessing services. This unmet need was associated with younger age, diverse sexual identities and anxiety symptoms. Of 199 pregnancies, 6.6% (3.9%-11.1%) scored as 'unplanned'; less planning was associated with younger age, lower social grade and unemployment. CONCLUSIONS Just under a third of participants sought contraceptive services during the pandemic and most were successful, indicating resilience and adaptability of service delivery. However, one in six reported an unmet need due to the pandemic. COVID-induced inequalities in service access potentially exacerbated existing reproductive health inequalities. These should be addressed in the post-pandemic period and beyond.
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Affiliation(s)
- Andrew J Baxter
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rebecca S Geary
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Emily Dema
- Institute for Global Health, University College London, London, UK
| | - Raquel Bosó Pérez
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Julie Riddell
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Malachi Willis
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Anne Conolly
- Institute for Global Health, University College London, London, UK
- NatCen Social Research, London, UK
| | - Laura L Oakley
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew J Copas
- Institute for Global Health, University College London, London, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | | | - Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
| | | | - Soazig Clifton
- Institute for Global Health, University College London, London, UK
- NatCen Social Research, London, UK
| | - Nigel Field
- Institute for Global Health, University College London, London, UK
| | - Kirsten Mitchell
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Mitchell KR, Willis M, Dema E, Baxter AJ, Connolly A, Riddell J, Bosó Pérez R, Clifton S, Gibbs J, Tanton C, Geary R, Ratna N, Mohammed H, Unemo M, Bonell C, Copas A, Sonnenberg P, Mercer CH, Field N. Sexual and reproductive health in Britain during the first year of the COVID-19 pandemic: cross-sectional population survey (Natsal-COVID-Wave 2) and national surveillance data. Sex Transm Infect 2023; 99:386-397. [PMID: 36973042 PMCID: PMC10447381 DOI: 10.1136/sextrans-2022-055680] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/03/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES To assess sexual behaviour, and sexual and reproductive health (SRH) outcomes, after 1 year of the COVID-19 pandemic in Britain. METHODS 6658 participants aged 18-59 and resident in Britain completed a cross-sectional web-panel survey (Natsal-COVID-Wave 2, March-April 2021), 1 year after the first lockdown. Natsal-COVID-2 follows the Natsal-COVID-Wave 1 survey (July-August 2020) which captured impacts in the initial months. Quota-based sampling and weighting resulted in a quasi-representative population sample. Data were contextualised with reference to the most recent probability sample population data (Natsal-3; collected 2010-12; 15 162 participants aged 16-74) and national surveillance data on recorded sexually transmitted infection (STI) testing, conceptions, and abortions in England/Wales (2010-2020). The main outcomes were: sexual behaviour; SRH service use; pregnancy, abortion and fertility management; sexual dissatisfaction, distress and difficulties. RESULTS In the year from the first lockdown, over two-thirds of participants reported one or more sexual partners (women 71.8%; men 69.9%), while fewer than 20.0% reported a new partner (women 10.4%; men 16.8%). Median occasions of sex per month was two. Compared with 2010-12 (Natsal-3), we found less sexual risk behaviour (lower reporting of multiple partners, new partners, and new condomless partners), including among younger participants and those reporting same-sex behaviour. One in 10 women reported a pregnancy; pregnancies were fewer than in 2010-12 and less likely to be scored as unplanned. 19.3% of women and 22.8% of men were distressed or worried about their sex life, significantly more than in 2010-12. Compared with surveillance trends from 2010 to 2019, we found lower than expected use of STI-related services and HIV testing, lower levels of chlamydia testing, and fewer conceptions and abortions. CONCLUSIONS Our findings are consistent with significant changes in sexual behaviour, SRH, and service uptake in the year following the first lockdown in Britain. These data are foundational to SRH recovery and policy planning.
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Affiliation(s)
- Kirstin R Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Malachi Willis
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Emily Dema
- Institute for Global Health, University College London, London, UK
| | - Andrew J Baxter
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anne Connolly
- Institute for Global Health, University College London, London, UK
- NatCen Social Research, London, UK
| | - Julie Riddell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Raquel Bosó Pérez
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Soazig Clifton
- Institute for Global Health, University College London, London, UK
- NatCen Social Research, London, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | - Clare Tanton
- Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Geary
- Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Natasha Ratna
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Magnus Unemo
- Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Christopher Bonell
- Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
| | | | - Nigel Field
- Institute for Global Health, University College London, London, UK
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Choo SN, Ong J. ‘Roe’lling with the punches: Telehealth contraception and abortion. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022. [DOI: 10.47102/annals-acadmedsg.2022226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dema E, Sonnenberg P, Gibbs J, Conolly A, Willis M, Riddell J, Bosó Pérez R, Copas AJ, Tanton C, Bonell C, Oeser C, Clifton S, Unemo M, Mercer CH, Mitchell KR, Field N. How did the COVID-19 pandemic affect access to condoms, chlamydia and HIV testing, and cervical cancer screening at a population level in Britain? (Natsal-COVID). Sex Transm Infect 2022; 99:261-267. [PMID: 35981863 DOI: 10.1136/sextrans-2022-055516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/16/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate how differential access to key interventions to reduce STIs, HIV and their sequelae changed during the COVID-19 pandemic. METHODS British participants (18-59 years) completed a cross-sectional web survey 1 year (March-April 2021) after the initial lockdown in Britain. Quota-based sampling and weighting resulted in a quasi-representative population sample. We compared Natsal-COVID data with Natsal-3, a household-based probability sample cross-sectional survey (16-74 years) conducted in 2010-2012. Reported unmet need for condoms because of the pandemic and uptake of chlamydia testing/HIV testing/cervical cancer screening were analysed among sexually experienced participants (18-44 years) (n=3869, Natsal-COVID; n=8551, Natsal-3). ORs adjusted for age and other potential confounders describe associations with demographic and behavioural factors. RESULTS In 2021, 6.9% of women and 16.2% of men reported unmet need for condoms because of the pandemic. This was more likely among participants: aged 18-24 years, of black or black British ethnicity, and reporting same-sex sex (past 5 years) or one or more new relationships (past year). Chlamydia and HIV testing were more commonly reported by younger participants, those reporting condomless sex with new sexual partners and men reporting same-sex partners; a very similar distribution to 10 years previously (Natsal-3). However, there were differences during the pandemic, including stronger associations with chlamydia testing for men reporting same-sex partners; with HIV testing for women reporting new sexual partners and with cervical screening among smokers. CONCLUSIONS Our study suggests differential access to key primary and secondary STI/HIV prevention interventions continued during the first year of the COVID-19 pandemic. However, there was not strong evidence that differential access has changed during the pandemic when compared with 2010-2012. While the pandemic might not have exacerbated inequalities in access to primary and secondary prevention, it is clear that large inequalities persisted, typically among those at greatest STI/HIV risk.
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Affiliation(s)
- Emily Dema
- Institute for Global Health, University College London, London, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London, London, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
| | - Anne Conolly
- Institute for Global Health, University College London, London, UK.,Health and Biomedical Surveys, NatCen Social Research, London, UK
| | - Malachi Willis
- Social and Public Health Sciences Unit, University of Glasgow MRC/CSO, Glasgow, UK
| | - Julie Riddell
- Social and Public Health Sciences Unit, University of Glasgow MRC/CSO, Glasgow, UK
| | - Raquel Bosó Pérez
- Social and Public Health Sciences Unit, University of Glasgow MRC/CSO, Glasgow, UK
| | - Andrew J Copas
- Institute for Global Health, University College London, London, UK
| | - Clare Tanton
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Bonell
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Clarissa Oeser
- Institute for Global Health, University College London, London, UK
| | - Soazig Clifton
- Institute for Global Health, University College London, London, UK.,Health and Biomedical Surveys, NatCen Social Research, London, UK
| | - Magnus Unemo
- Department of Laboratory Medicine, Örebro University Hospital, Orebro, Sweden
| | | | - Kirstin R Mitchell
- Social and Public Health Sciences Unit, University of Glasgow MRC/CSO, Glasgow, UK
| | - Nigel Field
- Institute for Global Health, University College London, London, UK
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