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Spence T, Howarth A, Reid D, Sheringham J, Apea V, Crundwell D, Day S, Dewsnap C, Jackson L, Mercer CH, Mohammed H, Ross JDC, Sullivan A, Williams A, Winter A, Wong G, Burns F, Gibbs J. How does online postal self-sampling (OPSS) shape access to testing for sexually transmitted infections (STIs)? A qualitative study of service users. BMC Public Health 2024; 24:2339. [PMID: 39198751 PMCID: PMC11360737 DOI: 10.1186/s12889-024-19741-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/09/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a serious public health issue in many countries. Online postal self-sampling (OPSS) is increasingly used to test for STIs, a trend accelerated by the COVID-19 pandemic. There remains limited understanding of how service users experience OPSS and what leads them to access it over clinic-based services, or vice versa. This research seeks to address these gaps, by undertaking a large qualitative study which sits within the ASSIST study, a mixed-methods, realist evaluation of OPSS. METHODS Participants were recruited via clinic-based and online sexual health services in three case study areas in England. Purposive sampling was used to over-represent populations disproportionately affected by poor sexual health: young people; people of colour; men who have sex with men; and trans and non-binary people. Semi-structured interviews were analysed using Levesque's conceptual framework of access to healthcare. RESULTS We interviewed 100 service users. Participants typically became aware of OPSS from sexual health services, the internet or word of mouth. Acceptability of OPSS was facilitated by the perceived privacy it offered over clinic-based services, which some participants found embarrassing to access. OPSS also enabled participants to overcome barriers to reaching clinic-based services, such as a lack of appointment availability, although difficulty obtaining OPSS kits in some areas undermined this. As all services in our case study areas were free to use, affordability did not significantly shape access, although OPSS enabled some participants to avoid costs associated with travelling to clinic-based services. Participants were usually able to engage with OPSS, finding it easy to use and reliable, although blood self-sampling was challenging for most. Participants valued the support offered by clinic-based services beyond STI testing, including the opportunity to access contraception or ask staff questions, and felt this was more appropriate when they had specific concerns about their sexual health, such as STI symptoms. CONCLUSIONS Our findings constitute one of the largest qualitative studies to have explored OPSS and offer valuable insights to providers. OPSS shapes access to STI testing in a number of ways, including facilitating access in many circumstances, but users also want to retain access to clinic-based services, particularly for when they believe they need support beyond STI testing.
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Affiliation(s)
- Tommer Spence
- Institute of Epidemiology and Health Care, University College London, London, UK.
| | - Alison Howarth
- Institute for Global Health, University College London, London, UK
| | - David Reid
- Institute for Global Health, University College London, London, UK
| | - Jessica Sheringham
- Institute of Epidemiology and Health Care, University College London, London, UK
| | | | | | - Sara Day
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Claire Dewsnap
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Louise Jackson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Hamish Mohammed
- STIs and HIV Division, Blood Safety, Health Security Agency, Hepatitis, London, UK
| | - Jonathan D C Ross
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Jo Gibbs
- Institute for Global Health, University College London, London, UK
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Manabe YC, Hardick J, Uhteg K, Ramdeep N, Armington G, Mostafa HH, Hamill MM. Retrospective Monkeypox Virus Surveillance Among Male Users of I Want the Kit in Maryland, United States. Clin Infect Dis 2024; 79:138-140. [PMID: 38629511 PMCID: PMC11259223 DOI: 10.1093/cid/ciae208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
Retrospective surveillance leveraging male rectal swab sample remnants from I Want the Kit from July 2021 through October 2023 identified 1 symptomatic and 1 asymptomatic mpox case at the peak of transmission in 2022. Although sporadic cases continue to be reported in Maryland, additional asymptomatic cases were not identified in this leveraged surveillance.
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Affiliation(s)
- Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Justin Hardick
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katherine Uhteg
- Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nisha Ramdeep
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gretchen Armington
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Heba H Mostafa
- Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew M Hamill
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Al-Bdairi AA, Makki HA, Shawki O, Alkhudair SH, Al-Hilli NM, Alkhalidi BA, Alkadhim HK, Shweliyya AA. The Multi-faceted Effects of COVID-19 on Female Reproductive Health: An Updated Narrative Review. Cureus 2024; 16:e57944. [PMID: 38738039 PMCID: PMC11082527 DOI: 10.7759/cureus.57944] [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: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Concerns about the SARS-CoV-2 pandemic's possible impact on sexual and reproductive health have grown significantly. In this narrative review, the latest research on the effects of SARS-CoV-2 infection on several facets of sexual and reproductive health is reviewed. The review starts initially by going through the possible consequences of SARS-CoV-2 on female menstrual cycles. The virus may interfere with the menstrual cycle, which could affect hormone synthesis and endometrial reactions, according to newly available evidence. Menstrual blood loss may be impacted by COVID-19's potential to influence endothelial cell function and systemic hemostasis. Hypothalamic amenorrhea may be brought on by severe COVID-19 disease. There is little research on this subject, although most women resume their regular menstrual cycles after 1-2 months of recuperation. The review also examines how SARS-CoV-2 infection may affect assisted reproductive technology (ART) treatments. There are few clinical data, although some research points to potential effects on embryo quality. Overall, ART results, however, did not materially change from the time before the epidemic. Obstetric problems are more likely when SARS-CoV-2 infection occurs during pregnancy, especially in the third trimester. Even though the maternal death rate is still low, pregnant women, especially those with comorbidities, are more likely to experience serious sickness. The review emphasizes how the COVID-19 vaccine affects menstrual cycles, showing brief, modest modifications without serious health hazards. Also included are the psychological effects of family planning choices during the pandemic. In conclusion, this narrative review offers a thorough assessment of the complicated and changing effects of SARS-CoV-2 on sexual and reproductive health. The different requirements of people and couples during and after the pandemic are highlighted, underscoring the necessity for ongoing study and specialized healthcare practices.
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Affiliation(s)
- Adnan A Al-Bdairi
- Infertility, Assisted Reproductive Technologies, Teba IVF and Genetic Center, Babylon, IRQ
| | - Hayder A Makki
- Pharmacology and Toxicology, College of Pharmacy, University of Babylon, Babylon, IRQ
| | - Osama Shawki
- Gynecology Surgery, School of Medicine, Cairo University, Cairo, EGY
| | - Sallama H Alkhudair
- Fertility, Assisted Reproductive Technology, Alzaitoon Specialized Fertility Center, Baghdad, IRQ
| | - Nadia M Al-Hilli
- Obstetrics and Gynecology, College of Medicine, University of Babylon, Babylon, IRQ
| | - Batool A Alkhalidi
- Obstetrics and Gynecology, College of Medicine, University of Kufa, Najaf, IRQ
| | - Hanan K Alkadhim
- Obstetrics and Gynecology, Iraqi Fertility Society, College of Medicine, University of Babylon, Babylon, IRQ
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Gaines TL, Werb D, Harris O. Young, Black/African American, and Latino communities are left behind despite legislative efforts in California to reduce HIV/STI disparities. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1179334. [PMID: 37779638 PMCID: PMC10538965 DOI: 10.3389/frph.2023.1179334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives Sexually transmitted infections (STI) have been on the rise in the United States with racial/ethnic minority groups, gay and bisexual men, and youth experiencing the highest STI and HIV infection rates. In 2022, California became the first state in the nation to pass legislation, Senate Bill 306 (SB 306), requiring health care plans to cover the costs of home test kits for STIs, including HIV. This study examines provisions within SB 306 and its potential to reduce STI and HIV disparities among key demographic groups and geographic regions within California. Study design Ecological cross-sectional study involving 58 California counties. Methods Descriptive statistics and choropleth maps compared HIV/STI prevalence rates, uninsured rates, demographic composition, and healthcare provider coverage across California counties. Three geographically weighted Poisson regression analyses were conducted to separately examine the association between proportion of uninsured and HIV, gonorrhea, and chlamydia prevalence rates. Results HIV/STI rates were significantly and positively associated with the proportion of uninsured residents in Central and Southern California counties. These counties had a higher proportion of demographic groups vulnerable to HIV/STI including a large Latino, Black/African American, and younger (age 15-24) population but had a lower rate of healthcare providers with prescription authority for home testing kits, which is a requirement under SB 306. Conclusions Cutting-edge solutions are needed to stem the rising tide of new STI and HIV infections. While SB 306 is novel and innovative in intent, its coverage gaps will increase disparities and inequities among historically underserved populations.
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Affiliation(s)
- Tommi L. Gaines
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Dan Werb
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
- Centre on Drug Policy Evaluation, MAP Centre on Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada
| | - Orlando Harris
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
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Yu T, Melendez JH, Armington GS, Silver B, Gaydos CA, Ruby K, Olthoff G, Greenbaum A, Hamill MM, Manabe YC. Added Value of Extragenital Sexually Transmitted Infection Testing in "IWantTheKit" Program Users. Sex Transm Dis 2023; 50:138-143. [PMID: 36729630 PMCID: PMC10104591 DOI: 10.1097/olq.0000000000001743] [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: 02/03/2023]
Abstract
BACKGROUND The 2021 Centers for Disease Control and Prevention sexually transmitted infection treatment guidelines recommend extragenital testing for gonorrhea and chlamydia in men who have sex with men and for women based on reported behaviors and exposures. The "IWantTheKit (IWTK)" program is a free online platform for specimen self-collection and mail-in for combined chlamydia/gonorrhea testing. We sought to assess the additional diagnostic value of extragenital testing compared with genital testing only for chlamydia/gonorrhea and determine factors associated with a positive extragenital test result among IWTK users. METHODS From August 2013 to January 2022, 7612 unique IWTK users returned swabs for testing; 3407 (45%) users requested both genital and extragenital tests and were included in this analysis. Descriptive statistics were summarized for demographic characteristics, reported behaviors, and genital and extragenital test results, and data were stratified by gender and age group. A logistic regression model was used to estimate associations between factors and extragenital sexually transmitted infection positivity. RESULTS Chlamydia positivity rates were 4.7%, 2.4%, and 1.5% at genital, extragenital, and both sites, respectively; for gonorrhea, 0.4%, 1.1%, and 0.4% were positive at those sites, respectively. Among women, age 25 years and younger was significantly associated with extragenital chlamydia (odds ratio [OR], 4.0; P = 0.010). Being in high-risk quiz score group was associated with extragenital chlamydia (OR, 2.6; P = 0.005) and extragenital gonorrhea in men and women (OR, 8.5; P = 0.005). CONCLUSIONS Extragenital testing detected additional chlamydia and gonorrhea cases in the IWTK user population that would have been missed by genital-only testing, especially for women younger than 25 years and people reported to be at high risk.
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Affiliation(s)
- Tong Yu
- Johns Hopkins School of Medicine, Baltimore, Maryland, U.S
| | | | | | - Barbara Silver
- Johns Hopkins School of Medicine, Baltimore, Maryland, U.S
| | | | - Kenneth Ruby
- Baltimore City Health Department, Sexual Health and Wellness Clinics, Baltimore, Maryland, U.S
| | - Glen Olthoff
- Baltimore City Health Department, Sexual Health and Wellness Clinics, Baltimore, Maryland, U.S
| | - Adena Greenbaum
- Baltimore City Health Department, Sexual Health and Wellness Clinics, Baltimore, Maryland, U.S
| | - Matthew M. Hamill
- Johns Hopkins School of Medicine, Baltimore, Maryland, U.S
- Baltimore City Health Department, Sexual Health and Wellness Clinics, Baltimore, Maryland, U.S
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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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Hamill MM, Yu T, Armington GS, Hsieh YH, Manabe YC, Melendez JH. Factors Associated With New Sexual Partnerships During the COVID-19 Pandemic: A Survey of Online Sexually Transmitted Infection Testing Platform Users. Sex Transm Dis 2022; 49:695-699. [PMID: 35830655 PMCID: PMC9477713 DOI: 10.1097/olq.0000000000001675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic has coincided with an explosion of online platforms for sexually transmitted infections (STIs) testing using self-collected, mail-in specimens. Reports on the effect of COVID-19-associated restrictions on sexual behaviors have been mixed, but STI transmissions have continued during the pandemic. We sought to understand the pandemic impact on sexual habits associated with STIs among IWantTheKit users. METHODS Users of IWantTheKit, a free, online STI testing platform, were invited to complete an anonymous questionnaire. Descriptive statistics were used to describe survey responses. Associations with reports of new sex partnerships were explored as a marker of STI risk. Descriptive statistics, univariate and multivariate logistic regression models were used to analyze individual characteristics and reported behaviors associated with self-reported new sexual partnerships during the first 2 COVID-19 pandemic waves. RESULTS Of the 3462 users of the online STI testing platform between June 2020 and February 2021, 1088 (31.4%) completed the online survey; 705 (66.2%) of 1065 reported a new sex partner. One-quarter met their sex partners using apps. Overall, 10% were symptomatic and almost 18% were concerned that their partner had an STI. White race in men (odds ratio, 1.81; 95% confidence interval, 1.04-3.16), women younger than 25 years (odds ratio, 1.85; 95% confidence interval, 1.09-3.14), and increased condom use in both men and women were significantly associated with reports of new sexual partnerships in adjusted analysis. CONCLUSIONS Despite pandemic restrictions on social gatherings, new sexual partnerships were common in this population, associated with common risk factors, and may help to explain ongoing STI transmission.
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Affiliation(s)
- Matthew M. Hamill
- From the Division of Infectious Diseases, John Hopkins School of Medicine
- Sexual Health and Wellness Clinics, Baltimore City Health Department
| | - Tong Yu
- From the Division of Infectious Diseases, John Hopkins School of Medicine
| | | | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, John Hopkins School of Medicine, Baltimore MD
| | - Yukari C. Manabe
- From the Division of Infectious Diseases, John Hopkins School of Medicine
| | - Johan H. Melendez
- From the Division of Infectious Diseases, John Hopkins School of Medicine
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Tuddenham S, Ghanem KG. The Critical Need to Modernize Syphilis Screening. JAMA 2022; 328:1209-1211. [PMID: 36166050 DOI: 10.1001/jama.2022.15227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Susan Tuddenham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Khalil G Ghanem
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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