Mapping Evidence of Impacts of COVID-19 Outbreak on Sexual and Reproductive Health: A Scoping Review

Determinants of Repeating an HIV Test Among Gay, Bisexual, and Other Men Who have Sex with Men, and Transgender People Who Use an Online-Requested Self-Sampling Program and Attending Community-Based Testing Venues in Spain (2018-2021)

Our aims were: (1) to characterize gay, bisexual and other men who have sex with men (GBMSM) and transgender (TG) populations using internet-based self-sampling services in the TESTATE project or attending community-based STI/HIV voluntary counselling and testing (CBVCT) services as alternative strategies to formal HIV testing within the Spanish national health system, and (2) to identify factors associated with repeat use of the same screening strategy from November 2018 to December 2021. Demographic, health, and behavioral characteristics of users using complementary strategies were analyzed. We developed a cross-sectional study, with descriptive analysis, HIV cascade, and a multivariate logistic model to identify factors associated with participants' repeated use of the same screening strategy. We included 9939 users, of whom 94.1% were GBMSM (n = 9348) and 5.9% TG (n = 580), with a high representation of migrants. Reactive results were 3.4% (n = 340), with 3.0% in GBMSM (n = 277/9348) and 10.7% in TG (n = 63/591). 73.8% (n = 251) were confirmed HIV positive and 76.7% (n = 194) were linked to health services. Users repeated the online screening strategy more than CBVCT (44.3% vs. 31.8%), but TG population used face-to-face community services more (8.4% vs. 0.6%). Factors influencing the repetition of the online self-sampling strategy included older age, non-migrant status, and recent HIV testing. In the CBVCT strategy, factors included older age, TG identity, non-migrant status, condom use during the last sexual encounter, and recent HIV testing. In conclusion, both CBVCT and online-requested self-sampling at home are important alternatives to the health system for the provision of HIV testing to GBMSM and TG.

Delays in Obtaining Abortion and Miscarriage Care Among Pregnant Persons in New York State During the COVID-19 Pandemic: The CAP Study

Background

We sought to investigate delays obtaining abortion and miscarriage care during the COVID-19 pandemic, compared with before the pandemic, among pregnant persons in New York State (NYS).

Methods

We administered a cross-sectional survey in June-July 2020 to NYS residents aged 18-44 years who identified as female or transgender male (N = 1,525). This analysis focused on a subsample who had an abortion or miscarriage during COVID-19, were seeking an abortion at the time of the survey, or had an abortion or miscarriage before COVID-19 (n = 116). We conducted bivariate analyses to determine differences in delays to seeking or obtaining an abortion or miscarriage during versus before the pandemic, as well as consideration of abortion among those pregnant during versus before the pandemic. We also asked open-ended questions about miscarriage and abortion experiences.

Main Findings

Of the 21 respondents who sought or were seeking an abortion during the COVID-19 pandemic, 76.2% (n = 16) reported experiencing a delay in obtaining abortion care, compared with 18.2% (n = 4) of those who experienced a delay before the pandemic (p < 0.001). A significantly higher proportion of respondents who were pregnant during the pandemic considered abortion, compared with those who gave birth before the pandemic (39.1% vs. 7.6%; p < 0.001). Of the 39 respondents who miscarried during the pandemic, 35.9% (n = 14) delayed care, compared with 5.9% (n = 2) before the pandemic (p < 0.01). Some respondents also commented on the difficulty of accessing miscarriage services during COVID-19 in open-ended responses.

Principal Conclusions

Those who sought abortion or miscarriage care during the COVID-19 pandemic experienced significant delays in getting care. These are essential services that must be available during public health emergencies, and yet access to these services is now severely limited in many states due to the Dobbs vs. Jackson Women's Health Organization decision.

Family planning service disruptions in the first two years of the COVID-19 pandemic: Evidence from health facilities in seven low- and middle-income countries

Many speculated that COVID-19 would severely restrict the delivery of essential health services, including family planning (FP), but evidence of this impact is limited, partly due to data limitations. We use cross-sectional data collected from regional and national samples of health facilities (n = 2,610) offering FP across seven low- and middle-income countries (LMICs) between 2019 and 2021, with longitudinal data from four geographies, to examine reported disruptions to the FP service environment during COVID-19, assess how these disruptions varied according to health system characteristics, and evaluate how disruptions evolved throughout the first two years of the pandemic, relative to a pre-pandemic period. Findings show significant variation in the impact of COVID-19 on facility-based FP services across LMICs, with the largest disruptions to services occurring in Rajasthan, India, where COVID-19 cases were highest among geographies sampled, while in most sub-Saharan African settings there were limited disruptions impacting FP service availability, method provision, and contraceptive supplies. Facility-reported disruptions to care were not reflected in observed changes to the number of FP clients or types of stockouts experienced in the first two years of the pandemic. Public and higher-level facilities were generally less likely to experience COVID-19-related disruptions to FP services, suggesting policy mitigation measures-particularly those implemented among government-operated health facilities-may have been critical to ensuring sustained delivery of reproductive healthcare during the pandemic.

COVID-19 pandemic hits differently: examining its consequences for women's livelihoods and healthcare access - a cross-sectional study in Kinshasa DRC

OBJECTIVES

The emergence of the COVID-19 pandemic led to multiple preventive actions as primary interventions to contain the spread of the virus. Globally, countries are facing enormous challenges with consequences for use of social, economic and health services. The Democratic Republic of Congo (DRC) was among the African countries implementing strict lockdown at the start of the pandemic, resulting in shortages and decreased access to services. The adverse effects of the pandemic had unpleasant consequences for the country. This study aimed to examine the association between COVID-19 pandemic-related factors, sociodemographic factors, and the need to visit healthcare facilities, including family planning services, among women aged 15-49 years in the DRC.

METHODS

We conducted a secondary analysis of a performance monitoring for action (PMA) cross-sectional COVID-19 phone survey in Kinshasa, DRC, which had a response rate of 74.7%. In total, 1325 randomly selected women aged 15-49 years from the Kinshasa province who had previously participated in the PMA baseline survey participated in the survey. Bivariate and multivariate logistic regressions were used to assess associations.

RESULTS

The COVID-19 pandemic and related factors affected 92% of women in the Kinshasa province socioeconomically. A majority were highly economically dependent on their partner or some other sources for their basic needs to be met, and even more worried about the future impact of the pandemic on their household finances. Over 50% of women did not attempt visiting a health service, with some of the top reasons being fear of being infected with COVID-19 and not being able to afford services. We found a significant association between age groups and contraceptive use. The need for and use of contraceptives was higher among women aged 25-34 years than those aged 15-24 or 35-49 years.

CONCLUSION

Effective social/economic support to women and girls during pandemics and in crises is essential as it can have lasting beneficial effects on many domains of their lives, including their ability to access health services and the contraceptives of their choice.

Barriers and facilitators to accessing and using sexual and reproductive health services during the COVID-19 pandemic outbreak in Africa: a protocol for a systematic review and meta-analysis

INTRODUCTION

Access and utilisation of sexual and reproductive health services remain an important component in averting adverse sexual and reproductive health outcomes. However, the unprecedented emergence of the 2019 coronavirus disease (COVID-19) left most of these services disrupted in Africa. Thus, this protocol study seeks to conduct a systematic review and meta-analysis of barriers and facilitators to accessing and using sexual and reproductive health services during the COVID-19 pandemic outbreak in Africa.

METHOD AND ANALYSIS

An open electronic database search will be conducted in African journals online, PubMed, CINAHL, EMBASE and PsycINFO to identify potentially eligible studies published between January 2020 and December 2022. Two authors from the research team will screen the title and abstract of the potential studies, and another two authors will independently assess the full articles based on the inclusion or exclusion criteria. Studies will be selected if they examine barriers and facilitators to accessing and using sexual and reproductive health services, including family planning counselling and services, sexually transmitted infections (STIs)/HIV testing, consultation, and treatment, and provision of abortion services during the COVID-19 pandemic outbreak in Africa. The data extracted from the included studies will be analysed using Review Manager (RevMan V.5) and Meta-Analysis software V.3. Each outcome measure will be analysed separately against barriers and facilitators; the dichotomous data will be presented in odd ratios with a 95% CI, while mean and standardised mean differences will be employed to present the continuous data. We envisage that the potential results of this study will identify the barriers and facilitators to family planning counselling and services, STIs/HIV testing, consultation, and treatment, and provision of abortion services during the COVID-19 pandemic outbreak in Africa, which can be used to develop required interventions and policies to curb identified barriers.

ETHICS AND DISSEMINATION

Ethical approval is not required for a systematic review and meta-analysis. Findings from this study will be disseminated through conferences and peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42022373335.

The Impact of First UK-Wide Lockdown (March-June 2020) on Sexual Behaviors in Men and Gender Diverse People Who Have Sex with Men During the COVID-19 Pandemic: A Cross-Sectional Survey

The global COVID-19 pandemic resulted in strict social distancing measures restricting close physical contact. Men (cis and trans) and other gender diverse people who have sex with men (MGDSM) are at higher risk of sexually transmitted infections (STIs) and may have experienced changes in sexual behavior during government restrictions on social and sexual contact. We aimed to examine self-reported sexual behavior of MGDSM during the first UK-wide lockdown to identify the characteristics of the individuals who might most require sexual health promotion and clinical support. In April-May 2020, we conducted an online survey of MGDSM, promoted on social media and Grindr. Our exploratory approach used descriptive analysis to identify self-reported changes in sexual behavior and performed regression analyses to identify correlates of casual sex during the lockdown. A total of 1429 respondents completed the survey: mean age 36 years, 84% White, 97% male or trans male, 98% assigned male sex at birth, 2% female or non-binary, 65% degree educated or higher. During the lockdown, 76% reported not having any casual sex partners. While the majority reported reduced casual sex, 3% reported an increase in casual sex with one person and 2% with three or more people (group sex). About 12% of the sample engaged in casual sex with only one person and 5% with four or more sexual partners during the lockdown. Reporting casual sex during lockdown was associated with: lower level of education OR = 2.37 [95% CI 1.40-4.01]; identifying as a member of an ethnic minority OR = 2.27[1.40-3.53]; daily usage of sexual networking apps OR = 2.24[1.54-3.25]; being less anxious about contracting SARS-CoV-2 through sex OR = 1.66[1.12-2.44]; using PrEP before lockdown OR = 1.75[1.20-2.56]; continuing to use PrEP OR = 2.79[1.76-4.57]; and testing for STIs during lockdown OR = 2.65[1.76-3.99]. A quarter of respondents remained sexually active with casual partners, indicating a need to provide STI screening services and health promotion targeted to groups most likely to have need over this period. Future research is required to better understand how to support sexual and gender minorities to manage sexual risk in the context of pandemic public health initiatives.

Disruptions in Accessing Women's Health Care Services: Evidence Using COVID-19 Health Services Disruption Survey

INTRODUCTION

The world is experiencing the Coronavirus pandemic and the aftermath consequences leading to lockdown and travel restrictions. The pandemic has brought a far-reaching impact on various sectors, including the economic, and health sectors. Therefore, this study analyses the possible impact of the COVID-19 pandemic on the disruption - in accessing family planning measures i.e. contraception facilities; and in seeking help from women organizations for health services.

METHODS

This study has used the COVID-19 health services disruption survey-2020 and data was obtained from the Institute of Health Metrics and Evaluation. This survey was conducted in 76 countries using the smartphone-based premise data collection platform. Respondents were individual members of the general population ages 15-49 years who were identified as women. Data were collected from 12,354 respondents. Our data analysis has been done on both aggregate samples as well as region-wise samples (i.e. Africa, Asia, Europe, and Latin America & the Caribbean) to assess the change in levels of service delivery in both pre-COVID and post-COVID periods.

RESULTS

Descriptive statistics results shows that two particular reasons - unable to access due to lockdown restrictions (5.4%), and fear of being infected with COVID-19 (9.7%) were reported as mostly impacting the access to contraception facilities due to lockdown restriction. Further, the logit regression using socio-economic and demographic variables suggests that geographical location (rural), and poor financial status turned out negative and significant, showing higher odds of facing difficulty than the reference category for the aggregate sample. The region-wise analysis suggests that Europe and Asia are the regions with the highest percentage of respondents reporting unavailability of services during COVID-19.

CONCLUSION

The study concludes that pandemic-related emergencies affect the health care system, especially women-related health care services. The implication of our study indicates the requirement of a supply chain strategy for managing health care demand during emerging situations. So, the disruptions and bottlenecks in health care facilities should be addressed by various governments through appropriate policies and interventions.

Prevalence and determinants of intention to use modern contraceptives among grand-multiparous women in sub-Saharan Africa

BACKGROUND

Sub-Saharan Africa, characterised by high fertility and low contraceptive use prevalence, remains one of the settings with the poorest maternal and child health indices globally. Studies have established that grand-multiparous women are at increased risk of these adverse maternal health outcomes, and contraceptive use is important to averting these adverse outcomes. Thus, this study examines the prevalence and determinants of intention to use modern contraceptives among grand-multiparous women in 10 sub-Saharan African countries with high fertility rates.

MATERIALS AND METHODS

The study utilized data from the last installments of the Demographic and Health Survey from the 10 leading countries with the highest total fertility rates in sub-Saharan Africa. These countries include: Angola, Benin, Burundi, Chad, Cote d'Ivoire, the Republic of the Congo, Democratic Republic of Congo, Mali, Niger, and Nigeria. Data analysis of 23,500 grand-multiparous women was done at three univariate levels involving a frequency table and bar chart. We employed bivariate logit and multivariate logit regression at the bivariate and multivariate levels to achieve the study objectives. A significant level was determined at p < 0.05.

RESULTS

Our study found that less than 40% of grand-multiparous women in these high fertility countries in sub-Saharan Africa, have the intention to use modern contraceptives (39%), but country variations exist with as low as 32.8% in Angola to as high as 71.2% in the Republic of the Congo. The study found that modern contraceptives use intention among grand-multiparous women in these high fertility countries was predicted by a history of contraceptive use and pregnancy termination, exposure to family planning messages on social media, and knowledge of family planning methods. Others were women's fertility planning status, ideal family size, number of marriages (remarriage), couple's fertility desire, current age, and level of education.

CONCLUSION

In the high fertility context of sub-Saharan Africa, characterized by low contraceptive use, improving contraceptive use intention among grand-multiparous women is vital for preventing adverse maternal and child health outcomes, including mortality, resulting from a high-risk pregnancy. Hence, interventions should be more innovative in targeting this group of women to increase the contraceptive prevalence rate in line with Family Planning 2030 goals, and ultimately reduce high fertility rates in the region.

Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: a scoping review

Introduction

The COVID-19 pandemic has negatively impacted health systems globally and widened preexisting disparities. We conducted a scoping review on the impact of the COVID-19 pandemic on women and girls’ access to and utilisation of sexual and reproductive health (SRH) services for contraception, abortion, gender-based and intimate partner violence (GBV/IPV) and sexually transmitted infections (STIs).

Methods

We systematically searched peer reviewed literature and quantitative reports, published between December 2019 and July 2021, focused on women and girls’ (15–49 years old) access to and utilisation of selected SRH services during the COVID-19 pandemic. Included studies were grouped based on setting, SRH service area, study design, population and reported impact. Qualitative data were coded, organised thematically and grouped by major findings.

Results

We included 83 of 3067 identified studies and found that access to contraception, in-person safe abortion services, in-person services for GBV/IPV and STI/HIV testing, prevention and treatment decreased. The geographical distribution of this body of research was uneven and significantly less representative of countries where COVID-19 restrictions were very strict. Access was limited by demand and supply side barriers including transportation disruptions, financial hardships, limited resources and legal restrictions. Few studies focused on marginalised groups with distinct SRH needs.

Conclusion

Reports indicated negative impacts on access to and utilisation of SRH services globally, especially for marginalised populations during the pandemic. Our findings call for strengthening of health systems preparedness and resilience to safeguard global access to essential SRH services in ongoing and future emergencies.

Factors Associated with Uptake of Effective and Ineffective Contraceptives among Polish Women during the First Period of the COVID-19 Pandemic

The COVID-19 pandemic has burdened the healthcare system and influenced individuals' health-related choices. The aim of the study was to estimate the prevalence and to identify the correlates of the use of more and less effective contraceptive methods among Poles in the initial period of the COVID-19 pandemic. The cross-sectional online study was conducted among the representative sample of 642 female respondents aged 18-49. Three groups of contraception choices (only effective methods-42.2%, mixed effective and ineffective methods-26.8%, none-31.0%) were distinguished and 11 potential determinants were considered. One in ten women declared having difficulty in accessing contraception during the first months of the pandemic. A multinomial logistic regression model explained 48.7% of the variation in contraceptive method choice. Both effective and ineffective methods were more often declared by young women, and less often in case of lower education, planning children or subjective no need for contraception. In addition, factors that reduced the chance of effective contraception were poor financial situation, already having children and a relatively higher degree of religiosity. The study confirmed that a significant share of Polish women do not opt for effective methods of contraception. Their choices had strong demographic, social and cultural determinants.

Sexual Health During COVID-19: A Scoping Review

INTRODUCTION

The COVID-19 pandemic impacted profoundly on the wellbeing and social interactions of the world population, and all dimensions of sexual health were potentially affected by globally implemented preventive measures.

OBJECTIVES

The scoping review aimed to compile existing research investigating possible effects of COVID-19 lockdowns on adult sexual health, that is, sexual behavior, functioning, and satisfaction. Further, studies on the interplay between mental health and sexual well-being during the pandemic were reviewed.

METHODS

The review was conducted in accordance with guidelines established by the Joanna Briggs Institute and the Extension for Scoping Reviews (PRISMA-ScR) Checklist. On October 11-12, 2021, PubMed, Embase, PsycInfo, Cinahl, Cochrane, Sociological Abstracts and Scopus were systematically searched for relevant peer-reviewed papers employing quantitative methodology. Additionally, unpublished ("grey") research studies on the subject were retrieved. The screening, data extraction, and analysis of evidence were conducted by 4 independent reviewers using an iterative approach.

RESULTS

Based on 107 studies included, the scoping review showed that the pandemic had had a wide impact on all dimensions of sexual health. Except for solo sex activities, mainly negative COVID-19 implications were identified, although findings were, in sum, characterized by complexity and unpredictability. Thus, sexual behavior, functioning, and satisfaction during the pandemic appeared to be mitigated by a broad range of sociodemographic and contextual factors. Finally, sexual health seemed deeply entwined with overall mental health.

CONCLUSION

The scoping review revealed a broad range of COVID-19-related effects on sexual health, including an overall decline in partnered sex and a concurrent increase in solo sex activities. It also emphasized a need for future research to shed light on possible long-term consequences of the pandemic in various population groups and on all aspects of sexual health. Toldam NE, Graugaard C, Meyer R, et al. Sexual Health During COVID-19: A Scoping Review. Sex Med Rev 2022;10:714-753.

Abortion as an Essential Health Service in Latin America During the COVID-19 Pandemic

Background

The rapid increase in demand for health services as a result of the COVID-19 outbreak has created significant challenges for health systems. National and international health authorities have declared reproductive health services as essential, particularly those related to prevention, care during pregnancy, delivery and postpartum, as well as abortion services. This research was conducted by a regional team in cooperation with nine local organizations that are members of the Latin American Consortium against Unsafe Abortion (Consorcio Latinoamericano Contra el Aborto Inseguro, CLACAI).

Objectives

Our research aimed to examine the provision of reproductive healthcare services, with a focus on abortion, in nine countries during the first few months of the pandemic (March to September 2020).

Methods

Our research design developed a set of quantitative and qualitative indicators to monitor the availability and accessibility of abortion services during the COVID-19 pandemic. Researchers collected the quantitative data by reviewing regulations and other documents, government and civil society reports, and official statistics; the qualitative data was acquired through interviews with key actors, and non-representative surveys completed by healthcare professional and end users of reproductive services.

Results

Although six of the nine countries we researched deemed reproductive health services essential, only two of these six countries considered abortion services to be essential, and all nine countries reported difficulties in accessing abortion services. Restrictive abortion laws remained in place in the majority of countries (seven), and as a result access to abortion services became even more limited than it had been before the pandemic. At the same time, good practices to facilitate access to abortion services in healthcare facilities, updated regulatory frameworks, and collaboration between civil society and government agencies were identified and should continue to be promoted even after the pandemic crisis has subsided.

Conclusions

The pandemic catalyzed what was already happening in each country, and as such abortion services have become more accessible in countries like Argentina, where the so-called green wave has been generating social, legal and policy changes, whereas in countries such as Ecuador, where abortion is legally restricted and opposed to by the government, access to safe abortion became even more difficult than it was before the pandemic. However, the general trend has been a lack of adequate adaptation in order to guarantee quality in abortion care. That said, there have also been some interesting and positive service provision initiatives, such as telemedicine, implemented in at least two countries, which, if maintained long-term, could improve access to safe abortion.

"Sex Seems Less Important When You Are Worried About a Deadly Virus." A Content Analysis of Reported Reasons for Changes in Sexual Behavior and Satisfaction During the COVID-19 Pandemic

The purpose of this study is to assess how the COVID-19 pandemic impacted various sexual behaviors and levels of sexual and relationship satisfaction by performing a content analysis of participants' (N = 1051 American adults) responses to open-ended survey questions. Results revealed a variety of impacts that increased, decreased, or otherwise qualitatively changed sexual behavior and satisfaction. Major themes included emotions and mental health, changes in routines, social distancing and fears related to COVID-19, and changes in romantic relationships. These findings are contextualized within the emerging quantitative research on COVID-19 and sexuality, and areas for future research based on these findings are discussed.

Spatial Healthcare Accessibility: A District-Level Analysis of Travel for Outpatient Diabetology in Czechia

Assessments of regional differences in the accessibility and capacity of health services often rely on indicators based on data from the permanent residents of a given region. However, a patient does not always use health services in their place of residence. The objective of this article is to evaluate the influence of spatial healthcare accessibility on regional differences in the provision and take-up of health services, using outpatient diabetology in Czechia as a case study. The analysis is grounded in monitoring the differences in the patient’s place of residence and the location of the healthcare provided. Anonymized individual data of the largest Czech health insurance company for 2019 are used (366,537 patients, 2,481,129 medical procedures). The data are aggregated at the district level (LAU 1). It has been identified that regions where patients travel outside their area of residence to access more than half of their healthcare needs are mostly in local/regional centres. Moreover, these patients increase the number of medical services provided in local/regional centres, often by more than 20%, which has been reflected in greater healthcare capacity in these centres. To assess regional differences, it is important to take the spatial healthcare accessibility into account and also consider why patients travel for healthcare. Reasons could be the insufficient local capacity, varied quality of health services or individual factors. In such cases, healthcare actors (health insurance companies, local government etc.) should respond to the situation and take appropriate action to reduce these dissimilarities.

Impact of COVID-19 on the Use of Emergency Contraceptives in Ghana: An Interrupted Time Series Analysis

The Coronavirus disease pandemic has disrupted reproductive health services including decline in the use of pre-coital contraceptives. However, evidence of its impact on the use of emergency contraceptives, often, post-coital methods, is limited in the emerging literature, hence this study. Data on total number of emergency contraceptive users from January 2018 to February 2020 (pre-pandemic) and March to December 2020 (during the pandemic) were extracted from the Ghana Health Service District Health Information Management System. Interrupted Time Series analysis was used to estimate the impact of the pandemic on the trend of emergency contraceptive use, adjusting for serial autocorrelation and seasonality. The results showed a gradual upward trend in emergency contraceptive use before the pandemic, increasing at a rate of about 67 (95% CI 37.6–96.8; p = 0.001) users per month. However, the pandemic caused a sudden spike in the use of emergency contraceptives. The pandemic and its related restrictions had an immediate effect on the use of emergency contraceptives, increasing significantly by about 1939 users (95% CI 1096.6–2781.2; p = 0.001) in March 2020. Following March 2020, the number of emergency contraceptive users continued to increase by about 385 users per month (95% CI 272.9–496.4; p = 0.001). The evidence shows that use of emergency contraceptives, often used as post-coital methods for unprotected sex was not negatively impacted by the pandemic. In fact, it is the opposite. Hence, in planning for similar situations attention should be given to the distribution of post-coital contraceptive methods.

Sexual and Reproductive Health during the COVID-19 Pandemic: Results from a Cross-Sectional Online Survey in Germany

The accumulated evidence maps the COVID-19 pandemic's diverse impacts on sexual and reproductive health (SRH); however, the precise changes in sexual behaviours and the underlying causes producing these changes are rarely considered. This study is aimed at assessing the changes in sexual behaviours during the COVID-19 pandemic in Germany, using quantitative methods, and it is also aimed at identifying the underlying reasons, using qualitative methods. It is a part of the broader I-SHARE project, which administered a cross-sectional online survey in 33 countries to describe the effects of the COVID-19 restrictions on different aspects of SRH. In the current study, a total of 611 adults from Germany are included. The findings demonstrate a decline in sexual satisfaction, as well as increases in sexual problems and partnership conflicts. Furthermore, the findings indicate an increase in pornography consumption and masturbation. Psychological stress, due to the pandemic, seemed to be the main reason for the changes in the participants' sexual behaviours, followed by a decrease in social contacts, and an increase in time resources. Thus, it is important to provide accessible clinical and psychosocial (online) interventions and services in order to maintain good sexual health in times of pandemic.

HIV and SRH healthcare delivery experiences of South African healthcare workers and adolescents and young people during COVID-19

While substantial research has emerged from the frontlines of the COVID-19 pandemic, as well as from studies with adolescent populations, there has been a dearth of research focused in South Africa on the context-specific experiences of healthcare workers (HCWs) and the adolescents and young people (AYP) to whom they provide services. This article documents the experiences of provision and receipt of HIV and sexual and reproductive health (SRH) services during the COVID-19 pandemic from the perspective of South African HCWs (n = 13) and AYP (n = 41, ages 17-29). Findings highlight several barriers to accessing comprehensive HIV and SRH services during the pandemic including lockdown-related mobility restrictions (reported by HCWs), prioritisation of COVID-19 above other healthcare needs, longer health facility waiting times, poor treatment by HCWs (reported by AYP), discomfort and perceived stigma from having to queue outside health facilities, and fear of contracting COVID-19 (reported by both groups). While HCWs reported that HIV and SRH services continued to be available during the pandemic, AYP described seeking these services - such as long-acting reversible contraception, check-ups for their babies and medical refills - and being told that because they were not considered emergency cases, they should return on a different date. By capturing diverse experiences and perspectives from both groups, our findings reiterate the growing call for health system investments to strengthen the delivery of adolescent services, including investing in appropriate channels of communication between young people and their healthcare providers (for example, through adolescent peer supporters or community healthcare workers) and differentiated models of service delivery (for example, multi-month ART refills and community pick-ups). Closing the gap between the experiences and needs of adolescents and the healthcare workers who serve them may support young people and HCWs in buffering against changes brought about by the COVID-19 pandemic.

The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response

BACKGROUND

The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic.

METHODS

We conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O'Malley's methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed.

RESULTS

Twenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings.

CONCLUSIONS

The health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised.