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Toller Erausquin J, Tan RKJ, Uhlich M, Francis JM, Kumar N, Campbell L, Zhang WH, Hlatshwako TG, Kosana P, Shah S, Brenner EM, Remmerie L, Mussa A, Klapilova K, Mark K, Perotta G, Gabster A, Wouters E, Burns S, Hendriks J, Hensel DJ, Shamu S, Marie Strizzi J, Esho T, Morroni C, Eleuteri S, Sahril N, Yun Low W, Plasilova L, Lazdane G, Marks M, Olumide A, Abdelhamed A, López Gómez A, Michielsen K, Moreau C, Tucker JD. The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave. Clin Infect Dis 2022; 75:e991-e999. [PMID: 35136960 PMCID: PMC9383436 DOI: 10.1093/cid/ciac102] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium. METHODS Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence. RESULTS Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%-42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%-5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%-8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. CONCLUSIONS Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.
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Affiliation(s)
| | | | | | - Joel M Francis
- Department of Family Medicine, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Navin Kumar
- Department of Sociology, Yale University, New Haven, Connecticut, USA
| | - Linda Campbell
- Center for Population, Family, and Health, University of Antwerp, Antwerp, Belgium,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Wei Hong Zhang
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium,School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Takhona G Hlatshwako
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Priya Kosana
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonam Shah
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erica M Brenner
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lore Remmerie
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Aamirah Mussa
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Katerina Klapilova
- Faculty of Humanities, Charles University, Prague, Czech Republic,National Institute of Mental Health, Klecany, Czech Republic
| | - Kristen Mark
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Gabriela Perotta
- Faculty of Psychology, University of Buenos Aires, Buenos Aires, Argentina
| | - Amanda Gabster
- Gorgas Memorial Institute for Health Studies, Panama City, Panama,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Edwin Wouters
- Center for Population, Family, and Health, University of Antwerp, Antwerp, Belgium
| | - Sharyn Burns
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, Australia
| | - Jacqueline Hendriks
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, Australia
| | - Devon J Hensel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA,Department of Sociology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Simukai Shamu
- Health Systems Strengthening, Foundation for Professional Development, Pretoria, South Africa,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Tammary Esho
- End FGM/C Centre of Excellence, Amref Health Africa, Nairobi, Kenya
| | - Chelsea Morroni
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana,MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Wah Yun Low
- Asia–Europe Institute, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Leona Plasilova
- Faculty of Humanities, Charles University, Prague, Czech Republic,National Institute of Mental Health, Klecany, Czech Republic
| | - Gunta Lazdane
- Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Amr Abdelhamed
- Department of Dermatology, Venereology & Andrology, Sohag University, Sohag, Egypt
| | | | - Kristien Michielsen
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Caroline Moreau
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAand,Primary Care and Prevention, Center for Research in Epidemiology and Public Health, National Institute of Health and Medical Research 1018, Villejuif, France
| | - Joseph D Tucker
- Correspondence: J. D. Tucker, London School of Hygiene and Tropical Medicine, Room 360, Keppel Street, London WC1E 7HT, UK ()
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Erausquin JT, Tan RKJ, Uhlich M, Francis JM, Kumar N, Campbell L, Zhang WH, Hlatshwako TG, Kosana P, Shah S, Brenner EM, Remmerie L, Mussa A, Klapilova K, Mark K, Perotta G, Gabster A, Wouters E, Burns S, Hendriks J, Hensel DJ, Shamu S, Strizzi JM, Esho T, Morroni C, Eleuteri S, Sahril N, Low WY, Plasilova L, Lazdane G, Marks M, Olumide A, Abdelhamed A, López Gómez A, Michielsen K, Moreau C, Tucker JD. The International Sexual Health And Reproductive Health Survey (I-SHARE-1): A Multi-Country Analysis of Adults from 30 Countries Prior to and During the Initial COVID-19 Wave. medRxiv 2021. [PMID: 34704103 PMCID: PMC8547535 DOI: 10.1101/2021.09.18.21263630] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The COVID-19 pandemic forced billions of people to shelter in place, altering social and sexual relationships worldwide. In many settings, COVID-19 threatened already precarious health services. However, there is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of COVID-19 disease. To address this gap, our team organized a multi-country, cross-sectional online survey as part of a global consortium. Methods Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes <200 were included in descriptive meta-analyses. Results Respondents were mean age 34 years; most identified as women (15160; 66.7%), cis-gender (19432; 86.6%) and heterosexual (16592; 77.9%). Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%) people and 640 (14.1%) people reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063/15144, 7.0%) compared to the period before COVID-19 measures (1469/15887, 9.3%). COVID-19 measures impeded access to condoms (933/10790, 8.7%), contraceptives (610/8175, 7.5%), and HIV/STI testing (750/1965, 30.7%). Pooled estimates from meta-analysis indicate during COVID-19 measures, 32.3% (95% CI 23.9-42.1) of people needing HIV/STI testing had hindered access, 4.4% (95% CI 3.4-5.4) experienced partner violence, and 5.8% (95% CI 5.4-8.2) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. Conclusion Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.
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Hlatshwako TG, Shah SJ, Kosana P, Adebayo E, Hendriks J, Larsson EC, Hensel DJ, Erausquin JT, Marks M, Michielsen K, Saltis H, Francis JM, Wouters E, Tucker JD. Online health survey research during COVID-19. Lancet Digit Health 2021; 3:e76-e77. [PMID: 33509387 PMCID: PMC10000261 DOI: 10.1016/s2589-7500(21)00002-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/30/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Takhona G Hlatshwako
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sonam J Shah
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Priya Kosana
- Department of Public Policy, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Emmanuel Adebayo
- Adolescent Health Unit, Institute of Child Health, University of Ibadan, Ibadan, Nigeria
| | - Jacqueline Hendriks
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Devon J Hensel
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, USA; Department of Sociology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jennifer Toller Erausquin
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | - Kristien Michielsen
- International Centre for Reproductive Health, Department of Public Health and Primary Care, University of Ghent, Ghent, Belgium; Academic Network for Sexual and Reproductive Health and Rights Policy, University of Ghent, Ghent, Belgium
| | - Hanna Saltis
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Joel M Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Edwin Wouters
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Joseph D Tucker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 510095, USA.
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