Accessing needed sexual health services during the COVID-19 pandemic in British Columbia, Canada: a survey of sexual health service clients

ObjectivesWe assessed COVID-19 pandemic impacts on accessing needed sexual health services, and acceptability of alternative service delivery models, among sexual health service clients in British Columbia (BC), Canada.MethodsWe administered an online survey on 21 July–4 August 2020 to clients using a provincial STI clinic or internet-based testing service, GetCheckedOnline, in the year prior to March 2020. We used logistic regression to identify factors associated with having unmet sexual health needs (ie, not accessing needed services) during March–July 2020 and the likelihood of using various alternative service models, if available.ResultsOf 1198 survey respondents, 706 (59%) reported needing any sexual health service since March 2020; of these 706, 365 (52%) did not access needed services and 458 (66%) had avoided or delayed accessing services. GetCheckedOnline users (univariate OR (uOR)=0.62; 95% CI 0.43 to 0.88) or clients with more urgent needs (eg, treatment for new STI, uOR 0.40 (95% CI 0.21 to 0.7)) had lower odds of unmet sexual health needs. The most common factors reported for avoiding or delaying access were public messaging against seeking non-urgent healthcare (234/662, 35%), concern about getting COVID-19 while at (214/662, 32%) or travelling to (147/662, 22%) a clinic or lab and closure of usual place of accessing services (178/662, 27%). All factors were positively associated with having unmet sexual health needs, with public messaging showing the strongest effect (adjusted OR=4.27 (95% CI 2.88 to 6.42)). Likelihood of using alternative sexual health service models was high overall, with the most appealing options being home self-collection kits (634/706, 90%), receiving test kits or antibiotics at home (592/700, 85%) and express testing (565/706, 80%).ConclusionsOf BC sexual health service clients needing services during March–July 2020, many had unmet needs. Offering alternative service delivery methods may help to improve access during and beyond the COVID-19 pandemic.

Partner number and use of COVID-19 risk reduction strategies during initial phases of the pandemic in British Columbia, Canada: a survey of sexual health service clients

Objectives Initial public health guidance related to sex and COVID-19 infection focused on reducing partner number. We characterized individuals having a higher partner number during the initial phases of the pandemic. Methods In British Columbia, the initial wave of COVID-19 cases was from March 14 to May 19, 2020, followed by gradual lifting of public health restrictions. We conducted an e-mail survey of existing sexual health service clients during the period of July 23 to August 4, 2020. We used bivariate logistic regression to examine the association between the reported number of sexual partners since the start of the pandemic and key variables (level of significance p < 0.01). Results Of the 1196 clients in our final sample, 42% reported 2+ partners since the start of the pandemic, with higher odds among participants who were men who have sex with men, and single or in open relationships prior to the pandemic. This group was more likely to perceive stigma associated with having sex during the pandemic, and had the highest use of strategies to reduce risk of COVID-19 infection during sexual encounters (mainly focused on reducing/avoiding partners, such as masturbation, limiting sex to a “bubble”, and not having sex). Conclusion Sexual health service clients in BC with 2+ partners during the initial phases of BC’s pandemic used strategies to reduce their risk of COVID-19 infection during sex. Our study provides support for a harm reduction approach to guidance on COVID-19 risk during sex, and highlights the need for further research on stigma related to having sex during the COVID-19 pandemic.

Photodiagnosis of genital herpes and warts within a specialist online sexual health service: an observational (mixed methods) study of user experience and clinical outcomes

ObjectivesTo evaluate the feasibility and acceptability of a pilot, free, online photodiagnosis service for genital herpes and warts with postal treatment delivered by a specialist digital sexual health service.SettingAn online sexual health service available free of charge in South East London, UK.ParticipantsRoutinely collected data from 237 users of the pilot service during the study period and qualitative interviews with a purposive sample of 15 users.InterventionA pilot, free, online photodiagnosis service for genital herpes and warts with postal treatment delivered by a specialist digital sexual health service.Primary and secondary outcome measuresProportion of users who successfully uploaded photographs and the proportion diagnosed, treated and referred to face-to-face clinical services. User experience of this service.ResultsThe service was accessed by 237 users during the study period with assessment possible for 86% of users based on the photographs provided. A diagnosis of genital herpes or warts was made for 40.5% and 89.6% were subsequently treated through the service. Eighteen per cent were diagnosed as normal/not needing treatment and 42% were signposted to clinic for further clinical assessment.Qualitative data showed that users felt able and willing to provide genital images for diagnosis. Those who were treated or reassured expressed high satisfaction with the service, valuing the convenience, discreetness and support provided. However, users, particularly those who required referral to other services requested more personal and detailed communication when a clinical diagnosis is given remotely.ConclusionsFindings suggest that online photodiagnosis was feasible and acceptable. However, effective and acceptable management of those who require referral needs careful remote communication.

Accelerated Partner Therapy contact tracing intervention for people with chlamydia: the LUSTRUM process evaluation using programme theory

Background Using programme theory we report a process evaluation of Accelerated Partner Therapy (APT) - a novel contact tracing (partner notification) intervention for people with chlamydia as part of the LUSTRUM trial. Methods Following the specification and visualisation of initial programme theory, questions of context dependency, fidelity, and functioning of putative intervention mechanisms were addressed using deductive thematic analysis of qualitative data collected through focus groups and individual interviews with purposively sampled health care professionals (n=34 from ten sites), index patients (n=15), and sex partners who received APT (n=17). Analyses were independent of trial results. Results APT was anticipated to change key interactions and sexual health service organisation to accommodate safe and optimal remote care. APT training and resources transformed key interactions as anticipated. Overall intervention fidelity was good and APT was well-liked by those who delivered and received it. Putative intervention mechanisms worked mostly as expected although those concerned with local implementation sometimes worked counter to expectations. APT and its trial struggled to be implemented at scale across all sites. Considerable pressures drove services to constantly adapt to achieve efficiencies. APT was perceived as time consuming without visible impact on perceived patient numbers in clinic curtailing positive feedback loops driving normalisation. Discussion Using programme theory we show an evidence-based, theoretically informed, overview of how APT worked dynamically within the context of the trial and within UK sexual health services. We find a mixed picture of a well-liked, intuitive, coherent intervention struggling to gain purchase within an already pressured service.

Safeguarding teenagers in a sexual health service during the COVID-19 pandemic

ObjectivesThe first aim was to examine how the COVID-19 restrictions on movement impacted on teenagers’ access to a local sexual health service (SHS). The second aim was to audit whether safeguarding assessments were carried out for those accessing the service remotely.MethodsApril–September 2020 consultation numbers for teenagers aged 17 years and under were compared with the 2019 equivalent. Service safeguarding assessment standards were reviewed for teenagers receiving telephone consultations for the first 6 months of lockdown, April–September 2020.ResultsThere was a reduction in contact with the service of 100% for those aged 13 years and younger, 52% for those aged 14 and 15 years and 31% for those aged 16 and 17 years for the compared months. A safeguarding assessment was either carried out by the service or accounted for by a partner community practitioner for all contacts with the service by young people 15 years or younger. 96% of safeguarding assessments were carried out for those aged 16–17 years.ConclusionsThere was a reduction in consultations for all age groups examined in the 6 months following lockdown. This adds to the evidence that restrictions during lockdown are barriers to young people accessing SHSs. For those who did have a consultation, safeguarding assessments were consistently carried out. Nevertheless, due to reduced contact overall, it is likely that some safeguarding issues remain undisclosed. Multiagency safeguarding networks and telephone consultations with a low threshold for promoting an in-person consultation facilitated access to the SHS and a robust safeguarding pathway during the constraints of the COVID-19 pandemic.