The Impact of the COVID-19 Pandemic on STI and HIV Services in the Netherlands According to Health Care Professionals
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Participants and Recruitment
2.3. Online Survey
2.4. In-Depth Interviews
2.5. Data Analysis
3. Results
3.1. Participant Characteristics
3.2. Access to Care for Priority Populations
3.3. Demand and Availability of STI/HIV Care
3.4. Shifts to Online Counseling and Care
3.5. Quality Assurance of STI/HIV Care
3.6. Results from the In-Depth Interviews
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Tang, K.; Gaoshan, J.; Ahonsi, B.; Ali, M.; Bonet, M.; Broutet, N.; Kara, E.; Kim, C.; Thorson, A.; Thwin, S.S. Sexual and reproductive health (SRH): A key issue in the emergency response to the coronavirus disease (COVID-19) outbreak. Reprod. Health 2020, 17, 59. [Google Scholar] [CrossRef] [PubMed]
- Simões, D.; Stengaard, A.R.; Combs, L.; Raben, D. Impact of the COVID-19 pandemic on testing services for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region, March to August 2020. Eurosurveillance 2020, 25, 2001943. [Google Scholar] [CrossRef] [PubMed]
- The Lancet. Editorial Maintaining the HIV response in a world shaped by COVID-19. Lancet 2020, 396, 1703. [Google Scholar] [CrossRef] [PubMed]
- Mirzaei, H.; Moradi, Y.; Abbaszadeh, S.; Nasiri, N.; Mehmandoost, S.; Khezri, M.; Tavakoli, F.; Sharifi, H. The Impact of COVID-19 on Disruptions of HIV-related Services: A Rapid Review. Med. J. Islam. Repub. Iran 2022, 36, 98. [Google Scholar] [CrossRef] [PubMed]
- Ogunbodede, O.T.; Zablotska-Manos, I.; Lewis, D.A. Potential and demonstrated impacts of the COVID-19 pandemic on sexually transmissible infections. Curr. Opin. Infect. Dis. 2021, 34, 56–61. [Google Scholar] [CrossRef] [PubMed]
- Kim, J.Y.; Barth, S.K.; Monroe, A.K.; Ahsan, S.; Kovacic, J.; Senn, S.; Castel, A.D. The impact of COVID-19 on the HIV continuum of care: Challenges, innovations, and opportunities. Expert Rev. Anti-Infect. Ther. 2023, 21, 831–846. [Google Scholar] [CrossRef] [PubMed]
- Van Bergen, J.E.A.M.; Dekker, J.H.; Boeke, A.J.P.; Kronenberg, E.H.A.; Van der Spruit, R.; Burgers, J.S.; Bouma, M.V.E. NHG Standaard: Het Soa-Consult. In NHG-Standaarden 2009; Bohn Stafleu van Loghum: Houten, The Netherlands, 2013. [Google Scholar]
- Nederlandse Vereniging voor HIV Behandelaren. NVHB Richtlijnen. Available online: https://richtlijnhiv.nvhb.nl/index.php/Inhoud (accessed on 1 October 2022).
- RIVM. LCI-Richtlijnen—DraaiboekSeksuele Gezondheid. 2018. Available online: https://lci.rivm.nl/sites/default/files/bestanden/draaiboek-consult-seksuele-gezondheid/6-testbeleid.pdf (accessed on 1 October 2022).
- Braun, V.; Clarke, V. Using Thematic Analysis in Psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- Staritsky, L.; Visser, M.; van Aar, F.; op de Coul, E.; Heijne, J.; van Wees, D.; Kusters, J.; Alexiou, Z.; Vries de, A.; Gotz, H.; et al. Sexually Transmitted Infections in the Netherlands in 2020; Rijksinstituut voor Volksgezondheid en Milieu: Bilthoven, The Netherlands, 2021. [Google Scholar]
- Adam, P.; Op de Coul, E.; Zuilhof, W.; Zantkuijl, P.; Den Daas, C.; De Wit, J. Changes in MSM’s sexual activity, PrEP use, and access to HIV/STI testing during and after the first Dutch COVID-19 lockdown. Sex. Transm. Infect. 2021, 97 (Suppl. S1), A26. [Google Scholar]
- Xiridou, M.; Heijne, J.; Adam, P.; de Coul, E.O.; Matser, A.; de Wit, J.; Wallinga, J.; van Benthem, B. How the Disruption in Sexually Transmitted Infection Care Due to the COVID-19 Pandemic Could Lead to Increased Sexually Transmitted Infection Transmission Among Men Who Have Sex With Men in The Netherlands: A Mathematical Modeling Study. Sex. Transm. Dis. 2022, 49, 145–153. [Google Scholar] [CrossRef] [PubMed]
- Kersh, E.N.; Shukla, M.; Raphael, B.H.; Habel, M.; Park, I. At-Home Specimen Self-Collection and Self-Testing for Sexually Transmitted Infection Screening Demand Accelerated by the COVID-19 Pandemic: A Review of Laboratory Implementation Issues. J. Clin. Microbiol. 2021, 59, 10–1128. [Google Scholar] [CrossRef] [PubMed]
- Van Benschoten, H.; Kuganantham, H.; Larsson, E.C.; Endler, M.; Thorson, A.; Gemzell-Danielsson, K.; Hanson, C.; Ganatra, B.; Ali, M.; Cleeve, A. Impact of the COVID-19 pandemic on access to and utilisation of services for sexual and reproductive health: A scoping review. BMJ Glob. Health 2022, 7, e009594. [Google Scholar] [CrossRef] [PubMed]
GP practices (n = 77) | PSHS (n = 93) | Total (n = 170) | ||||
---|---|---|---|---|---|---|
M | SD | M | SD | M | SD | |
1. Access to care for priority populations | ||||||
In my practice/center, access to STI/HIV care for youth was… a | ||||||
Period 1 | 2.16 | 0.96 | 1.29 | 0.69 | 1.68 2,3,4 | 0.93 |
Period 2 | 2.71 | 0.71 | 2.01 | 0.76 | 2.33 1,4 | 0.82 |
Period 3 | 2.64 | 0.62 | 1.96 | 0.85 | 2.26 1,4 | 0.83 |
Period 4 | 2.95 | 0.56 | 2.66 | 0.94 | 2.79 1,2,3 | 0.80 |
Total over periods | 2.61 | 0.70 | 1.98 | 0.68 | 2.30 *** | 0.65 |
In my practice/center, access to STI/HIV care for MSM was… a | ||||||
Period 1 | 2.24 | 0.92 | 1.67 | 0.76 | 1.92 2,3,4 | 0.88 |
Period 2 | 2.60 | 0.67 | 2.22 | 0.71 | 2.39 1,4 | 0.71 |
Period 3 | 2.64 | 0.63 | 2.21 | 0.79 | 2.40 1,4 | 0.75 |
Period 4 | 2.88 | 0.39 | 2.87 | 0.77 | 2.88 1,2,3 | 0.63 |
Total over periods | 2.59 | 0.70 | 2.24 | 0.67 | 2.42 ** | 0.78 |
In my practice/center, access to STI/HIV care for sex workers was… a | ||||||
Period 1 | 2.55 | 0.81 | 1.76 | 0.80 | 2.02 | 0.88 |
Period 2 | 2.74 | 0.63 | 2.26 | 0.77 | 2.42 | 0.76 |
Period 3 | 2.81 | 0.48 | 2.15 | 0.77 | 2.37 | 0.75 |
Period 4 | 2.97 | 0.18 | 2.69 | 0.64 | 2.78 | 0.55 |
Total over periods | 2.78 | 0.88 | 2.21 | 0.67 | 2.49 ** | 0.78 |
2. Demand and availability of STI/HIV care | ||||||
The demand for STI/HIV care was larger than we could offer b | ||||||
Period 1 | 1.82 | 0.80 | 4.42 | 1.09 | 3.24 | 1.62 |
Period 2 | 1.88 | 0.80 | 4.20 | 1.00 | 3.15 | 1.48 |
Period 3 | 1.92 | 0.83 | 4.23 | 1.16 | 3.18 | 1.54 |
Period 4 | 2.02 | 0.96 | 3.88 | 1.20 | 3.04 | 1.43 |
Total over periods | 1.91 | 1.08 | 4.18 | 1.09 | 3.05 *** | 1.10 |
Less people received the STI/HIV care that they needed b | ||||||
Period 1 | 2.87 | 1.31 | 4.24 | 1.17 | 3.63 2,4 | 1.41 |
Period 2 | 2.70 | 1.20 | 3.98 | 1.03 | 3.41 1,4 | 1.28 |
Period 3 | 2.72 | 1.21 | 3.95 | 1.18 | 3.40 4 | 1.33 |
Period 4 | 2.60 | 1.14 | 3.50 | 1.22 | 3.10 1,2,3 | 1.26 |
Total over periods | 2.72 | 1.35 | 3.92 | 1.34 | 3.32 *** | 1.36 |
3. Shifts to online counseling and care | ||||||
In my practice/center, the number of face-to-face consultations for STI/HIV care was… a | ||||||
Period 1 | 1.38 | 0.71 | 1.26 | 0.75 | 1.32 2,3,4 | 0.73 |
Period 2 | 2.43 | 0.90 | 2.03 | 0.90 | 2.21 1,3,4 | 0.92 |
Period 3 | 2.15 | 0.83 | 1.81 | 0.83 | 1.96 1,2,4 | 0.85 |
Period 4 | 3.28 | 0.84 | 2.63 | 1.04 | 2.92 1,2,3 | 1.01 |
Total over periods | 2.31 | 0.70 | 1.93 | 0.77 | 2.12 ** | 0.78 |
In my practice/center, the number of telephone or online consultations was… a | ||||||
Period 1 | 3.56 | 1.66 | 3.64 | 1.48 | 3.60 | 1.57 |
Period 2 | 3.37 | 1.20 | 3.35 | 1.19 | 3.35 | 1.19 |
Period 3 | 3.49 | 1.25 | 3.51 | 1.22 | 3.50 | 1.23 |
Period 4 | 3.51 | 0.92 | 3.38 | 0.86 | 3.44 | 0.89 |
Total over periods | 3.48 | 1.23 | 3.46 | 1.25 | 3.47 | 1.30 |
In my practice/center, referring to online STI/HIV testing by private providers was… a | ||||||
Period 1 | 2.64 | 0.90 | 4.04 | 1.04 | 3.37 | 1.20 |
Period 2 | 2.68 | 0.66 | 3.76 | 0.84 | 3.24 | 0.93 |
Period 3 | 2.74 | 0.68 | 3.75 | 0.96 | 3.27 | 0.97 |
Period 4 | 2.89 | 0.60 | 3.27 | 0.97 | 3.09 | 0.71 |
Total over periods | 2.74 | 0.79 | 3.71 | 0.87 | 3.22 *** | 0.92 |
In my practice/center, the space for personal STI/HIV counseling was… a | ||||||
Period 1 | 2.15 | 0.96 | 1.59 | 0.75 | 1.85 2,3,4 | 0.90 |
Period 2 | 2.67 | 0.65 | 2.28 | 0.70 | 2.46 1,4 | 0.70 |
Period 3 | 2.56 | 0.67 | 2.12 | 0.73 | 2.33 1,4 | 0.73 |
Period 4 | 2.87 | 0.66 | 2.72 | 0.70 | 2.79 1,2,3 | 0.68 |
Total over periods | 2.56 | 0.68 | 2.18 | 0.70 | 2.37 *** | 0.69 |
STI/HIV care has become more efficient a | ||||||
Period 1 | 2.58 | 1.06 | 2.65 | 1.24 | 2.62 2,3,4 | 1.16 |
Period 2 | 2.74 | 1.06 | 2.87 | 1.16 | 2.82 1,4 | 1.11 |
Period 3 | 2.79 | 1.14 | 2.89 | 1.15 | 2.85 1,4 | 1.14 |
Period 4 | 2.84 | 1.15 | 3.04 | 1.19 | 2.96 1 | 1.17 |
Total over periods | 2.74 | 1.09 | 2.86 | 1.09 | 2.80 | 1.11 |
4. Quality assurance of STI/HIV care | ||||||
Quality of STI/HIV care was lower than before COVID-19 b | ||||||
Period 1 | 2.82 | 1.30 | 3.26 | 1.53 | 3.07 2,3,4 | 1.44 |
Period 2 | 2.43 | 1.04 | 2.84 | 1.36 | 2.66 1,4 | 1.19 |
Period 3 | 2.45 | 1.02 | 2.84 | 1.36 | 2.67 1,4 | 1.23 |
Period 4 | 2.32 | 1.07 | 2.47 | 1.40 | 2.41 1,2,3 | 1.27 |
Total over periods | 2.51 | 1.15 | 2.86 | 1.16 | 2.68 | 1.17 |
STI/HIV care to vulnerable populations was negatively impacted b | ||||||
Period 1 | 3.37 | 1.15 | 4.44 | 0.90 | 3.98 2,3,4 | 1.14 |
Period 2 | 3.05 | 1.09 | 4.15 | 1.00 | 3.67 1,4 | 1.17 |
Period 3 | 2.98 | 1.07 | 4.23 | 1.06 | 3.68 1,4 | 1.23 |
Period 4 | 2.95 | 0.99 | 3.79 | 1.21 | 3.42 1,2,3 | 1.19 |
Total over periods | 3.09 | 0.97 | 4.16 | 0.97 | 3.62 *** | 0.98 |
People in vulnerable circumstances at elevated STI/HIV risk went off-radar more b | ||||||
Period 1 | 2.93 | 1.23 | 4.23 | 0.98 | 3.59 2,3,4 | 1.24 |
Period 2 | 2.66 | 1.06 | 3.85 | 0.89 | 3.32 1,4 | 1.13 |
Period 3 | 2.61 | 1.07 | 3.85 | 0.89 | 3.30 1,4 | 1.22 |
Period 4 | 2.44 | 1.00 | 3.50 | 1.09 | 3.03 1,2,3 | 1.17 |
Total over periods | 2.66 | 0.97 | 3.83 | 0.97 | 3.24 *** | 0.97 |
My job satisfaction was… a | ||||||
Period 1 | 2.19 | 1.00 | 2.14 | 0.92 | 2.16 2,4 | 0.95 |
Period 2 | 2.62 | 0.88 | 2.56 | 0.82 | 2.59 1,3 | 0.85 |
Period 3 | 2.23 | 0.80 | 2.37 | 0.94 | 2.30 2,4 | 0.87 |
Period 4 | 2.43 | 0.91 | 2.65 | 0.83 | 2.55 1,3 | 0.87 |
Total over periods | 2.37 | 0.83 | 2.43 | 0.88 | 2.40 | 0.86 |
In my practice/center, the opportunities for mentoring and professional education were… a | ||||||
Period 1 | 2.02 | 1.02 | 1.56 | 0.88 | 1.77 2,3,4 | 0.97 |
Period 2 | 2.38 | 0.94 | 1.86 | 0.73 | 2.09 1,4 | 0.86 |
Period 3 | 2.35 | 0.89 | 1.92 | 0.79 | 2.11 1,4 | 0.86 |
Period 4 | 2.69 | 0.72 | 2.37 | 0.67 | 2.51 1,2,3 | 0.71 |
Total over periods | 2.36 | 0.86 | 1.93 | 0.85 | 2.14 ** | 0.86 |
In my practice/center, the workload was… a | ||||||
Period 1 | 2.97 | 1.49 | 3.72 | 1.46 | 3.34 3,4 | 1.52 |
Period 2 | 3.71 | 0.94 | 3.54 | 1.20 | 3.63 3,4 | 1.07 |
Period 3 | 4.17 | 0.94 | 3.60 | 1.18 | 3.89 1,2,4 | 1.10 |
Period 4 | 4.43 | 0.78 | 3.95 | 1.04 | 4.19 1,2,3 | 0.95 |
Total over periods | 3.82 | 1.02 | 3.70 | 1.13 | 3.76 | 1.08 |
GP Practice | PSHS | HIV Clinic | Private Online Testing Provider |
---|---|---|---|
1. Access to STI/HIV care for priority populations | |||
“Those very vulnerable groups, the question is whether we really saw them. At one point I had someone at the consultation […]. That turned out to be someone who had had paid sex. It turned out she had been walking around with trichomonas all that time, but she didn’t dare to come because it was corona time. She had quite a lot of symptoms and yes, also a risk of passing it on of course. Yes, I found that quite shocking.” | “We [normally] do a lot of outreach, of course. So, we go […] to sex workers, to a group that stands up for lgbti+ interests, or to [agency X] for women who are here illegally. There are all kinds of projects for that, but they’re just temporarily shut down.” | “I notice that the PSHS is still busy with COVID, so my HIV-patients […] have nowhere to go. GPs often can’t, don’t know, do not take anal swabs, the PSHS has no space, and my first spot here at dermatology is end of November.” “What I said: refugees, there are a lot of MSM, and HIV problems are common. And they can’t find us. […] Actually, we had to learn that it was not the best decision, to close [outreach] immediately, when the corona crisis started.” | “Before corona we saw more low-risk, more young people and ‘security seekers’. […] In the corona period we saw more MSM. We saw that in the test results: there was more syphilis, more anal tests were ordered by men, which heterosexual men don’t do.” “Also the percentage of people that contacted [the client service] increased. Because these people were used to someone explaining the procedures. And now they had to do it themselves. So they just had more questions.” |
2. Demand and availability of STI/HIV care | |||
“I think a large part of the men started to limit their contacts, and many did not have any contacts whatsoever. So on the one hand, the demand was lowered, but on the other hand, we started delivering more care to other people.” “People also rather didn’t want to go sit in the waiting room. […] What I hear back, is ‘actually I had these complaints a bit longer already’, like a contact bleeding, but they thought ‘maybe it will pass’.” | “Because of the lockdown, very few men were still having sex. Because everybody stayed home. In the first lockdown, we all had the motivation to stay home. And I really think that there was less sex.” | “It’s not the case that we received more people in the clinic saying they could not get PrEP.” | “My dream would be that you have a network with GPs and PSHS and the right online providers. That wherever you want to test, you get the right and good care. That they work together. That if there is a positive gonorrhea test in one part of the country, that you can go to your GP for treatment but can test with us.” |
3. Shifts to online counseling and care | |||
“The module we use is not very user friendly. So it goes both ways. The patient had a hard time filling out the application, and the doctor had a hard time getting it operational.” | “We also had a lot of technical problems. The wifi did not work, the connection failed, and you think ‘man, what a hassle’. For the same amount of money I could just visit [the client].” | “I think that because of COVID, things have gained momentum. […] The measuring of your own blood pressure and weight at home, that is also increased. But to be honest, my impression is that this is mainly the case for the health empowered, higher educated, white gay men, to put it bluntly. There is a large group that does not appreciate this. […] In the end it is not about us, but what your client prefers most.” | “What I also think is that apart from the PSHS closing, people also had a fear and discomfort of bothering the GP […]. “I’ll get it tested myself” was said frequently, and there was more active referral. It’s more accepted [to get tested at a private provider].” “Actually, this [online testing] really took off because of COVID. […] A GP that did not want to do [a test] and asked ‘I want you to have complaints before you come here’. Well, you know, asymptomatic infections are common with STIs.” |
4. Quality assurance of STI/HIV care | |||
“Well, if a GP practice has to organize vaccination in addition to actually catching up on care for people with complaints who have often waited too long, who need all kinds of complex care…” | “And then very occasionally, I have a man who has syphilis and is a sex worker, and he asks, “is PrEP something for me?”. Yes! And then he asks: ‘When can I start?’, ‘Yesterday’, I say. And then I [prescribe] PrEP, and then he goes again, and then he disappears again. Then he goes off the radar. Then he moves house, and then he doesn’t come anymore. So I struggle to get the vulnerable people to stay with us. The non-vulnerable people, they will come. I don’t worry about them.” | “You notice that, instead of half an hour face-to-face [consultation], in which you also take non-verbal attitude and mental wellbeing into account, we now telephoned for 5 minutes, in which you ask ‘how is it going’, talk about COVID, discuss the lab results for people with HIV, and then make an appointment for in six months, thinking, at the time, that it would be face-to-face.” | “Look at those commercial corona ‘test streets’ that now have limited demand of clients, they are now throwing themselves en masse into STI testing. We are genuinely concerned about that, because are they going to offer the quality needed, if you offer these kind of diagnostic tests? That’s almost impossible.” |
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Reilingh, A.; Van Ditzhuijzen, J.; Albers, T.; Bos, H.; De Wit, J. The Impact of the COVID-19 Pandemic on STI and HIV Services in the Netherlands According to Health Care Professionals. Int. J. Environ. Res. Public Health 2024, 21, 678. https://doi.org/10.3390/ijerph21060678
Reilingh A, Van Ditzhuijzen J, Albers T, Bos H, De Wit J. The Impact of the COVID-19 Pandemic on STI and HIV Services in the Netherlands According to Health Care Professionals. International Journal of Environmental Research and Public Health. 2024; 21(6):678. https://doi.org/10.3390/ijerph21060678
Chicago/Turabian StyleReilingh, Annemarie, Jenneke Van Ditzhuijzen, Thijs Albers, Hanna Bos, and John De Wit. 2024. "The Impact of the COVID-19 Pandemic on STI and HIV Services in the Netherlands According to Health Care Professionals" International Journal of Environmental Research and Public Health 21, no. 6: 678. https://doi.org/10.3390/ijerph21060678