ABSTRACT
BACKGROUND: Sexual health service disruptions due to COVID-19 mitigation measures may have decreased gonorrhea screening and biased case-ascertainment towards symptomatic individuals. We assessed changes in reported symptoms and other characteristics among reported gonorrhea cases during- vs. pre-pandemic periods in one city with persistent gonorrhea transmission. METHODS: Enhanced surveillance data collected on a random sample of gonorrhea cases reported to the Baltimore City Health Department between March 2018-September 2021 was used. Logistic regression assessed differences in case characteristics by diagnosis period (during-pandemic: March 2020-September 2021; pre-pandemic: March 2018-September 2019). RESULTS: Analyses included 2,750 (1,090 during-pandemic, 1,660 pre-pandemic) gonorrhea cases, representing 11,904 reported cases. During- vs. pre-pandemic, proportionally fewer cases were reported by sexual health clinics (8.8% vs. 23.2%), and more frequently reported by emergency departments/urgent care centers (23.3% vs. 11.9%). Adjusting for diagnosing provider, fewer cases who were males with urethral infections [aOR: 0.65, 95% CI: (0.55-0.77)], aged <18 [aOR: 0.64, (0.47-0.89)], and females [aOR: 0.84, (0.71-0.99)] were reported, and cases with insurance [aOR: 1.85, (1.40-2.45)], living with HIV [aOR: 1.43, (1.12-1.83)], or recent (≤12 months) gonorrhea history [aOR: 1.25, (1.02-1.53)] were more frequently reported during- vs. pre-pandemic. Reported symptoms and same-day/empiric treatment did not differ across periods. CONCLUSIONS: We observed no changes in reported symptoms among cases diagnosed during- vs. pre-pandemic. Increased frequency of reported diagnoses who were insured, living with HIV, or with recent gonorrhea history are suggestive of differences in care access and/or care seeking behaviors among populations with high gonorrhea transmission during the pandemic.
ABSTRACT
Background. Although research dissemination to participants and community stakeholders is a fundamental component of translational research, it rarely occurs. The objective of this study was to create a community-led, theory-based dissemination plan to engage local Black sexual minority men in an active dissemination process throughout a sexual health research study. Method. Seven focus groups (N = 38) were conducted with Black, cisgender sexual minority men aged 18 to 45 years. Findings were analyzed through thematic content analysis guided by McGuire's persuasive communication theory. Findings were used to draft a dissemination plan, which was then reviewed and edited by the study's community advisory board (CAB). The plan continues to be updated in response to community needs through CAB discussions. Results. Participants preferred messages concerning syphilis and other health concerns as well as information on local resources. Preferred sources included researchers working with trusted community organizations and leaders. Preferred channels included community events and social media, implemented with consistency. CAB feedback included expanding the target audience of dissemination efforts as well as the development of ideas for channels (i.e., events) and sources (i.e., community organizations and leaders). Additional revisions occurred in response to the COVID-19 pandemic. Conclusion. Given the continued lack of research dissemination to participant and community stakeholders, the process of developing a community-led, theory-based dissemination plan may benefit and help guide researchers to adopt this practice. It is critical that participant and community stakeholder dissemination become more highly prioritized as we strive for public health improvements and the elimination of health disparities.
ABSTRACT
BACKGROUND: The impact of coronavirus disease 2019 (COVID-19) mitigation measures on sexually transmitted infection (STI) transmission and racial disparities remains unknown. Our objectives were to compare sex and drug risk behaviors, access to sexual health services, and STI positivity overall and by race during the COVID-19 pandemic compared with pre-pandemic among urban sexual minority men (MSM). METHODS: Sexually active MSM aged 18-45 years were administered a behavioral survey and STI testing every 3-months. Participants who completed at least 1 during-pandemic (April 2020-December 2020) and 1 pre-pandemic study visit (before 13 March 2020) that occurred less than 6 months apart were included. Regression models were used to compare during- and pre-pandemic visit outcomes. RESULTS: Overall, among 231 MSM, reports of more than 3 sex partners declined(pandemic-1: adjusted prevalence ratio 0.68; 95% confidence interval: .54-.86; pandemic-2: 0.65, .51-.84; pandemic-3: 0.57, .43-.75), substance use decreased (pandemic-1: 0.75, .61-.75; pandemic-2: 0.62, .50-.78; pandemic-3: 0.61, .47-.80), and human immunodeficiency virus/preexposure prophylaxis care engagement (pandemic-1: 1.20, 1.07-1.34; pandemic-2: 1.24, 1.11-1.39; pandemic-3: 1.30, 1.16-1.47) increased. STI testing decreased (pandemic-1: 0.68, .57-.81; pandemic-2: 0.78, .67-.92), then rebounded (pandemic-3: 1.01, .87-1.18). Nei-ther Chlamydia (pandemic-2: 1.62, .75-3.46; pandemic-3: 1.13, .24-1.27) nor gonorrhea (pandemic-2: 0.87, .46 1.62; pandemic-3: 0.56, .24-1.27) positivity significantly changed during vs pre-pandemic. Trends were mostly similar among Black vs. non-Black MSM. CONCLUSIONS: We observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared with pre-pandemic. Our findings underscore the need for novel STI prevention strategies that can be delivered without in-person interactions.