The Ongoing Impact of COVID-19 on Testing for and Diagnoses of HIV and Bacterial Sexually Transmitted Infections in Oregon.

BACKGROUND: The COVID-19 pandemic has disrupted HIV and sexually transmitted infection (STI) testing accessibility. We sought to assess the longer-term impacts of COVID-19 on HIV and STI testing and diagnosis in Oregon. METHODS: First, we examined HIV, Neisseria gonorrhoeae / Chlamydia trachomatis (CT), and syphilis tests conducted at the Oregon State Public Health Laboratory (public sector) and a large commercial laboratory (private sector) and HIV, N. gonorrhoeae , CT, and primary and secondary (P&S) syphilis diagnoses in Oregon from January 1, 2019, to December 31, 2021. We compared monthly testing and diagnosis rates in 5 prespecified periods: pre-COVID-19 (January 2019-February 2020), stay-at-home order (March 2020-May 2020), reopening (June 2020-December 2020), vaccine availability (January 2021-June 2021), and Delta/early Omicron spread (July 2021-December 2021). Second, we calculated the number of HIV and STI diagnoses per test in the public and private sectors. Finally, we used seasonal autoregressive integrated moving average models to predict expected HIV and STI diagnoses for comparison to those observed. RESULTS: Both public and private sector HIV and bacterial STI testing fell to nadirs in April 2020 with incomplete recovery to 2019 levels by the close of 2021. Compared with pre-COVID-19, public sector and private sector testing was significantly lower in all subsequent periods. Compared with pre-COVID-19, P&S syphilis cases were 52%, 75%, and 124% greater in the reopening, vaccine availability, and Delta/early Omicron periods, respectively. From March 2020 to December 2021, we observed an excess of P&S syphilis cases (+37.1%; 95% confidence interval, 22.2% to 52.1%) and a deficit in CT cases (-10.7%; 95% confidence interval, -15.4% to -6.0%). CONCLUSIONS: By December 2021, HIV/STI testing had not recovered to pre-COVID-19 levels, and HIV/STI continues to be underdiagnosed. Despite decreased testing, P&S syphilis cases have increased substantially.

‘Stepping up to Reg’ – a near peer regional teaching programme to support level 1 trainees’ transitioning to the middle-grade rota

BackgroundThe promotion from ‘SHO’ to ‘Registrar’ can be daunting. As a group of senior trainees, we were keen to support our more junior colleagues through this transition by providing a bespoke ‘Stepping up to Reg’ teaching programme, utilising our own recent experiences targeted with stakeholder feedback.ObjectivesTo identify perceived areas for development ahead of transitioning to a middle-grade rota from SHO, consultant and recently appointed registrar perspectives. To create and facilitate a teaching programme to meet these perceived learning needs.MethodsSupported by the Northern Ireland Medical and Dental Training Agency (NIMDTA) School of Paediatrics we assembled a faculty of senior trainees to create and deliver the teaching programme. A pre-course online questionnaire, completed by both SHOs and consultants, identified areas of perceived learning needs and was used to design the content of the programme. The SHO questionnaire included a 5-point Likert scale, to assess their perceived preparedness for certain aspects of the job;managing a resuscitation, phoning the consultant on-call, managing out-patients, safeguarding, prioritising workload and managing colleagues.The same questionnaire was completed 6 months later to assess the experience of their first registrar post and ask ‘in hindsight’ how prepared they actually were to transition for those certain aspects of the job. We then compared these responses to the same questions posed prior to the transition using the Man Whitney U-test.Faced with COVID-19 restrictions we adapted to virtual delivery creating an interactive half day online programme, with the use of breakout rooms, case presentations and question/answer sessions.ResultsThe SHO (n=15) and consultant (n=12) pre-course questionnaires identified some similar themes for development, including the management of paediatric and neonatal emergencies and team management/prioritisation. However, SHOs initially emphasised further specific clinical scenarios as areas of concern whilst consultants suggested a greater focus should be on managerial and career development aspects.On the follow up questionnaire (n=7), trainees identified ‘managing junior colleagues’ as the most challenging aspect of their first registrar post with less emphasis on the management of clinical scenarios.In hindsight, new registrars felt that they were actually better prepared than they had initially thought ‘in general’ (p<0.05) and specifically for ‘managing resuscitations’ and ‘safeguarding scenarios’ (p<0.05). Interestingly, they expressed being less well prepared for ‘managing colleagues’ than they had initially anticipated but this did not reach statistical significance.ConclusionsSHO anxiety during the transition to middle-grade relates to the responsibility of managing emergency situations, but following a 6-month period of ‘on the job’ experience they identified managerial aspects of the role as the biggest challenge, more in line with what consultants had already identified as an important area for development.Trainees responded positively to this near peer teaching programme with plans in place for this to be an annual event. Future iterations of the course need to be revised to continue to incorporate feedback from all stakeholders.

Seroprevalence of SARS-CoV-2 antibodies in children of United Kingdom healthcare workers: a prospective multicentre cohort study protocol.

BACKGROUND: A novel coronavirus SARS-CoV-2 has been responsible for a worldwide pandemic. Children typically have very mild, or no, symptoms of infection. This makes estimations of seroprevalence in children difficult. Research is therefore required to determine the seroprevalence of SARS-CoV-2 antibodies in children. The primary objective of this study is to report the seroprevalence of SARS-CoV-2 IgM and/or IgG antibodies in healthy children at baseline, 2 months and 6 months. This is the only longitudinal UK study of seroprevalence in an exclusively paediatric population. Determining the changing seroprevalence is of vital public health importance and can help inform decisions around the lifting of paediatric specific social distancing measures such as school closures and the cancellation of routine paediatric hospital services. METHODS AND ANALYSIS: 1000 healthy children of healthcare workers aged between 2 and 15 years will be recruited from five UK sites (Belfast, Cardiff, Glasgow, London and Manchester). The children will undergo phlebotomy at baseline, 2 months and 6 months to measure IgM and/or IgG positivity to SARS-CoV-2. A sample size of 675 patients is required to detect a 5% change in seroprevalence at each time point assuming an alpha of 0.05 and a beta of 0.2. Adjusted probabilities for the presence of IgG and/or IgM antibodies and of SARS-CoV-2 infection will be reported using logistic regression models where appropriate. ETHICS AND DISSEMINATION: Ethical approval was obtained from the London - Chelsea Research Ethics Committee (REC Reference-20/HRA/1731) and the Belfast Health & Social Care Trust Research Governance (Reference 19147TW-SW). Results of this study will be made available as preprints and submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT0434740; Results.

Seroprevalence of SARS-CoV-2 antibodies in children: a prospective multicentre cohort study.

BACKGROUND: Studies based on molecular testing of oral/nasal swabs underestimate SARS-CoV-2 infection due to issues with test sensitivity, test timing and selection bias. The objective of this study was to report the presence of SARS-CoV-2 antibodies, consistent with previous infection. DESIGN: This multicentre observational cohort study, conducted between 16 April to 3 July 2020 at 5 UK sites, recruited children of healthcare workers, aged 2-15 years. Participants provided blood samples for SARS-CoV-2 antibody testing and data were gathered regarding unwell contacts and symptoms. RESULTS: 1007 participants were enrolled, and 992 were included in the final analysis. The median age of participants was 10·1 years. There were 68 (6.9%) participants with positive SARS-CoV-2 antibody tests indicative of previous SARS-CoV-2 infection. Of these, 34/68 (50%) reported no symptoms prior to testing. The presence of antibodies and the mean antibody titre was not influenced by age. Following multivariable analysis four independent variables were identified as significantly associated with SARS-CoV-2 seropositivity: known infected household contact OR=10.9 (95% CI 6.1 to 19.6); fatigue OR=16.8 (95% CI 5.5 to 51.9); gastrointestinal symptoms OR=6.6 (95% CI 3.0 to 13.8); and changes in sense of smell or taste OR=10.0 (95% CI 2.4 to 11.4). DISCUSSION: Children demonstrated similar antibody titres in response to SARS-CoV-2 irrespective of age. Fatigue, gastrointestinal symptoms and changes in sense of smell or taste were the symptoms most strongly associated with SARS-CoV-2 antibody positivity. TRIAL REGISTRATION NUMBER: NCT0434740.