UK sexual health services are being decimated by COVID-19

Nearly half of doctors surveyed say that capacity to see patients in person has shrunk by more than 80%
Image credit: Gustavo Fring / Pexels

A rapid survey conducted by the British Association for Sexual Health and HIV (BASHH) has found that in-person services for patients needing STI tests and treatments, contraception, and HIV testing, medications and PrEP have shrunk drastically since the COVID-19 pandemic hit the UK in mid-March.

Fifty-four per cent of local clinics have closed altogether, and staffing is less than half of what it was at the beginning of March.

STI services are preserving as much capacity as they can to meet patients’ needs by rapidly expanding online and phone services; instituting phone triage to restrict in-person attendance to emergencies; retrenching services to operate only in the largest ‘hub’ clinics; and posting out far more STI and HIV home-testing kits plus prescriptions to be filled at high street pharmacies.

Glossary

capacity

In discussions of consent for medical treatment, the ability of a person to make a decision for themselves and understand its implications. Young children, people who are unconscious and some people with mental health problems may lack capacity. In the context of health services, the staff and resources that are available for patient care.

long-acting

In pharmacology, a medication which maintains its effects over a long period of time, such as an injection or implant.

oral

Refers to the mouth, for example a medicine taken by mouth.

post-exposure prophylaxis (PEP)

A month-long course of antiretroviral medicines taken after exposure or possible exposure to HIV, to reduce the risk of acquiring HIV.

home testing

The term may be used to describe either self-testing or self-sampling. 

If these virtual services are counted, then 56% of respondents reported managing to preserve more than 50% of their pre-coronavirus capacity. Many in-clinic services such as injectable STI treatments, oral contraception, HIV post-exposure prophylaxis (PEP), and services to vulnerable populations such as homeless people are being preserved.

However, the provision of long-acting injectable contraceptives, routine vaccinations, and microscopy to confirm STI diagnoses have suffered, with only a third of clinics, for instance, able to provide the Depo-Provera contraceptive. Nine per cent of clinics report not being able to provide HIV pre-exposure prophylaxis (PrEP) and another 20% have very limited capacity.

One hundred and ninety-six BASHH members – doctors, nurses, pharmacists and others – responded to the survey between 7 April and 17 April. Because many staff operate at a number of local clinics, the respondents were between them were working at, or part of a network of, 456 different sites that offered STI services – 54% fewer than at the beginning of March. Responses were received from all regions and all countries of the United Kingdom.

Fifty-three per cent said they were operating less than 20% of their pre-COVID in-person appointments. Regarding HIV services specifically, 54% reported a more than 80% shrinkage in appointments and 35% a more than 90% drop.

One respondent commented, “We have no personal protective equipment (PPE) so are operating no personal appointments at all currently.” Another said, “Our team of 70 has shrunk to seven.”

Respondents reported that 48% of their staff were still in service; 38% had been redeployed to COVID-19 care; and 17% were shielding or isolating at home, or ill.

Eighty per cent reported that their capacity to offer HIV appointments had shrunk by more than half; 12% reported the same of STI appointments and 90% of contraceptive appointments.

More than half of prescriptions – 55% for STIs and 59% for HIV – are being sent by post. In contrast, courier-delivered services have not grown much, with only 45% of sites able to offer couriered HIV drugs.

In some cases, local logistical or bureaucratic delays have meant that patients are still collecting meds or prescriptions “at the clinic door.” One particular issue is that prescriptions for STIs and HIV should be exempt from prescription changes, but some high street pharmacies are refusing to accept clinics’ endorsements of free prescriptions.

One respondent said: “One pharmacy did not recognise the endorsement but [our] clinic shared documents and issue was resolved. [We] have contacted pharmacist at clinical care group about educating local pharmacists in case this arises again; info to be sent out in news bulletin.”

Another said: “We have not had posting medicines approved by our medical management committee and therefore are giving them out at the clinic door rather than posting or sending FP10s (free prescription endorsements) where people cannot travel.”

And one doctor was acting as a courier: “We only have a base site. Patients can attend (outside the clinic door) to pick up essential medication / contraception supplies. The consultant (myself) has acted as the courier – on my drive home – dropping in meds to patients who are self-isolating.”

Ninety-nine per cent of clinics are operating phone triage to restrict in-person STI attendance and 92% the same for HIV appointments. Clinics have rapidly ramped up online and postal services: 77% are sending out home STI tests, 67% home HIV tests, and 35% are assessing people for STI treatment online.

One clinic said: “Demand is being managed with stringent telephone triage. This capacity represents the people who are still coming through the door after triage. We would have capacity to see a little more face-to-face, if we relaxed the triage criteria, but that…would 'open the floodgates' to overwhelming demand.”

Some services have to be done in person. Over 80% of clinics reported they were able to offer injectable STI medications such as benzathine penicillin (for syphilis) and ceftriaxone (for gonorrhoea) as well as oral contraceptives. Most were preserving their services to vulnerable populations such as people who use drugs and those with mental health problems – though most counselling and psychotherapy has gone online.

In contrast only 13% were still offering routine vaccinations, 14% long-acting contraceptives other than Depo-Provera, and only two-thirds were able to offer HIV PrEP and intra-uterine devices as emergency contraception.

References

The BASHH survey results can be read in full here.