The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave
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Abstract
Background
There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium.
Methods
Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence.
Results
Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%–42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%–5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%–8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy.
Conclusions
Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.
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SciScore for 10.1101/2021.09.18.21263630: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Eligible participants were age 18 years or older (or younger if the country’s Institutional Review Board and ethical regulation permitted it and the in-country lead ensured appropriate procedures), resided in the respective participating country, were capable of reading and understanding the survey language, could access an online survey, and were willing to provide informed consent.
Consent: Eligible participants were age 18 years or older (or younger if the country’s Institutional Review Board and ethical regulation permitted it and the in-country lead ensured appropriate procedures), resided in the respective participating country, were capable of reading and understanding the …SciScore for 10.1101/2021.09.18.21263630: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Eligible participants were age 18 years or older (or younger if the country’s Institutional Review Board and ethical regulation permitted it and the in-country lead ensured appropriate procedures), resided in the respective participating country, were capable of reading and understanding the survey language, could access an online survey, and were willing to provide informed consent.
Consent: Eligible participants were age 18 years or older (or younger if the country’s Institutional Review Board and ethical regulation permitted it and the in-country lead ensured appropriate procedures), resided in the respective participating country, were capable of reading and understanding the survey language, could access an online survey, and were willing to provide informed consent.Sex as a biological variable Secondary study aims were to examine changes in HIV/STI testing, harmful cultural practices (e.g., female genital mutilation/cutting and child marriage), mental health, and food security. Randomization not detected. Blinding not detected. Power Analysis The consortium recommended a sample size of at least 200, but precise sample size calculations were made by each country’s research team. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has several limitations. First, this was an online survey organized during COVID-19 measures, introducing risk for selection bias. Although there is no guideline for conducting online surveys, we used several strategies to limit bias, including the use of online panels, partnerships with organizations for sample recruitment, review of analytics, and prespecified analysis plans.13 Second, although we were able to capture data from different times during the COVID-19 epidemic, this was a series of retrospective cross-sectional studies, and we did not capture how sexual behaviors and access evolved over the course of the pandemic. A follow-up survey in selected countries is now underway. Third, our sample included more women, people with higher education, and people living in high-income countries compared to populations in respective countries. At the same time, data from one of the convenience samples included in this analysis suggested that the convenience sample included similar proportions of adults within subnational geographic areas compared to census data.30 Fourth, our study had fewer studies from low-income countries which may have been due to later COVID-19 initial waves and less capacity for research alongside the pandemic. At the same time, our main findings were robust when stratifying based on country income level. Although COVID-19 measures made it more difficult to obtain population-representative samples, we organized a multi-country analysis of data ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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