Reduced Odds of Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection After Vaccination Among New York City Adults, July 2021-November 2021.

BACKGROUND: Belief that vaccination is not needed for individuals with prior infection contributes to coronavirus disease 2019 (COVID-19) vaccine hesitancy. Among individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before vaccines became available, we determined whether vaccinated individuals had reduced odds of reinfection. METHODS: We conducted a case-control study among adult New York City residents who tested positive for SARS-CoV-2 infection in 2020 and had not died or tested positive again >90 days after an initial positive test as of 1 July 2021. Case patients with reinfection during July 2021-November 2021 and controls with no reinfection were matched (1:3) on age, sex, timing of initial positive test in 2020, and neighborhood poverty level. Matched odds ratios (mORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. RESULTS: Of 349 827 eligible adults, 2583 were reinfected during July 2021-November 2021. Of 2401 with complete matching criteria data, 1102 (45.9%) were known to be symptomatic for COVID-19-like illness, and 96 (4.0%) were hospitalized. Unvaccinated individuals, compared with individuals fully vaccinated within the prior 90 days, had elevated odds of reinfection (mOR, 3.21; 95% CI, 2.70 to 3.82), of symptomatic reinfection (mOR, 2.97; 95% CI, 2.31 to 3.83), and of reinfection with hospitalization (mOR, 2.09; 95% CI, .91 to 4.79). CONCLUSIONS: Vaccination reduced odds of reinfections when the Delta variant predominated. Further studies should assess risk of severe outcomes among reinfected persons as new variants emerge, infection- and vaccine-induced immunity wanes, and booster doses are administered.

An investigation of the impact of the Global Gag Rule on women's sexual and reproductive health outcomes in Uganda: a difference-in-differences analysis.

In 2017, the Trump administration reinstated the Global Gag Rule (GGR), making non-U.S. non-governmental organisations ineligible for US government global health assistance if they provide access to or information about abortion. Little is known about the impact of the Trump administration's GGR on women's outcomes. Data for this analysis come from a panel of women surveyed in 2018 and 2019 in Uganda (n = 2755). We also used data from meetings with key stakeholders to create a detailed measure of exposure to the GGR within Uganda, classifying districts as more or less exposed to the GGR. Multivariable regression models were used to assess changes in contraceptive use, all births, unplanned births, and abortion from before to during implementation of the GGR. Difference-in-differences (DID) estimates were determined by calculating predicted probabilities from interaction terms for exposure/survey round. Descriptive analyses showed long-acting reversible contraceptive use increased more rapidly among women in less exposed districts after GGR implementation. DID estimates for contraceptive use were small. We observed a DID estimate of 3.5 (95% CI -0.9, 7.9) for all births and 2.9 (95% CI -0.2, 6.0) for unplanned births for women in more exposed districts during the period the policy was in effect. Our results suggest that the GGR may have attenuated Uganda's recent progress in improving SRHR outcomes, with women in less exposed districts continuing to benefit from this progress, while previously increasing trends for women in more exposed districts levelled off. Although the GGR was rescinded in January 2021, the impact of these disruptions may be felt for years to come.

Trends in U.S. adolescent sexual behavior and contraceptive use, 2006-2019.

OBJECTIVE: This study examines changes over time in the prevalence of select sexual behaviors and contraceptive use measures in a national sample of U.S. adolescents. STUDY DESIGN: We used data on adolescents aged 15-19 from the 2006-2010 (n=4,662), 2011-2015 (n=4,134), and 2015-2019 (n=3,182) National Surveys of Family Growth. We used logistic regression to identify changes between periods in sexual behaviors and contraceptive use by gender, and for some measures by age. We estimated probabilities of age at first penile-vaginal intercourse with Kaplan-Meier failure analysis. RESULTS: Over half of adolescents have engaged in at least one of the sexual behaviors measured. Males reported declines in sexual behaviors with a partner of a different sex. Adolescent males reported delays in the timing of first penile-vaginal intercourse. Adolescent females reported increases from 2006-2010 to 2015-2019 in use at last intercourse of any contraceptive method (86%, 95%CI 83-89; 91%, 95%CI 88-94), multiple methods (26%, 95%CI 22-31; 36%, 95%CI 30-43), and IUDs or implants (3%, 95%CI 1-4; 15%, 95%CI 11-20). Adolescent males reported increases in partners' use of IUDs or implants use from <1% to 5% and recent declines in condom use at last intercourse (78%, 95%CI 75-82, 2011-2015; 72%, 95%CI 67-77, 2015-2019). Condom consistency declined over time. Males were more likely than females to report condom use at last intercourse and consistent condom use in the last 12 months. CONCLUSIONS: These findings identify declines in male adolescent sexual experience, increased contraceptive use overall, and declines in consistent condom use from 2006 to 2019. IMPLICATIONS: This analysis contributes a timely update on adolescent sexual behavior trends and contraceptive use, showing that adolescent behaviors are complex and evolving. Sexual health information and services must be available so that young people have the resources to make healthy and responsible choices for themselves and their partners.

Budgeting for comprehensive sexual and reproductive health and rights under universal health coverage.

Achieving universal health coverage (UHC) for sexual and reproductive health (SRH) requires informed budgeting that is aligned with UHC objectives. We draw data from Adding It Up 2019 (AIU-2019) to provide critical new country-level and regional, intervention-specific costs for the provision of SRH services. AIU-2019 is a cost-outcomes analysis, undertaken from the health system perspective, which estimates the costs and impacts of offering SRH care in low- and middle-income countries. We present direct cost estimates for 109 SRH interventions and find that human resources comprise the largest category of direct SRH service costs and that the most expensive services in the model are largely preventable. We use scenario analysis to explore the synergistic costs and impacts of providing SRH interventions in clusters, focussing on chlamydia and gonorrhoea treatment, provision of safe abortion and post-abortion care services, and safe childbirth services. When costs are considered for the preventive and impacted services in these three clusters, there are cost savings for some of the impacted services in the packages and for the abortion-related package overall. The direct cost estimates from our analysis can be used to guide UHC budgeting and planning efforts. Having these cost estimates and understanding the potential for cost savings when providing comprehensive SRH services are critical for efforts to fulfil the rights and needs of all individuals, including the most marginalised, to access this essential care.