HIV Testing Disruptions and Service Adaptations During the COVID-19 Pandemic: A Systematic Literature Review.

Access to treatment and care in safe clinical settings improves people's lives with HIV. The COVID-19 pandemic disrupted vital HIV programs and services, increasing the risk of adverse health outcomes for people with HIV and HIV transmission rates in the community. This systematic literature review provides a meta-analysis of HIV testing disruptions and a synthesis of HIV/AIDS services adapted during COVID-19. We searched scholarly databases from 01 January 2020 to 30 June 2022 using key terms on HIV testing rates and services during the COVID-19 pandemic. The process of how the included articles were identified, selected, appraised, and synthesised was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included 17 articles that reported changes in HIV testing during the COVID-19 pandemic and 22 that reported adaptations in HIV/AIDS services. We found that HIV testing decreased by 37% during the search period because of the COVID-19 pandemic. Service providers adopted novel strategies to support remote service delivery by expanding community antiretroviral therapy dispensing, setting up primary care outreach points, and instituting multi-month dispensing services to sustain client care. Therefore, service providers and policymakers should explore alternative strategies to increase HIV testing rates impacted by COVID-19 and leverage funding to continue providing the identified adapted services.

Climate change aggravating migration and health issues in the African context: The views and direct experiences of a community of interest in the field.

Climate change is an increasingly important theme in Africa, where a large majority of its people depend on livestock and agricultural activities for livelihood. Concurrently, the topic of health of migrants and people on the move is rapidly raising both in the health debate and migration governance agenda in the Region. The link with climate change from the perspective of health and migration experts needs to be systematically addressed. Objectives: The article aims to contribute to the discourse on the interrelation of climate change, migration, and health by providing contributions of experts in the field of health and migration directly working with migrant and refugee communities in Africa. Methods: A webinar was conducted to collect and discuss first-hand experience with 25 participants from a postgraduate online course on health and migration funded by the Austrian Government and implemented in a co-operation of the Center for Health and Migration, Austria, with Makerere University, Uganda, the International Organization for Migration - UN Migration, and Lancet-Migration. As a result from the discussions, two cases from Sudan and Zimbabwe were selected to be further analysed with desk research to illustrate and underpin the points made. Results: All webinar participants reported to encounter climate change effects on health and migration in their professional practice. In their experience, climate change aggravates issues of health and migration by fueling forced migration and displacement, increasing health care needs, and deteriorating access to health care. Specific health challenges were identified for mental health problems caused by effects of climate change-induced migration, which remain widely undiagnosed and untreated, and the special affectedness of women and girls, with their mental, sexual and reproductive health severely deteriorated in insecure environments. The case studies from Sudan and Zimbabwe underline these observations. Conclusions: The interplay of effects of climate change, (internal) migration, and health is reported by a community of experts in the field of health and migration who are residing in Africa and working with migrant communities. Webinars prove to be an easy to implement tool to collect first hand evidence from practice experts, to foster exchange of experiences, and to get people engaged in further collaboration and discussion.

Impact of COVID-19 Pandemic on Women's Rights and Wellbeing: Analysis of the Ugandan Response to the Global Virus.

The COVID-19 pandemic caused dilemmas for the most vulnerable populations around the world. This article describes the gendered effects of the pandemic on Ugandan women's rights and wellbeing and provides suggestions for local and international practice. Mandatory lockdowns and movement restrictions created negative implications for women's attainment of economic, social, cultural, political and civil rights and intensified pre-existing gender inequalities between women and men. The findings of intensified gender inequities, gender-based violence, sexual abuse, scanty access to reproductive health services and social justice, and barriers to participation in education, employment and politics indicate that response measures were not aligned with the government's legal and policy framework for addressing gender inequities. This research indicates that governments, civil society organisations and the international community must undertake proper gender analysis in designing response measures and guidelines not only for COVID-19 but also in other emergencies. All response measures during emergencies must be coordinated, monitored and evaluated to ensure efficient and effective protection of the vulnerable and conformity to human rights standards.

Access to HIV/AIDS or TB care among refugees in Kampala, Uganda: exploring the enablers and barriers during the COVID-19 pandemic.

The rapid spread of COVID-19 has overwhelmed the existing health care systems, finding it challenging to provide essential health services besides the COVID-19 response interventions. Refugees are disproportionately affected by the COVID-19 pandemic because of the barriers they face to access health care. However, there is limited research that investigates how access to HIV/AIDS or TB care services by urban refugees is affected during pandemics such as the COVID-19. This study adopted a cross-sectional survey utilizing quantitative (N=229) and qualitative data (26 in-depth interviews and 8 key informant interviews) held among urban refugees living in Kampala, Uganda. Results revealed that more females (75%) than males (25%) were able to access TB or HIV/AIDS services during COVID-19 related lockdowns. A decrease in queues, delivery of drugs through Village Health Teams (VHTs), proximity to health facilities, supply of necessities like food and the reception at the health facilities facilitated access to TB or HIV/AIDS services. On the other hand, restrictions on public transport, high transport costs, unemployment and subsequent poverty were barriers to access to TB or HIV/AIDS services. Results offer major insights into the effect of COVID-19 control measures on disruption of access to services particularly in relation to being able to access service points. The findings suggest that recognizing structural barriers to uninterrupted or continued access to HIV/AIDS or TB services during pandemics such as COVID-19 can go a long way in helping stakeholders to design measures that make it possible for more urban refugees to access HIV/AIDS or TB services.

Adolescent sexual behaviour in a refugee setting in Uganda.

BACKGROUND: Children under 18 years old constituted more than half (52%) of the refugee population in 2017. Adolescent Sexual and reproductive health is an essential component of primary health care. Yet, not every refugee adolescent is able to access sexual and reproductive health services. METHODS: Using quantitative data from 356 refugee adolescents and qualitative data (17 in-depth interviews and nine key informant interviews), we examine refugee adolescent sexual behaviour in Bidibidi settlement-the largest refugee settlement in Uganda using a binary logistic regression model. RESULTS: The results show that 25% of refugee adolescents in Bidibidi refugee settlement had ever had sex. After controlling for all factors, results show that refugee adolescents aged 16-18 years (OR = 3.47; 95% CI = 1.09-10.94), males (OR = 17.59; 95% CI = 4.48-69.07), not in school (OR = 14.57; 95% CI = 2.20-96.35) were more likely to engage in sexual behaviour than their counterparts. Refugee adolescents who do not agree that a girl cannot get pregnant if she has sex while standing up (knowledge about getting pregnant) were significantly less associated with sexual behaviour (OR = 0.30; 95% CI = 0.10-0.85). CONCLUSIONS: Results from this study show that keeping refugee adolescents in school and providing sexual and reproductive health information are likely to delay refugee adolescents' engagement in sexual behaviour. Therefore, there is need to promote keeping refugee adolescents in school in order to improve sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda.

Sexual and reproductive health is an essential component of primary health care. Limited access to sexual and reproductive health (SRH) services for adolescent refugees particularly in low income countries can affect their reproductive health. Similarly, limited knowledge of the determinants of sexual behaviour of adolescent refugees in low income countries puts them at risk of SRH challenges.This study uses quantitative data from 356 adolescent refugees and qualitative (17 in-depth interviews with adolescent refugees and nine key informant interviews with service providers) to examine the factors that influence the sexual behaviour of adolescent refugees in Bidibidi refugee settlement.The findings show that older age, male sex, not being in school and having knowledge of getting pregnant were associated with sexual behaviour among adolescent refugees in Bidibidi refugee settlement in Uganda.There is need to promote keeping refugee adolescents in school and providing them with relevant SRH information to contribute to improving sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda.

The socio-economic and psychosocial impact of Covid-19 pandemic on urban refugees in Uganda.

Considering the COVID-19 global public health crisis, this paper examines the socio-cultural, economic and psychosocial impact of the pandemic on urban refugees in Uganda. We analyse the living conditions of urban refugees that make it problematic for them to adhere to public health measures. Since COVID-19 is perceived as "imported", refugees are assumed as its potential transmitters, consequently experiencing heightened stigma and isolation. Lack of culturally and linguistically accessible information and services excludes them from on-going efforts to prevent the pandemic. The lockdown has affected refugee livelihoods and increased income insecurity, sexual and gender-based violence and anxiety. Given the paucity of government-led services to contain the epidemic, we argue that contingency planning must involve refugees and their communities to access accurate and relevant information in appropriate languages. It is also important to build the capacity of frontline workers to understand the specific needs of refugees to deliver appropriate protection in the context of the pandemic.