Health crisis within a crisis: Effect of COVID-19 on STI services for young adults in Lusaka, Zambia

Abstract

In Zambia, approximately 5% of women and 8% of men aged 15-49 reported having a Sexually Transmitted Infection (STI) 12 months prior to the 2018 Zambia Demographic Health Survey. Notably, 62% of women and 73% of men who had an STI sought treatment at a clinic, signifying the importance attached to health services by STI treatment seekers. Regrettably, during the COVID-19 pandemic, entry points for accessing STI health services were closed as a public health measure to control the spread of infection. This study assessed the pandemic's effect on accessibility, availability, and delivery of STI health services in Lusaka. An explanatory sequential mixed-methods approach, incorporating a retrospective record review over a period of two years and a hermeneutic phenomenological qualitative design, was used to explore the lived experiences of healthcare providers. We found that Out-Patient Department (OPD) attendance dropped by 23% and 31% during the first and second phases of the pandemic, respectively. There was a positive correlation (p = 0.002) between OPD attendance and reported STI cases. The lived experiences of health providers revealed challenges in availability of STI health services, stemming from a range of factors that included truncated service points, reduced working hours, and limited interactions, all of which affected STI diagnosis. Stay-at-home orders, fear, lockdowns, and logistical challenges impeded access to STI health services. We established an intricate nexus between COVID-19 and the accessibility, availability, and delivery of STI health services and products. We recommend addressing pandemic-induced barriers to individuals' access to STI health services through enhanced health communication, adopting flexible service delivery models, adapting healthcare infrastructure, addressing health provider challenges, and investing in research and preparedness to guide future pandemic responses.