Coronavirus (COVID-19) SPECIAL ISSUE
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26 March 2020 (Issue 58)
Welcome to the March issue of the Sexual Health, Reproductive Health & HIV Policy eBulletin. This will be a special issue focusing on the sector response to date to the COVID-19 pandemic.
The outbreak of COVID-19 is arguably the greatest public health challenge of our time. Most healthcare services are having to reduce capacity in clinics, limit unnecessary face-to-face contact and support the wider NHS response. According to member surveys conducted by FSRH and BASHH, this is already impacting on the provision and delivery of vital sexual health, reproductive health and HIV services. In this month’s eFeature, Dr Asha Kasliwal (FSRH President), Dr John McSorley (BASHH President), and Dr Laura Waters (BHIVA Chair) present the key elements of a joint emergency COVID-19 contingency plan drawn up for Government. The plan identifies high priority areas for care and recommends where Government action is needed to minimise adverse sexual health, reproductive health and HIV outcomes for the general population, including a rise in unplanned pregnancies, sexually transmitted infections (STIs) and abortions.
The round-up this month brings together the COVID-19 guidance and resources that have been produced by key sector organisations. The response to COVID-19 is evolving and linked documents from key professional organisations will be updated as new information becomes available. It also includes a reduced summary section on key policy developments in other areas during the last month.
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eFeature
The Faculty of Sexual and Reproductive Healthcare (FSRH), the British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA) have jointly produced a COVID-19 contingency plan outlining to Government what is necessary to support the delivery of essential sexual health, reproductive health and HIV healthcare. This month’s eFeature previews key elements of the plan, including a scaled up digital infrastructure to provide relief to services and maintain access to care; specific legislative and regulatory changes to remove barriers to care and action to secure access to emergency and urgent contraceptive, STI and HIV care to prevent adverse outcomes. The professional bodies are confident that the skilled and dedicated workforce who provide and deliver services can adapt to the current unprecedented challenges with the right kind of support from the centre and timely action from Government.
>Read eFeature from FSRH, BASHH and BHIVA and download the contingency plan
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COVID-19 Sector guidance & resources
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FRSH guidance & resources
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FSRH Position: Essential services in Sexual and Reproductive Healthcare
FSRH has issued guidance aimed at healthcare professionals and commissioners on what it considers to be essential sexual and reproductive healthcare (SRH) services that should continue to be provided throughout the duration of the COVID-19 outbreak. The guidance includes recommendations for alleviating pressure on services in primary and community settings and ensuring equitable access for vulnerable and marginalised women. In addition, FSRH has published further guidance on provision of effective contraception during COVID-19 and extended use of LARCs. It has also set up a dedicated COVID-19 hub on its website for professionals working in sexual and reproductive healthcare as well as a SRH professionals peer support page on Facebook to share how others are continuing to deliver SRH services during this time.
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COVID-19 and abortion care
FSRH, the Royal College of Obstetricians and Gynaecologists (RCOG), the British Society of Abortion Care Providers (BSACP) and the Royal College of Midwives (RCM) have issued guidance for health professionals and providers that cover abortion care during the COVID-19 pandemic. The guidance proposes that greater use of remote consultations and medical abortion at home are necessary to ensure continued safe and effective abortion care, especially where women and staff are self-isolating, or where acute hospital facilities are unavailable.
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BASHH guidance & resources
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COVID-19 Guidance: Provision of Sexual Services to the Community
BASHH has issued guidance on the provision of sexual health services to the community during the COVID-19 pandemic. The guidance offers options and strategies to services in their effort to maintain access to high quality sexual and reproductive healthcare and HIV care. This guidance has been informed through joint working with national reproductive health partner organisations and will be updated regularly. A page has also been set up on the BASHH website to help provide members with a central resource that can support local responses and contingency planning.
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BHIVA guidance & resources
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Statement on risk of COVID-19 for people living with HIV
BHIVA has issued a joint statement with the European AIDS Clinical Society (EACS) confirming that currently there is no evidence for a higher COVID-19 infection rate or different disease course in people with HIV. Advice has also been recently issued on social distancing and shielding for people with HIV and management of a woman living with HIV while pregnant during the COVID-19 outbreak.
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Other COVID-19 responses relevant to the sector
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Coronavirus Bill amendments sought on abortion
The Government has declined to temporarily amend abortion legislation to ensure efficient and safe care pathways for women during the COVID-19 outbreak. Earlier this week the FSRH, RCOG, RCM, BSACP and other key sector organisations wrote to the Secretary of State for Health and Social Care, Matt Hancock, urging him to amend the Coronavirus Bill currently before parliament to enable a single registered medical practitioner, nurse, or midwife to perform and certify an abortion under the Abortion Act 1967. However, Parliament adjourned for recess yesterday evening without making the amendment.
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Telemedical abortion services
The Government has declined to bring forward regulations that will enable all the medications needed for Early Medical Abortion to be used by women in their own homes during the COVID-19 outbreak to protect their own health, that of their families, and the doctors, nurses and midwives who care for them. Accessing care remotely by telemedicine is already recommended as best practice by the UK NICE guidelines, and joint guidelines from key professional bodies including RCOG, RCM, FSRH and BSACP. Despite publishing guidance permitting these measures earlier in the week, the Department of Health and Social Care (DHSC) has since rescinded the guidance and suggested that there are no plans to change abortion regulations.
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THT information on COVID-19 and HIV
Dr Michael Brady, Medical Director at the Terrence Higgins Trust (THT), has written a blog post to provide information and advice to those living with HIV relation to COVID-19 and to answer some frequently asked questions (FAQs).
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HIV Scotland COVID-19 mini-site and helpline
HIV Scotland has launched a new mini-site to bring together the most up-to-date advice and guidance for people living with HIV and others in Scotland. It has also set up a helpline to provide further support.
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Brook services
Until further notice, all Brook clinics are running appointment-only services. There is advice on their website on looking after sexual health when services are limited. Lisa Hallgarten, Head of Policy and Public Affairs at Brook, has published a comprehensive blog on the importance of maintaining sexual health and wellbeing during the COVID-19 outbreak.
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Local Government Association
The LGA has said that it is ready to coordinate and lead local partners in providing support systems for those most vulnerable to COVID-19. LGA has a dedicated webpage where you can access the latest official information as well as guidance and resources from the LGA.
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ADPH approach to COVID-19
The Association of Directors of Public Health (ADPH) has stated that its top priority is to support Directors of Public Health and their teams in the national and local efforts to minimise the impact of COVID-19 on the health and wellbeing of the UK.
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Links to UK Government COVID-19 advice and information
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Public Health Grant Allocations for local authorities for 2020/21
The Government has confirmed the Public Health Grant Allocations for local authorities for 2020/21. The total Public Health Grant to local authorities is £3.279 billion. The grant will continue to be ringfenced for use on Public Health functions, including sexual health, reproductive health and HIV services. Key sector organisations welcomed the real term increase in funding but reiterated the need for a long-term settlement so local authorities can plan more effectively, invest in key services and build a resilient local public health system.
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Routine commissioning of HIV PrEP in England
The Government has announced that preventative HIV pre-exposure prophylaxis (PrEP) will be made available across England. The PrEP Impact Trial is set to conclude later this year so the decision should ensure PrEP is made available by routine commissioning for all those people who need it most. NHS England will cover the cost of the drug and local authorities will receive £16 million in 2020 to 2021 to deliver PrEP services. PrEP is already freely available on the NHS in Scotland to people considered to be at high risk and is available in Wales through a 3-year trial and in Northern Ireland through sexual health clinics.
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Abortion law guidelines released for Northern Ireland
The Government has published its response to the consultation on a legal framework for abortion in Northern Ireland. The new guidelines permit access without conditionality to abortion services up to 12 weeks gestation. Abortion is permitted up to 24 weeks in cases where the continuance of the pregnancy would involve risk of injury to the physical or mental health of the pregnant woman or girl, and up to birth in the case of fatal fetal abnormality.
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Shortages of contraceptives and HRT
The RCOG, FSRH and the British Menopause Society have written to Matt Hancock raising concerns about continuing manufacturing and supply issues in relation to certain contraceptives and hormone replacement therapy (HRT). The professional bodies are calling for a working group to be set up to address these ongoing supply constraints, and have been in regular contact with the DHSC to assess the situation and discuss resupply of these treatments.
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Tampon tax changes
The Chancellor of the Exchequer, Rishi Sunak, confirmed in his budget on the 11 March that the Government would scrap the controversial tampon tax and remove VAT on all women’s sanitary products from 2021. Until then, organisations can apply for grants to fund projects which directly benefit disadvantaged women and girls.
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Call for evidence from JCVI : Single dose of HPV vaccine
The Joint Committee on Vaccination and Immunisation (JCVI) is calling for evidence to support a review of possible changes to the HPV immunisation programme. JCVI is interested in relevant evidence to support consideration of the potential to move to a single-dose schedule of HPV vaccine for the routine programme and other alternative dose HPV schedules. The closing date for responses is 29 April 2020.
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The Sexual Health & HIV Policy eBulletin was originally developed and published by MEDFASH.
It continues to be compiled and edited by Helen Christophers on behalf of FSRH and coalition partners. If you have any comments on the eBulletin or eFeature or suggestions for topics you would like to see covered in future eFeatures please get in touch (ebulletineditor@fsrh.org).
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> eBulletin archive (MEDFASH) > eFeature archive (MEDFASH/FSRH)
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