Sexual health inequalities among women aged 16-24

Abstract Introduction Gonorrhoea is the second most commonly diagnosed sexually transmitted infection in England, and diagnoses among young women increased 31% between 2018 and 2019. Understanding the patterns of testing and diagnosis among young women is likely to aid prevention among the most vulnerable segments of this population. Methods Data on gonorrhoea diagnoses at sexual health services among women aged 16-24 in England were obtained using the GUMCAD STI Surveillance System. We investigated the relationship between two exposure variables (deprivation and ethnicity), and two outcome variables (number of gonorrhoea tests and number of gonorrhoea diagnoses). Poisson regression was used to calculate rate ratios for the relationship between the exposure and outcome variables. The testing analysis was offset for the size of the population, and the diagnosis analysis was offset for the number of tests within the population. Results Between 2012 and 2019, gonorrhoea testing and diagnosis rates were highest among women living in the most deprived areas. The rate of testing in the least deprived 10% of neighbourhoods was significantly lower than that seen in the most deprived 10% of neighbourhoods (rate ratio (RR) 0.79; 95% confidence interval 0.79 - 0.80), and the rate of diagnosis in the least deprived 10% of neighbourhoods was around a third of that seen in the most deprived 10% of neighbourhoods (0.35; 0.33 - 0.36). When compared to White British women, the rate of gonorrhoea diagnosis was lower among Bangladeshi (RR 0.89; 0.75 - 1.05), Indian (0.76; 0.68 - 0.84), Pakistani (0.87; 0.77 - 1.00) and Chinese women (0.60; 0.51 - 0.71) and was highest among Black Caribbean (2.26; 2.18 - 2.33) and Black African (1.40; 1.34 - 1.45) women. Conclusions This analysis found inequalities in the distribution of gonorrhoea among young women in England that may indicate structural barriers to STI prevention that are affecting Black women and those living within the most deprived populations. Key messages • Gonorrhoea testing rates among young women in England are highest among women from deprived areas and Black women. • Gonorrhoea diagnosis rates among young women in England are highest among women from deprived areas and Black women.


Introduction:
Gonorrhoea is the second most commonly diagnosed sexually transmitted infection in England, and diagnoses among young women increased 31% between 2018 and 2019.Understanding the patterns of testing and diagnosis among young women is likely to aid prevention among the most vulnerable segments of this population.Methods: Data on gonorrhoea diagnoses at sexual health services among women aged 16-24 in England were obtained using the GUMCAD STI Surveillance System.We investigated the relationship between two exposure variables (deprivation and ethnicity), and two outcome variables (number of gonorrhoea tests and number of gonorrhoea diagnoses).Poisson regression was used to calculate rate ratios for the relationship between the exposure and outcome variables.The testing analysis was offset for the size of the population, and the diagnosis analysis was offset for the number of tests within the population.

Results:
Between 2012 and 2019, gonorrhoea testing and diagnosis rates were highest among women living in the most deprived areas.The rate of testing in the least deprived 10% of neighbourhoods was significantly lower than that seen in the most deprived 10% of neighbourhoods (rate ratio (RR) 0.79; 95% confidence interval 0.79 -0.80), and the rate of diagnosis in the least deprived 10% of neighbourhoods was around a third of that seen in the most deprived 10% of neighbourhoods (0.35; 0.33 -0.36).When compared to White British women, the rate of gonorrhoea diagnosis was lower among Bangladeshi (RR 0.89; 0.75 -1.05), Indian (0.76; 0.68 -0.84), Pakistani (0.87; 0.77 -1.00) and Chinese women (0.60; 0.51 -0.71) and was highest among Black Caribbean (2.26;

Key messages:
The DPP intervention may result in a widening of socioeconomic and disability related inequalities amongst people with NDH as the programme had fewer adults in deprived areas and with a disability.The programme has the potential to reduce ethnic inequalities, but efforts are required to support the completion of the programme by minority ethnic groups.
Abstract citation ID: ckac129.160A community-based participatory approach to engaging Congolese migrants in intervention co-design

Issue:
The World Health Organization has called for tailored, community-based interventions to address disparities in vaccination uptake affecting migrant and minoritised populations, however few exist.This study directly responds to global calls for community-centred and participatory approaches to engaging migrants in routine and COVID-19 vaccination.

Problem description:
Black and African migrants are known to be at risk of underimmunisation and have lower COVID-19 vaccine uptake rates in high-income countries.This UK study will use communitybased participatory approaches to engage Congolese migrants in co-developing a tailored intervention to increase vaccine uptake.A community-academic coalition will lead the study.Community members will be trained as peer researchers and financially compensated.The final output will be an intervention strategy tailored to and embedded within the Congolese migrant community.

Preliminary results:
The coalition held 20 hours of planning meetings and peer researcher training in 2021 and co-developed a phased study involving 1) community days with poster walls and qualitative in-depth interviews with Congolese migrants, 2) interviews and workshops with local stakeholders, and 3) co-design workshops with Congolese migrants.Following outreach and pre-engagement, approximately 80 migrants attended the community days, with more than 50 interviews and 100% left positive feedback (including: felt valued, welcomed, Congolese language recognised).

Lessons:
Community-academic partnerships are resource-intensive but can be an effective means to build and maintain trust required to deliver a community-based research study.Academic partners should support community partners in understanding the research process to help manage expectations and provide financial compensation for their time and effort.This study offers an innovative engagement model and study design that can be adapted to other underserved populations.

Key messages:
Global policy-setting organisations have called urgently for participatory research that engages migrants in the coproduction of tailored initiatives to address vaccination inequalities.This study uses a novel, theory-driven, participatory approach to engage with and identify barriers to vaccination in Congolese migrants and co-design a tailored strategy to increase uptake.