As elective and nonurgent procedures were cancelled or discouraged nationwide because of COVID-19, some reproductive health centers found creative ways to continue their services as safely as possible and to keep staff working during a period of low foot traffic.
Here are some of the methods they employed:
• Provide home-based testing for sexually transmitted infections (STIs). “Sexually transmitted infection testing is one of our primary focuses,” says Catriona Reynolds, executive director of Kachemak Bay Family Planning Clinic in Homer, AK.
The clinic completed STI health history and screening through telehealth and made STI test kits available for a safe pick-up. Patients could use the vaginal swab at home and place these in a container, which they returned to the clinic’s drive-through, she says.
Some of the clinic’s clients already were familiar with collecting urine samples. The state laboratory epidemiologist confirmed that at-home STI testing was appropriate, Reynolds says.
“We didn’t want to lose the ability to do STI testing [during the pandemic],” she adds. “We anticipate the demand for testing will go down as social distancing continues, but we still will have some demand for STI test kits.”
• Continue abortion services, including telemedicine abortion. “We still offer aspiration abortion,” says Evelyn Kieltyka, MSN, MS, FNP-BC, senior vice president of program services at Maine Family Planning.
Maine Family Planning has one office that provides these abortions, one day a week. “We don’t have N95 masks, but we’re screening for symptoms,” she adds. Surgical masks are provided for patients.
The National Abortion Federation (NAF) held a webinar that educated clinics on how to perform abortions safely during the COVID-19 crisis. NAF also provides COVID-19 fact sheets and guidance. (This information is available at: https://prochoice.org/abortion-covid-19/.)
“They walked us through it with infectious disease experts, and it’s all about harm reduction,” Kieltyka says. “It’s never going to be zero risk in a pandemic, so don’t be unrealistic.”
Methods include using masks and taking patients directly to exam rooms with no more than one patient in the waiting room. The patient undergoes the procedure, moves to the recovery room, and everything is wiped down with antiviral wipes, she explains.
Some family planning centers also are using telemedicine to prescribe misoprostol, the medication abortion. For example, Maine Family Planning provides no-touch telehealth abortion medication to patients who meet certain health history criteria and are fewer than 10 weeks pregnant, Kieltyka explains.
“We do all counseling through telehealth, get patients’ information, and do consenting,” she adds. “Our state doesn’t require ultrasounds, and there are new, emerging protocols and evidence that if women have a good mental history and are under 10 weeks pregnant, it is very safe to provide them with medication abortion.”
The telehealth abortion method works for patients. Family planning professionals can provide counseling, education, and obtain consent via telehealth, she adds.
• Create staffing resilience with remote work. “We’re a resilient and tightly bonded group,” Reynolds says.
The family planning clinic employed a robust youth education program, including visits to classrooms. When COVID-19 resulted in school closings, the clinic staff looked at moving its youth program to the virtual world. Educators and clinical staff are part of the virtual classroom experience, she notes.
“We’re in such early days, but that’s one of the things we’re exploring,” Reynolds says.
Other remote staff activities might include:
- Revising protocols;
- Revamping the site’s test evaluation and feedback loop;
- Updating the website.
• Use microscope attachment for tablets. This option might work for remote areas when it is challenging to send out samples for lab testing. With a tablet and a microscope attachment, a practitioner could evaluate a swab remotely, Reynolds says.
Patients could use an STI test kit, collect their own sample, and send it to the clinic. Clinic staff could put the sample on a slide, under the tablet microscope, so the practitioner could read it, she explains.
“The practitioner could look at it and make a diagnosis in the same day,” she adds.